Crash of a Sukhoi Superjet 100-95B in Moscow: 41 killed

Date & Time: May 5, 2019 at 1830 LT
Type of aircraft:
Operator:
Registration:
RA-89098
Survivors:
Yes
Schedule:
Moscow - Murmansk
MSN:
95135
YOM:
2017
Flight number:
SU1492
Country:
Region:
Crew on board:
5
Crew fatalities:
Pax on board:
73
Pax fatalities:
Other fatalities:
Total fatalities:
41
Captain / Total flying hours:
6800
Captain / Total hours on type:
1570.00
Copilot / Total flying hours:
765
Copilot / Total hours on type:
615
Aircraft flight hours:
2710
Aircraft flight cycles:
1658
Circumstances:
The aircraft departed runway 24C at Moscow-Sheremetyevo Airport at 1803LT on a schedule service to Murmansk. Few minutes after takeoff, while climbing to an altitude of 10,000 feet, the crew encountered problems with the electrical system and informed ATC about an emergency situation via the transponder codes 7700 because communication systems were unserviceable. The crew initiated a circuit to return to the airport, continued the approach to runway 24L. On approach at an altitude between 900 and 1,100 feet, the windshear warning system sounded five times 'Go around. Windshear ahead'. From a height of 80 m (260 ft) above ground level, the aircraft descended below the glide path and at a height of 55 m (180 ft) the TAWS warning sounded: "Glide Slope." From that moment on the airspeed increased to 170 knots. At 18:30 the aircraft overflew the runway threshold and touched down at a distance of 900 m past the threshold at a speed of 158 knots. Touchdown occurred at a g-force of at least 2.55g with a subsequent bounce to a height of about 2 m. After two seconds the aircraft landed again on the nose landing gear with a vertical load 5.85g, and bounced to a height of 6 m. The third landing of the aircraft occurred at a speed of 140 knots with a vertical overload of at least 5g. This caused a rupture of the wing structure and fuel lines. The aircraft caught fire, went out of control, veered off runway to the right and came to rest in a grassy area, bursting into flames. The aircraft was destroyed by fire. 37 occupants were evacuated while 41 people, among them a crew member, were killed.

Crash of a PZL-Mielec AN-2R in Vyun

Date & Time: May 4, 2019 at 1335 LT
Type of aircraft:
Registration:
RA-01443
Flight Type:
Survivors:
Yes
Schedule:
Ust-Nera - Vyun
MSN:
1G231-24
YOM:
1988
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
9700
Aircraft flight hours:
6305
Circumstances:
The single engine airplane departed Ust-Nera on a cargo flight to Vyun, carrying two pilots and a load of various equipment destined for the employees of a local gold mine. Upon landing on an unprepared terrain, the undercarriage collapsed. The airplane slid on its belly and came to rest. Both pilots escaped uninjured and the aircraft was damaged beyond repair. The accident occurred at location N 65° 54' E 138° 20'.
Probable cause:
The accident was the result of the destruction of the right main landing gear strut upon landing.
The following contributing factors were identified:
- Unsatisfactory performance of the welded joint in the manufacture of the strut with the formation of welding cracks in one of the most stressed zones of the strut,
- Pilot errors, which led to an early landing of the aircraft, possibly rough, on an unprepared (uncleared) area with possible obstacles.
Final Report:

Crash of a Let L-410UVP-E20 in Lukla: 3 killed

Date & Time: Apr 14, 2019 at 0907 LT
Type of aircraft:
Operator:
Registration:
9N-AMH
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Lukla - Manthali
MSN:
13 29 14
YOM:
2013
Flight number:
GO802D
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
15652
Captain / Total hours on type:
3558.00
Copilot / Total flying hours:
865
Copilot / Total hours on type:
636
Aircraft flight hours:
4426
Aircraft flight cycles:
5464
Circumstances:
On 14 April 2019, around 0322Hrs, Aircraft Industries' L410UPV-E20, registration 9NAMH, owned and operated by Summit Air Pvt. Ltd. met with an accident at Tenzing-Hillary Airport, Lukla when it veered right and excurred the runway during take-off roll from runway 24. The aircraft first collided with Manang Air's helicopter, AS350B3e, registration 9N-ALC, with its rotor blade running on idle power and then with Shree Airlines' helicopter, AS350B3e, registration 9N-ALK just outside the inner perimeter fence of the aerodrome into the helipad before coming to a stop. The PIC and Cabin Crew of 9N-AMH survived the accident, whereas the Co-pilot and one security personnel on ground were killed on the spot. One more security personnel succumbed to injury later in hospital during the course of treatment. 9N-AMH and 9N-ALC both were substantially damaged by impact forces. There was no post-crash fire. Prior to the accident the aircraft had completed 3 flights on Ramechhap-Lukla-Ramechhap sector. According to PIC, he was in the left seat as the pilot monitoring (PM) and the co-pilot, in the right seat was the pilot flying (PF). According to CCTV footages, the aircraft arrived at the apron from VNRC to VNLK at 0315Hrs and shut its LH engine. The PIC started the LH engine at about 0318 Hrs after unloading cargo and passengers. At 0322:30 Hrs, the PIC aligned the aircraft with the runway at the runway threshold 24 and then handed over the controls to the co-pilot for the take-off roll. The take-off roll commenced at 0322:50 Hrs. CCTV footage captured that within 3 seconds the aircraft veered right and made an excursion. The aircraft exited the runway and travelled about 42.8 ft across the grassy part on right side of runway 24, before striking the airport inner perimeter fence. It then continued to skid for about 43 ft, into the upper helipad, crashing into 9N-ALC. Eye witnesses statements, CCTV footages and initial examination of the wreckage showed that rotor blades of helicopter 9N-ALC were on idle when RH wing of the aircraft swept two security personnel (on ground) before slashing its rotor shaft. The moving rotors cut through the cockpit on the right side slaying the Co-pilot immediately. The helicopter toppled onto the lower helipad 6 ft below. The LH wing of the aircraft broke the skid of helicopter 9NALK and came to a halt with toppled 9N-ALC beneath its RH main wheel assembly. Due to 2impact, 9N-ALK shifted about 8 ft laterally and suffered minor damages. There was no post-crash fire. The PIC switched off the battery and came out of the aircraft through emergency exit along with the cabin crew. The captain of the helicopter 9N-ALC was rescued immediately. 9N-ALC's crew sustained a broken tail-bone whereas 9N-ALK's crew escaped without sustaining major injuries. All three deceased were Nepalese citizens. Aircraft 9N-AMH and helicopter 9N-ALC were substantially damaged while the helicopter 9N-ALK endured partial damages.
Probable cause:
The commission concluded that the probable cause of the accident was aircraft's veering towards right during initial take-off roll as a result of asymmetric power due to abrupt shifting of right power lever rearwards and failure to abort the takeoff by crew. There were not enough evidences to determine the exact reason for abrupt shifting of the power lever.
Contributing Factors:
1. Failure of the PF(being a less experienced co-pilot) to immediately assess and act upon the abrupt shifting of the right power lever resulted in aircraft veering to the right causing certain time lapse for PIC to take controls in order to initiate correction.
2. PIC's attempted corrections of adding power could not correct the veering. Subsequently, application of brakes resulted in asymmetric braking due to the position of the pedals, and further contributed veering towards right.
Final Report:

Crash of a Pilatus AU-23A Turbo Porter in Wat Bang Sala

Date & Time: Mar 5, 2019 at 1300 LT
Operator:
Registration:
74-2079
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Pattani - Hat Yai
MSN:
2079
YOM:
1974
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The single engine airplane departed Pattani (9th AF Command) at 1156LT bound for the Wing 56 Air Division 4 located at Hat Yai Airport. En route, the crew encountered technical problems with the engine and attempted an emergency landing when the airplane crashed in a banana plantation located in the region of Wat Bang Sala. All three occupants were injured and the aircraft was damaged beyond repair.

Crash of a Gulfstream G200 in Moscow

Date & Time: Feb 26, 2019 at 1244 LT
Type of aircraft:
Operator:
Registration:
4K-AZ88
Survivors:
Yes
Schedule:
Baku - Moscow
MSN:
189
YOM:
2008
Flight number:
EWS88
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
7608
Captain / Total hours on type:
2356.00
Copilot / Total flying hours:
2554
Copilot / Total hours on type:
609
Aircraft flight hours:
4174
Aircraft flight cycles:
1787
Circumstances:
The airplane departed Baku-Bina Airport on a charter flight to Moscow, carrying three passengers and three crew members. Following an uneventful flight, the crew was cleared for an approach to Moscow-Sheremetyevo Airport runway 24C. The aircraft landed at a speed of 150 knots some 250 metres past the runway threshold. After touchdown, the crew started the braking procedure and activated the thrust reversers. After a course of several hundred metres, the aircraft deviated to the left, made an almost 180 turn and veered off runway to the left. While contacting soft ground, the right main gear was torn off and the aircraft came to rest in a snow covered area. All six occupants evacuated safely and the aircraft was damaged beyond repair.
Probable cause:
The reason for the accident with the Gulfstream G200 4K-AZ88 was the stowing of the right-engine reverser by the pilot KVS from maximum thrust reversal while maintaining maximum thrust reversal on the left engine, which led to the appearance of a significant turning moment to the left. The aircraft turning to the left in the presence of a cross wind to the right, as well as turbulence of the airflow near the rudder due to the open thrust reversal mechanism of the left engine and possible ice deposition on the outer surfaces of the aircraft, which led to the development of a significant swing moment on the rudder. The development of a significant articulated moment on the rudder, in the absence of power steering in the rudder control system, led to its deviation to the leftmost position despite significant (up to 82 kg or 180 pounds) forces exerted by the crew on the pedals. The deviation of the rudder (pedals) to the left also led to the deviation of the nose wheel to the left. The total moment from the running reverse of the left engine, from the right engine in direct draft mode, and from the rudder and nose wheel deflection to the left, led to the aircraft rolling out of the runway and its damage. Separate braking applied by the crew could not prevent the aircraft from rolling out.

The following contributing factors were identified:
- The crew did not take into account the provisions of the AOM about the possible "destabilizing" effect of the thrust reverse when landing with a cross wind on the runway with a reduced braking coefficient;
- Increased psycho-emotional tension of the crew members due to long dissatisfaction and emotional discussion of instructions and actions of ATC controllers. At the same time, the instructions and actions of the ATC service controllers were in line with established procedures.
Final Report:

Crash of a De Havilland EO-5C (Dash-7-102) at Pyongtaek-Desiderio AAF

Date & Time: Feb 25, 2019
Operator:
Registration:
N89068
Flight Type:
Survivors:
Yes
Schedule:
Pyongtaek - Pyongtaek
MSN:
88
YOM:
1982
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The aircraft was complering a survey mission on behalf of the US Ministry of Defense. For unknown reasons, the four engine airplane landed hard at Pyongtaek-Desiderio AAF (Camp Humphreys), causing the right main gear to collapse. The right wing fell on the ground and the aircraft slid for few dozen metres before coming to rest. All occupants evacuated safely and the aircraft was damaged beyond repair.

Crash of a Boeing 707-3J9C in Fath: 15 killed

Date & Time: Jan 14, 2019 at 0830 LT
Type of aircraft:
Operator:
Registration:
EP-CPP
Flight Type:
Survivors:
Yes
Site:
Schedule:
Bishkek - Payam
MSN:
21128/917
YOM:
1976
Country:
Region:
Crew on board:
16
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
15
Circumstances:
The airplane, owned by the Islamic Republic of Iran Air Force (IRIAF) was completing a cargo flight from Bishkek, Kyrgyzstan, on behalf of Saha Airlines, and was supposed to land at Payam Airport located southwest of Karaj, carrying a load of meat. On approach, the crew encountered marginal weather conditions and the pilot mistakenly landed on runway 31L at Fath Airport instead of runway 30 at Payam Airport which is located 10 km northwest. After touchdown, control was lost and the airplane was unable to stop within the remaining distance (runway 31L is 1,140 meters long), overran and crashed in flames into several houses located past the runway end. The aircraft was destroyed by fire as well as few houses. The flight engineer was evacuated while 15 other occupants were killed.

Crash of a Lockheed C-130E Hercules at Chaklala-Nur Khan AFB

Date & Time: Nov 9, 2018 at 1438 LT
Type of aircraft:
Operator:
Registration:
4180
Flight Type:
Survivors:
Yes
Schedule:
Chaklala - Chaklala
MSN:
4180
YOM:
1966
Country:
Region:
Crew on board:
9
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The crew was completing a training mission at Chaklala-Nur Khan AFB in Islamabad. Upon touchdown, a tyre burst. Control was lost and the airplane veered off runway to the right and collided with a concrete wall before coming to rest, burstin into flames. All nine occupants escaped uninjured while the aircraft was destroyed by a post crash fire. It is believed that the landing was hard.

Crash of a PZL-Mielec AN-2R near Arkhangelsk

Date & Time: Nov 8, 2018 at 1054 LT
Type of aircraft:
Operator:
Registration:
RA-84674
Flight Phase:
Survivors:
Yes
Schedule:
Arkhangelsk – Soyana – Dolgoshchel’e – Mezen
MSN:
1G191-52
YOM:
1981
Flight number:
9135
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
12
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
4742
Captain / Total hours on type:
4336.00
Copilot / Total flying hours:
969
Copilot / Total hours on type:
761
Aircraft flight hours:
13509
Aircraft flight cycles:
20389
Circumstances:
The single engine airplane departed Arkhangelsk-Vaskovo Airport on a flight to Mezen with intermediate stops in Soyana and Dolgoshchel’e, carrying 12 passengers (11 adults and one child) and two pilots. En route, weather conditions deteriorated with drizzle. The crew reduced his altitude from 400 to 300 metres when frost formed on the windshield. The captain decided to return to Arkhangelsk but the aircraft' speed dropped from 170 to 120 km/h. Unable to maintain the speed and altitude, the crew attempted an emergency landing when the aircraft collided with trees and crashed in a wooded area located about 50 km northeast of Arkhangelsk-Talaghy Airport. All 14 occupants were rescued, among them two passengers were injured. The aircraft was destroyed.
Probable cause:
The accident with the An-2 RA-84674 aircraft occurred during a forced landing in the forest, the need for which was due to the impossibility of continuing the flight due to the effect of icing on the aerodynamic and traction characteristics of the aircraft (the inability to maintain altitude and speed even with the takeoff engine operating mode). The contributing factor, most likely, was the decision of the crew to climb over 150 m from the ground level, where the presence of stratus clouds and icing was predicted.
Final Report:

Crash of a Boeing 737 MAX 8 off Jakarta: 189 killed

Date & Time: Oct 29, 2018 at 0631 LT
Type of aircraft:
Operator:
Registration:
PK-LQP
Flight Phase:
Survivors:
No
Schedule:
Jakarta - Pangkal Pinang
MSN:
43000
YOM:
2018
Flight number:
JT610
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
181
Pax fatalities:
Other fatalities:
Total fatalities:
189
Captain / Total flying hours:
6028
Captain / Total hours on type:
5176.00
Copilot / Total flying hours:
5174
Copilot / Total hours on type:
4286
Aircraft flight hours:
895
Aircraft flight cycles:
443
Circumstances:
The aircraft departed runway 25L at Jakarta-Soekarno-Hatta Airport at 0621LT bound for Pangkal Pinang, carrying 181 passengers and 8 crew members. The crew was cleared to climb but apparently encountered technical problems and was unable to reach a higher altitude than 5,375 feet. At this time, the flight shows erratic speed and altitude values. The pilot declared an emergency and elected to return to Jakarta when control was lost while at an altitude of 3,650 feet and at a speed of 345 knots. The airplane entered a dive and crashed 12 minutes after takeoff into the Kerawang Sea, about 63 km northeast from its departure point. The airplane disintegrated on impact and few debris were already recovered but unfortunately no survivors. It has been reported that the aircraft suffered various technical issues during the previous flight on Sunday night but was released for service on Monday morning. Brand new, the airplane was delivered to Lion Air last August 18. At the time of the accident, weather conditions were considered as good. The Cockpit Voice Recorder (CVR) was found on 14 January 2019. In the initial stages of the investigation, it was found that there is a potential for repeated automatic nose down trim commands of the horizontal stabilizer when the flight control system on a Boeing 737 MAX aircraft receives an erroneously high single AOA sensor input. Such a specific condition could among others potentially result in the stick shaker activating on the affected side and IAS, ALT and/or AOA DISAGREE alerts. The logic behind the automatic nose down trim lies in the aircraft's MCAS (Maneuvering Characteristics Augmentation System) that was introduced by Boeing on the MAX series aircraft. This feature was added to prevent the aircraft from entering a stall under specific conditions. On November 6, 2018, Boeing issued an Operations Manual Bulletin (OMB) directing operators to existing flight crew procedures to address circumstances where there is erroneous input from an AOA sensor. On November 7, the FAA issued an emergency Airworthiness Directive requiring "revising certificate limitations and operating procedures of the airplane flight manual (AFM) to provide the flight crew with runaway horizontal stabilizer trim procedures to follow under certain conditions.
Probable cause:
Contributing factors defines as actions, omissions, events, conditions, or a combination thereof, which, if eliminated, avoided or absent, would have reduced the probability of the accident or incident occurring, or mitigated the severity of the
consequences of the accident or incident. The presentation is based on chronological order and not to show the degree of contribution.
1. During the design and certification of the Boeing 737-8 (MAX), assumptions were made about flight crew response to malfunctions which, even though consistent with current industry guidelines, turned out to be incorrect.
2. Based on the incorrect assumptions about flight crew response and an incomplete review of associated multiple flight deck effects, MCAS’s reliance on a single sensor was deemed appropriate and met all certification requirements.
3. MCAS was designed to rely on a single AOA sensor, making it vulnerable to erroneous input from that sensor.
4. The absence of guidance on MCAS or more detailed use of trim in the flight manuals and in flight crew training, made it more difficult for flight crews to properly respond to uncommanded MCAS.
5. The AOA DISAGREE alert was not correctly enabled during Boeing 737-8 (MAX) development. As a result, it did not appear during flight with the mis-calibrated AOA sensor, could not be documented by the flight crew and was therefore not available to help maintenance identify the mis-calibrated AOA sensor.
6. The replacement AOA sensor that was installed on the accident aircraft had been mis-calibrated during an earlier repair. This mis-calibration was not detected during the repair.
7. The investigation could not determine that the installation test of the AOA sensor was performed properly. The mis-calibration was not detected.
8. Lack of documentation in the aircraft flight and maintenance log about the continuous stick shaker and use of the Runaway Stabilizer NNC meant that information was not available to the maintenance crew in Jakarta nor was it available to the accident crew, making it more difficult for each to take the appropriate actions.
9. The multiple alerts, repetitive MCAS activations, and distractions related to numerous ATC communications were not able to be effectively managed. This was caused by the difficulty of the situation and performance in manual handling, NNC execution, and flight crew communication, leading to ineffective CRM application and workload management. These performances had previously been identified during training and reappeared during the accident flight.
Final Report: