Crash of a Convair C-131E Samaritan in Saint Johns: 4 killed

Date & Time: Feb 5, 1996 at 0950 LT
Type of aircraft:
Registration:
N131T
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Saint Johns – Brownsville – Chetumal
MSN:
338
YOM:
1956
Crew on board:
2
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
4
Captain / Total flying hours:
18400
Captain / Total hours on type:
8.00
Aircraft flight hours:
18715
Circumstances:
Witnesses observed the aircraft departing from runway 14 with a rolling start. They said the aircraft rotated at the departure end of the runway and remained in ground effect with an excessive, nose high attitude. It then struck the airport perimeter fence, a barrier wall, and power lines. Power line wires were dragged through a residential area, resulting in additional damage. The airplane then crashed in a pasture and burned. Investigation revealed the airplane had been loaded to a gross weight (GW) of 50,870 lbs. Its maximum GW was limited to 48,000 lbs at sea level with the use of antidetonation injection (ADI) fluid and 40,900 lbs without ADI. Density altitude at the airport was 6200 feet. For conditions at the airport, maximum GW for takeoff with ADI and 15° of flaps was 43,205 lbs; without ADI and with 13 degrees of flaps, maximum GW was 38,909 lbs. The airplane flaps were found in the retracted position, but there was no performance data for takeoff with the flaps retracted. No ADI fluid was found in the line to the right engine, although it was intact; the ADI tank was destroyed; the ADI line to the left engine was damaged. The airplane was being flown under provision of a ferry permit, which did not provide for the cargo or the two passengers that were aboard. The first pilot (PIC) had accrued about 8 hours of flight experience in the make and model of airplane.
Probable cause:
Inadequate preflight planning and preparation by the first pilot (PIC), his failure to ensure the aircraft was properly loaded within limitations, his failure to use proper flaps for takeoff, his failure to use ADI assisted takeoff, and his resultant failure to attain sufficient airspeed to climb after takeoff. Factors relating to the accident were: the high density altitude, and the PIC's lack of experience in the make and model of airplane.
Final Report:

Crash of a Douglas DC-8-55F in Asunción: 22 killed

Date & Time: Feb 4, 1996 at 1412 LT
Type of aircraft:
Operator:
Registration:
HK-3979X
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Barranquilla - Asunción - Campinas
MSN:
45882
YOM:
1966
Flight number:
ALA028
Country:
Crew on board:
3
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
22
Captain / Total flying hours:
9100
Captain / Total hours on type:
5919.00
Copilot / Total flying hours:
3500
Copilot / Total hours on type:
3158
Aircraft flight hours:
66326
Aircraft flight cycles:
20567
Circumstances:
The aircraft was completing a positioning flight from Asunción to Campinas on behalf of Alas Paraguayas, under flight number ALA028. As there was no cargo on board, the crew decided to make profit of the situation to perform training upon takeoff. During the takeoff roll on runway 02, at Vr speed, the captain reduced the power on engine n°1 and after liftoff, he reduced power on engine n°2. With the undercarriage still down and the flaps at 15°, the aircraft became unstable, lost height and crashed in the district of Mariano Roque Alonso, about 1,500 metres past the runway end. The aircraft was destroyed by impact forces and a post crash fire and all four occupants were killed as well as 18 people on ground, most of them children taking part to a volleyball game.
Probable cause:
It was determined that the loss of control during initial climb was the consequence of the decision of the crew to perform training upon takeoff, intentionally reducing power on both engines n°1 and 2. This decision was taken at a critical phase of flight and the copilot-in-command was unable to maintain control of the aircraft, causing the aircraft to lose speed and to stall.
The following contributing factors were reported:
- The captain's experience in such configuration was low,
- Lack of flight safety doctrine in the cockpit during all flight,
- Execution of unauthorized takeoff training under uncontrolled conditions,
- Execution of such take-off training by a person who was not qualified as an instructor.
Final Report:

Crash of a Cessna 402B in Kamuela: 1 killed

Date & Time: Jan 29, 1996 at 0435 LT
Type of aircraft:
Registration:
N999CR
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Kamuela - Honolulu
MSN:
402B-0616
YOM:
1974
Location:
Crew on board:
2
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
3434
Captain / Total hours on type:
1250.00
Aircraft flight hours:
19764
Circumstances:
The aircraft departed at night from runway 4R on a flight to transport mail. The pilot-in-command (PIC) was in the left seat, a pilot-rated cargo loader was in the right seat, and another cargo loader was aboard the aircraft, but was not in a seat. During takeoff, the aircraft entered a turn and flew into gradually rising terrain. The initial impact point was about 15 feet higher than the runway elevation and about 0.3 miles abeam the departure end of the runway. Investigation revealed that the company allowed pilot-rated cargo loaders to fly the aircraft from the right seat during positioning and ferry flight segments (to build multiengine flight time) as part of their compensation. There was evidence that at the time of the accident, the aircraft was being piloted on this flight from the copilot's position. The right side of the instrument panel was equipped with only EGT gauges (no flight instruments on the copilot's side). There were cloud layers in the vicinity, no moon illumination, and no visible ground lighting in the direction of flight. No preimpact mechanical malfunction or failure was identified during the investigation. Except at the pilot and copilot positions, the airplane had no other seat and/or restraint system. The operator stated that the pilot was not authorized to carry company personnel or passengers without the required seating.
Probable cause:
Failure of the copilot (pilot-rated cargo loader, who was flying the aircraft) to establish and maintain a positive rate of climb after taking off at night; and inadequate supervision by the pilot-in-command (PIC), by failing to ensure that proper altitude was obtained and maintained during the departure. Factors relating to the accident were: darkness; the lack of visual cues; and the resultant visual illusion, which the copilot failed to recognize during the night departure. Also, the lack of a restraint system (seat belt and/or shoulder harness) for the passenger was a possible related factor.
Final Report:

Crash of a Piper PA-31-350 Navajo Chieftain in Johannesburg: 2 killed

Date & Time: Jan 26, 1996
Operator:
Registration:
ZS-KBY
Flight Phase:
Flight Type:
Survivors:
No
MSN:
31-7852067
YOM:
1978
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Circumstances:
Shortly after takeoff from Johannesburg-Oliver Reginald Tambo Airport, while climbing, the twin engine aircraft went out of control and crashed near Boksburg, about 5 km south of the airport. Both occupants were killed.

Crash of an Antonov AN-32B in Kinshasa: 298 killed

Date & Time: Jan 8, 1996 at 1243 LT
Type of aircraft:
Operator:
Registration:
RA-26222
Flight Phase:
Flight Type:
Survivors:
Yes
Site:
Schedule:
Kinshasa - Kahemba
MSN:
2301
YOM:
1989
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
298
Circumstances:
The aircraft was completing a cargo flight from Kinshasa to Kahemba, carrying two passengers, four crew members and a load of food and basic necessities. During the takeoff roll, at a speed of 204 km/h, the pilot-in-command pulled up the control column to start the rotation but the aircraft failed to respond. The crew decided to abort the take off procedure but this decision was taken too late. Unable to stop within the remaining distance (the runway is 1,700 metres long), the aircraft overran, rolled for about 240 metres and came to rest in the district of Simbazikita, bursting into flames. A crew member was killed while five other occupants were injured. On ground, at least 297 people were killed while 253 others were injured, some seriously.
Probable cause:
It was determined that the aircraft was unable to take off because its total weight at the time of the accident was well above the MTOW. Due to lack of evidences, investigations were unable to determine the exact value of the excess mass, probably between 2 and 7 tons. Nevertheless, the decision of the crew to abort the takeoff procedure was taken too late and the runway length was insufficient. It was also reported that the aircraft was operated by African Air and leased from Moscow Airways. The flight was operated illegally on behalf of Scibe-Airlift which was not concerned about such operation. The certificate of airworthiness expired last December and the aircraft was not authorized to fly.

Crash of a PZL-Mielec AN-2TP in Novy Bor

Date & Time: Dec 27, 1995 at 1230 LT
Type of aircraft:
Operator:
Registration:
RA-32366
Flight Phase:
Survivors:
Yes
Schedule:
Novy Bor - Ust-Tsylma
MSN:
1G100-17
YOM:
1968
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
12
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
After takeoff from Novy Bor Airfield, while climbing to a height of about 10 metres, the aircraft nosed up. The pilot reduced the engine power when the aircraft stalled and crashed on the runway about 150 metres from its end. All 14 occupants evacuated safely while the aircraft was damaged beyond repair. It was reported that the CofG was well beyond the aft limit.

Crash of a Casa 212M Aviocar 100 in Rancagua: 1 killed

Date & Time: Dec 23, 1995
Type of aircraft:
Operator:
Registration:
212
Flight Phase:
Survivors:
Yes
Schedule:
Rancagua - Rancagua
MSN:
107
YOM:
1978
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
10
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
The aircraft departed Rancagua-de la Independencia Airport on a local skydiving mission. During the takeoff roll, the captain noticed a unknown technical problem and abandoned the procedure. The aircraft went out of control, veered off runway and came to rest. A passenger was killed.

Crash of a Boeing 747-136 in New York

Date & Time: Dec 20, 1995 at 1136 LT
Type of aircraft:
Operator:
Registration:
N605FF
Flight Phase:
Survivors:
Yes
Schedule:
New York - Miami
MSN:
20271
YOM:
1971
Flight number:
FF041
Crew on board:
17
Crew fatalities:
Pax on board:
451
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
16455
Captain / Total hours on type:
2905.00
Copilot / Total flying hours:
17734
Copilot / Total hours on type:
4804
Aircraft flight hours:
90456
Aircraft flight cycles:
17726
Circumstances:
The captain initiated a takeoff on runway 04L, which was covered with patches of ice and snow. The wind was from 330 degrees at 11 knots. Before receiving an 80-knot call from the 1st officer, the airplane began to veer to the left. Subsequently, it went off the left side of the runway and collided with signs and an electric transformer. Investigation revealed evidence that the captain had overcontrolled the nosewheel steering through the tiller, then applied insufficient or untimely right rudder inputs to effect a recovery. The captain abandoned an attempt to reject the takeoff, at least temporarily, by restoring forward thrust before the airplane departed the runway. The current Boeing 747 operating procedures provide inadequate guidance to flightcrews regarding the potential for loss of directional control at low speeds on slippery runways with the use of the tiller. Current Boeing 747 flight manual guidance was inadequate about when a pilot should reject a takeoff following some indication of a lack of directional control response. Improvements in the slippery runway handling fidelity of flight simulators used for Boeing 747 pilot training were considered to be both needed and feasible.
Probable cause:
The captain's failure to reject the takeoff in a timely manner when excessive nosewheel steering tiller inputs resulted in a loss of directional control on a slippery runway. Inadequate Boeing 747 slippery runway operating procedures developed by Tower Air, Inc., and the Boeing Commercial Airplane Group and the inadequate fidelity of B-747 flight training simulators for slippery runway operations contributed to the cause of this accident. The captain's reapplication of forward thrust before the airplane departed the left side of the runway contributed to the severity of the runway excursion and damage to the airplane.
Final Report:

Crash of a Beechcraft B200 Super King Air in Ingleside

Date & Time: Dec 18, 1995 at 1730 LT
Registration:
N231RL
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Ingleside - Cartagena
MSN:
BB-868
YOM:
1981
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
2000
Circumstances:
On December 18, 1995, at 1730 central standard time, a Beech B200, N231RL, was substantially damaged, during takeoff near Ingleside, Texas. The commercial pilot and his passenger were not injured. The airplane was owned by R.A. Beeler Leasing Company, of Carrizo Springs, Texas, and operated by Western Airways Inc., of Houston, Texas. The airplane was stolen from the West Houston Airport at 1600. Visual meteorological conditions prevailed and no flight plan was filed. According to U.S. Customs officials, the operator's chief mechanic reported the aircraft stolen as soon as the airplane was broken into by the two occupants. A U.S. Customs airplane was vectored to intercept the stolen airplane. The owner of the airplane reported there was approximately 800 pounds of fuel aboard at the time the airplane was stolen. The airplane was intercepted as it was landing at the T.P. McCampbell Airport, near Ingleside, Texas. The Customs aircraft landed and blocked the single 4,996 foot runway. While attempting to takeoff to evade law enforcement personnel, the airplane impacted a fence, crossed a ditch, and came to rest in a swamp. The two occupants of the airplane jumped out and ran. The pilot's son was captured, but the pilot was not apprehended. The following items were found in the airplane: bolt cutters, 2 masks, loaded weapons, the pilot's wallet, and charts and maps indicating that the planned destination of the flight was near Cartagena, Colombia. The nose landing gear collapsed, the left wing sustained structural damage, and the pressure bulkhead was punctured.
Probable cause:
The pilot's improper decision, while evading law enforcement personnel during an illegal/unauthorized operation.
Final Report:

Crash of a Beechcraft G18S in Nome

Date & Time: Dec 18, 1995 at 1316 LT
Type of aircraft:
Operator:
Registration:
N340K
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Nome - Gambell
MSN:
BA-605
YOM:
1962
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
8500
Captain / Total hours on type:
450.00
Aircraft flight hours:
6886
Circumstances:
The pilot was attempting to transport by-pass mail from Nome to Gambell, Alaska. The pilot stated that the takeoff run was normal until he rotated the nose of the airplane to lift off. The pilot said the airplane pitched up and he had to apply full forward control yoke pressure while he adjusted the pitch trim to nose down. The airplane rolled to the left and the pilot used the rudders to level the wings prior to impact. The information provided by the company, the FAA, and the post office, indicate that the airplane weighed 10,114 pounds at the time of the takeoff. The certificated maximum gross weight was 10,100 pounds. A weight and balance calculation, based upon information obtained from the company and the placarded limits on the airplane, showed a center of gravity of 121.9 inches. The center of gravity limits shown in the airplane manual are 113 to 120.5 inches. The wreckage examination showed that the elevator trim indicator was indicating full nose up trim.
Probable cause:
The pilot exceeding the weight and balance limitations of the airplane and improperly utilizing the airplane's elevator trim by selecting full nose up trim.
Final Report: