Crash of a Gippsland GA-8 Airvan in Orange

Date & Time: Jul 6, 2010 at 1745 LT
Type of aircraft:
Operator:
Registration:
VH-YBH
Flight Type:
Survivors:
Yes
Schedule:
Parkes - Orange
MSN:
GA8-08-131
YOM:
2008
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The pilot was performing a cargo flight from Parkes to Orange, New South Wales. On final approach, the single engine aircraft was too low and impacted the roof of a metal hangar located near the runway threshold. The aircraft stalled and struck the runway surface. Upon impact, the nose gear was torn off. Out of control, the aircraft veered off runway and eventually collided with a metal hangar under construction. While the pilot was injured, the aircraft was destroyed.

Crash of a Beechcraft RC-12K Guardrail in Wiesbaden

Date & Time: Jun 30, 2010 at 1540 LT
Type of aircraft:
Operator:
Registration:
85-0155
Flight Type:
Survivors:
Yes
Schedule:
Wiesbaden - Wiesbaden
MSN:
FE-9
YOM:
1987
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The crew departed Wiesbaden-Erbenheim AFB on a local training flight. On approach, technical problem forced the crew to attempt an emergency landing in a cornfield 200 metres short of runway. Both pilots were slightly injured while the aircraft was damaged beyond repair.
Probable cause:

Crash of a McDonnell Douglas MD-82 in Kinshasa

Date & Time: Jun 21, 2010 at 1200 LT
Type of aircraft:
Operator:
Registration:
9Q-COQ
Survivors:
Yes
Schedule:
Kinshasa – Lubumbashi
MSN:
49178/1122
YOM:
1983
Flight number:
EO601
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
103
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
During the takeoff roll at Kinshasa-N'Djili Airport, a tyre burst on the left main gear. After liftoff, while in initial climb, the crew was forced to shut down the left engine while the hydraulic system failed. The crew declared an emergency and was cleared for an immediate return. On approach, he was unable to lower the nose gear due to the malfunction of the hydraulic system. After touchdown on runway 06, the aircraft rolled for a distance of 1,000 metres then veered off runway to the right, slid on a grassy area and came to rest 500 metres further. All 110 occupants evacuated safely while the aircraft was damaged beyond repair.
Probable cause:
A tyre burst on the left main gear during the takeoff procedure. Debris damaged hydraulic lines and were ingested in the left engine that should be shut down.

Crash of a Cessna 401 in Plymouth

Date & Time: Jun 19, 2010 at 1703 LT
Type of aircraft:
Registration:
N401TE
Flight Type:
Survivors:
Yes
Schedule:
Plymouth - Plymouth
MSN:
401-0180
YOM:
1971
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
3500
Captain / Total hours on type:
1200.00
Aircraft flight hours:
2004
Circumstances:
The airplane was returning from a 3-hour aerial mapping mission and was lined up for a straight-in, 5-mile final approach for landing. About 3 miles out on final approach, and prior to performing the before-landing check, both engines stopped producing power in sequence, one almost immediately after the other. The pilot said that by the time he completed his remedial actions the airplane had descended to about 200 feet above the ground and the engines would not restart. The auxiliary fuel tank gauges were bouncing between 2-5 gallons and the main tanks were bouncing around at 25 gallons per side. The pilot then selected a forced landing site between two large trees and landed the airplane in heavily wooded terrain. A detailed examination of the wreckage revealed no evidence of preimpact mechanical anomalies. According to information contained in the aircraft manufacturer’s owner's manual, the auxiliary fuel tanks are designed for cruising flight and are not equipped with pumps; operation near the ground (below 1000 feet) using auxiliary fuel tanks is not recommended. The first step in the before-landing check was to select the main fuel tanks on both the left and right fuel selectors, respectively. The pilot indicated that he should have selected the main tanks sooner and performed the before-landing check earlier in the approach.
Probable cause:
A total loss of engine power during final approach due to fuel starvation as a result of the pilot’s delayed configuration of the airplane for landing.
Final Report:

Crash of a Dassault Falcon 20F in Chiclayo

Date & Time: Jun 18, 2010 at 1930 LT
Type of aircraft:
Operator:
Registration:
FAP-300/OB-1433
Flight Type:
Survivors:
Yes
Schedule:
Chiclayo – Lima
MSN:
434
YOM:
1983
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
6
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Shortly after takeoff from Chiclayo Airport, while climbing, the crew contacted ATC, reported technical problems and was cleared for an immediate return. On final approach, the crew was forced to make an emergency landing when the aircraft crash landed about 500 metres short of runway. All 8 occupants escaped uninjured while the aircraft was damaged beyond repair.
Probable cause:
One of the engine failed during initial climb for unknown reasons.

Crash of a Swearingen SA226TC Metro II in Lanseria

Date & Time: Jun 13, 2010 at 1100 LT
Type of aircraft:
Operator:
Registration:
ZS-ZOC
Survivors:
Yes
Schedule:
Lanseria – Polokwane
MSN:
TC-293
YOM:
1979
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
13
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
6900
Captain / Total hours on type:
400.00
Copilot / Total flying hours:
1630
Copilot / Total hours on type:
35
Aircraft flight hours:
27532
Aircraft flight cycles:
27353
Circumstances:
Two flight crew members accompanied by thirteen passengers departed from FALA to FAPP. The flight was uneventful until during the approach to land on Runway 05 at FAPP. The flight crew selected landing gear down and observed a red light which indicate undercarriage unsafe. The flight crew reported the situation to FAPP Air Traffic Control (ATC). FAPP ATC gave instruction to do a missed approach at low level fly-past. The intention was to conduct a visual inspection of the undercarriage to determine its condition. The ATC observed that the left main gear had not extended. FAPP ATC gave an instruction to the flight crew, to hold over the beacon (BHV), where they could attempt to extend the gear by means of normal and emergency procedure. The flight crew was not successful and undercarriage remained retracted. The flight crew returned to FALA with the intention to carry out an emergency landing. FALA ATC give instructions to the flight crew to hold over the beacon (LIV), to again attempt the normal and emergency undercarriage extension procedures. But jet again; the flight crew was unsuccessful to lower the left main gear. ATC then instructed that the aircraft should execute the emergency landing on Runway 24R. During short finals overhead the threshold, prior to touchdown, the flight crew shut down both engines, feathered the propellers and switched off all the electronics. The aircraft landed and came to a gradual stop on its lower fuselage on the centreline of the runway.
Probable cause:
The pilot executed a belly “wheels up” emergency landing after the left main landing gear failed to extend.
Contributory Factors:
The new tyres installed on the main landing gear wheels were not in compliance with the instructions of the Fairchild Service Letter 226-SN-131.
Final Report:

Crash of a Piper PA-46-310P Malibu in Ontario

Date & Time: Jun 10, 2010 at 1627 LT
Registration:
N121HJ
Flight Type:
Survivors:
Yes
Schedule:
Santa Monica – Lake Havasu
MSN:
46-8508105
YOM:
1985
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
850
Captain / Total hours on type:
1.00
Copilot / Total flying hours:
5735
Copilot / Total hours on type:
192
Aircraft flight hours:
4803
Circumstances:
The pilot was conducting a cross-country flight with a certified flight instructor (CFI). During the climb-to-cruise phase of the flight, as the airplane was ascending through 16,000 feet mean sea level (msl), the pilot noticed a reduction in manifold pressure. He advanced the throttle and observed an increase of one or two inches of manifold pressure. Shortly thereafter, the pilot heard a loud bang originate from the engine followed by an immediate loss of engine power. The pilot and CFI attempted to troubleshoot the engine anomalies and noted that it seemed to respond with the low boost "on", however it began to run rough whenever the throttle was advanced more than half way. They diverted to a nearby airport and conducted an emergency descent. As the airplane approached the airport, the pilot descended through an overcast cloud layer and attempted to enter the airport traffic pattern. While on final approach to the airport, the pilot thought the airplane was high and extended the landing gear and applied flaps. Shortly thereafter, the airspeed and altitude decreased drastically and the pilot realized he was too low. The pilot applied throttle and noticed no change in engine performance. The airplane subsequently struck a fence and landed hard in an open field just short of the airport, which resulted in structural damage to the fuselage and wings. A postaccident examination of the engine revealed that the induction elbow for cylinders 1-3-5 (right side) was displaced from the throttle and metering assembly where the elbow couples with the throttle and metering assembly by an induction hose and clamp. The clamp was secure to the induction hose, however, the portion of the clamp that should have been installed
beyond the retention bead on the throttle and control assembly was observed on the inboard side of the bead on the induction elbow. Review of the aircraft maintenance logbooks revealed that cylinders 4 and 5 were recently replaced prior to the accident flight due to low compression. The replacement of these cylinders required removal of the induction system to allow for cylinder removal and installation. In addition, a manufacturer service bulletin stated that during the reinstallation of the induction system, one must slide the induction hose and clamp(s) onto one of the tubes to be joined and that the connection joint and both tube beads are to be positioned in the center of the induction hose. The clamps should be installed in a position centered between the tubing bead and end of the induction hose.
Probable cause:
A loss of engine power due to the in-flight separation of the 1-3-5 cylinder induction tube elbow, which was caused by the improper installation of the induction tube elbow by maintenance personnel.
Final Report:

Crash of a Lockheed C-130 Hercules at Sharana AFB

Date & Time: Jun 4, 2010
Type of aircraft:
Operator:
Registration:
S9-BAT
Flight Type:
Survivors:
Yes
MSN:
4134
YOM:
1966
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Upon landing, the undercarriage collapsed. The aircraft slid on its belly for few dozen metres then veered off runway to the right and came to rest in a sandy area. All four crew members escaped uninjured while the aircraft was damaged beyond repair. It is believed that the airplane touched down few metres short of runway 14/32 which is 4,265 feet long, causing the landing gear to be torn off.

Crash of a Boeing 737-800 in Mangalore: 158 killed

Date & Time: May 22, 2010 at 0605 LT
Type of aircraft:
Operator:
Registration:
VT-AXV
Survivors:
Yes
Schedule:
Dubai - Mangalore
MSN:
36333/2481
YOM:
2007
Flight number:
IX812
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
160
Pax fatalities:
Other fatalities:
Total fatalities:
158
Captain / Total flying hours:
10215
Captain / Total hours on type:
2844.00
Copilot / Total flying hours:
3620
Copilot / Total hours on type:
3319
Aircraft flight hours:
7199
Aircraft flight cycles:
2833
Circumstances:
Air India Express flight IX-811/812 is a daily round trip between Mangalore and Dubai. The outbound flight IX-811 was uneventful and landed at Dubai at 23:44 hours Local Time. The airplane was serviced and refuelled. The same flight crew operated the return leg, flight IX-812. The airplane taxied out for departure at 01:06 LT (02:36 IST). The takeoff, climb and cruise were uneventful. There was no conversation between the two pilots for about 1 hour and 40 minutes because the captain was asleep. The First Officer was making all the radio calls. The aircraft reported position at IGAMA at 05:33 hours IST and the First Officer was told to expect an ILS DME Arc approach to Mangalore. At about 130 miles from Mangalore, the First Officer requested descent clearance. This was, however, denied by the ATC Controller, who was using standard procedural control, to ensure safe separation with other air traffic. At 05:46 IST, the flight reported its position when it was at 80 DME as instructed by Mangalore Area Control. The aircraft was cleared to 7000 ft and commenced descent at 77 DME from Mangalore at 05:47 IST. The visibility reported was 6 km. Mangalore airport has a table top runway. As the AIP India states "Aerodrome located on hilltop. Valleys 200ft to 250ft immediately beyond paved surface of Runway." Owing to the surrounding terrain, Air India Express had made a special qualification requirement that only the PIC shall carry out the take off and landing. The captain on the accident flight had made a total of 16 landings in the past at this airport and the First Officer had operated as a Co-pilot on 66 flights at this airport. While the aircraft had commenced descent, there was no recorded conversation regarding the mandatory preparation for descent and landing briefing as stipulated in the SOP. After the aircraft was at about 50 miles and descending out of FL295, the conversation between the two pilots indicated that an incomplete approach briefing had been carried out. At about 25 nm from DME and descending through FL184, the Mangalore Area Controller cleared the aircraft to continue descent to 2900 ft. At this stage, the First Officer requested, if they could proceed directly to Radial 338 and join the 10 DME Arc. Throughout the descent profile and DME Arc Approach for ILS 24, the aircraft was much higher than normally expected altitudes. The aircraft was handed over by the Mangalore Area Controller to ATC Tower at 05:52 IST. The Tower controller, thereafter, asked the aircraft to report having established on 10 DME Arc for ILS Runway 24. Considering that this flight was operating in WOCL (Window Of Circadian Low), by this time the First Officer had also shown signs of tiredness. This was indicated by the sounds of yawning heard on the CVR. On having reported 10 DME Arc, the ATC Tower had asked aircraft to report when established on ILS. It appears that the captain had realized that the aircraft altitude was higher than normal and had selected Landing Gear 'DOWN' at an altitude of approximately 8,500 ft with speed brakes still deployed in Flight Detent position, so as to increase the rate of descent. As indicated by the DFDR, the aircraft continued to be high and did not follow the standard procedure of intercepting the ILS Glide Path at the correct intercept altitude. This incorrect procedure led to the aircraft being at almost twice the altitude as compared to a Standard ILS Approach. During approach, the CVR indicated that the captain had selected Flaps 40 degrees and completed the Landing Check List. At 06:03 hours IST at about 2.5 DME, the Radio Altimeter had alerted an altitude of 2500 ft. This was immediately followed by the First Officer saying "It is too high" and "Runway straight down". In reply, the captain had exclaimed "Oh my god". At this moment, the captain had disconnected the Auto Pilot and simultaneously increased the rate of descent considerably to establish on the desired approach path. At this stage, the First Officer had queried "Go around?" To this query from the First Officer, the captain had called out "Wrong loc .. ... localiser .. ... glide path". The First Officer had given a second call to the captain for "Go around" followed by "Unstabilized". However, the First Officer did not appear to take any action, to initiate a Go Around. Having acquired the runway visually and to execute a landing, it appears that the captain had increased the rate of descent to almost 4000 ft per minute. Due to this, there were numerous warnings from EGPWS for 'SINK RATE' and 'PULL UP'. On their own, the pilots did not report having established on ILS Approach. Instead, the ATC Tower had queried the same. To this call, the captain had forcefully prompted the First Officer to give a call of "Affirmative". The Tower controller gave landing clearance thereafter and also indicated "Winds calm". The aircraft was high on approach and touched down on the runway, much farther than normal. The aircraft had crossed the threshold at about 200 ft altitude with indicated speed in excess of 160 kt, as compared to 50 ft with target speed of 144 kt for the landing weight. Despite the EGPWS warnings and calls from the First Officer to go around, the captain had persisted with the approach in unstabilized conditions. Short of touchdown, there was yet another (Third) call from the First Officer, "Go around captain...We don't have runway left". However, the captain had continued with the landing and the final touchdown was about 5200 ft from the threshold of runway 24, leaving approximately 2800 ft of remaining paved surface. The captain had selected Thrust Reversers soon after touchdown. Within 6 seconds of applying brakes, the captain had initiated a 'Go Around', in contravention of Boeing SOP. The aircraft overshot the runway including the strip of 60 metres. After overshooting the runway and strip, the aircraft continued into the Runway End Safety Area (RESA) of 90 metres. Soon after which the right wing impacted the localiser antenna structure located further at 85 metres from the end of RESA. Thereafter, the aircraft hit the boundary fence and fell into a gorge.
Probable cause:
The Court of Inquiry determines that the cause of this accident was Captain's failure to discontinue the unstabilized approach and his persistence in continuing with the landing, despite three calls from the First Officer to go around and a number of warnings from the EGPWS.
Contributing Factors were:
1. In spite of availability of adequate rest period prior to the flight, the Captain was in prolonged sleep during flight, which could have led to sleep inertia. As a result of relatively short period of time between his awakening and the approach, it possibly led to impaired judgment. This aspect might have got accentuated while flying in the Window of Circadian Low (WOCL).
2. In the absence of Mangalore Area Control Radar (MSSR), due to unserviceability, the aircraft was given descent at a shorter distance on DME as compared to the normal. However, the flight crew did not plan the descent profile properly, resulting in remaining high on approach.
3. Probably in view of ambiguity in various instructions empowering the 'copilot' to initiate a 'go around ', the First Officer gave repeated calls to this effect, but did not take over the controls to actually discontinue the ill-fated approach.
Final Report:

Crash of an Embraer EMB-110P Bandeirante in Cascavel

Date & Time: May 19, 2010 at 0510 LT
Operator:
Registration:
PT-GKQ
Flight Type:
Survivors:
Yes
Schedule:
Sorocaba – Cascavel
MSN:
110125
YOM:
1976
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
6879
Captain / Total hours on type:
2000.00
Copilot / Total flying hours:
1121
Copilot / Total hours on type:
15
Circumstances:
The twin engine aircraft departed Sorocaba on a cargo flight to Cascavel, carrying two pilots and a load consisting of pharmaceutical materials. On final approach in low visibility due to bad weather conditions and night, the aircraft descended below the glide and impacted the ground 700 metres short of runway 33. On impact, it lost its undercarriage then slid for 150 metres before coming to rest. Both pilots escaped uninjured while the aircraft was damaged beyond repair. Visibility at the time of the accident was 1,200 metres with mist, local patches of fog and ceiling at 100 feet. Cascavel Airport was equipped with an NDB only.
Probable cause:
Controlled flight into terrain after the crew descended too low in IMC conditions. The following contributing factors were identified:
- Visibility was below minimums,
- The crew continued the descent until the aircraft impacted ground and failed to initiate a go-around procedure,
- A probable crew fatigue,
- It is possible that the crew suffered optical illusions,
- Overconfidence on part of the captain,
- The captain did not request any assistance from the copilot during the approach procedure,
- Inexperienced, the copilot did not interfere despite dangerous flight conditions,
- Poor organizational culture,
- Deficiencies in crew training,
- Lack of crew discipline,
- Poor flight planning,
- Lack of supervision on part of the operator,
- The copilot was inexperienced on this type of aircraft.
Final Report: