Country
code

New South Wales

Crash of a Rockwell 500U Shrike Commander on Mt Barren Jack: 2 killed

Date & Time: Nov 18, 1989 at 1241 LT
Operator:
Registration:
VH-BMR
Flight Phase:
Survivors:
No
Site:
Schedule:
Canberra – Dalby
MSN:
500-1754-45
YOM:
1968
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Circumstances:
When the survey aircraft failed to arrive at the destination, and on expiry of the SAR time, a search was commenced. Wreckage of the aircraft was subsequently found on the eastern slope of Mt Barren Jack, to the north west of the mouth of Carrolls Creek, and on the planned track for the survey operation. Observers at the Burrinjuck reservoir near the mouth of Carrolls Creek described the weather in the accident area at the time as black clouds spilling over and obscuring the mountain tops. The aircraft collided with trees on the side of the mountain, while banked steeply to the right and in a tail low attitude. The pilot was thrown from the aircraft during the impact sequence. Medical opinion held that there was no evidence of body trauma consistent with the seat belt being fastened at the time of impact. The flight was completed on behalf of the Bureau of Mineral Resources (BMR) and both occupants were killed.
Probable cause:
Because of the destruction of the aircraft by the ensuing fire the status of the seat belt assemblies were unable to be determined. The investigation revealed that both engines were operating at high power at the time of impact. No malfunction or defect could be found with the aircraft which could have contributed to the accident. The survey task required the pilot to adhere strictly to a particular track and the target height for the flight was 500 feet above ground level while maintaining visual contact with the ground at all times. The pilot was suitably qualified to act as pilot in command of survey operations down to a height of 200 feet above ground level. The investigation concluded that the aircraft was being operated at a height substantially lower that 500 feet above ground level prior to the accident. Impact marks, wreckage and mechanical evidence suggest that the aircraft impacted terrain at a time when the pilot was attempting to carry out an evasive manoeuvre to remain clear of terrain. The reason why the aircraft was being operated at such a height and why the pilot delayed turning away from the steeply rising terrain could not be determined.
The following factors were reported:
- The pilot continued the flight into adverse weather conditions.
- The pilot flew the aircraft towards steeply rising terrain at a height substantially lower that 500 feet above ground level.
Final Report:

Crash of a Piper PA-61 Aerostar (Ted Smith 601) off Wollongong: 1 killed

Date & Time: Apr 2, 1989 at 1030 LT
Operator:
Registration:
VH-NOE
Flight Type:
Survivors:
No
Schedule:
Sydney - Wollongong
MSN:
61-0849-8162154
YOM:
1981
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
The pilot was to conduct a charter with passengers from Sydney to Wollongong, Nowra, Canberra and return to Sydney, departing Sydney at about 10.00am. Earlier that morning he positioned the aircraft at Sydney and had it refuelled. When the passengers arrived he explained that the weather in the various destinations was very poor and that there was a possibility they may not be able to land. However, he was prepared to give it a try. As the passengers were pressed for time, they could not afford to take a chance with the weather and so they decided to drive. They told the pilot that if he could land at Wollongong later that day they would continue the flight with him. However, they impressed on him that there was no pressure for him to depart immediately as they would not be in Wollongong for several hours. After driving for a short time, the passengers decided that the weather did not appear as if it would improve, and believed that it would be better to complete the journey by car. They contacted the charter company by phone to cancel the charter, but the pilot had already departed. The flight to Wollongong appears to have proceeded normally where the pilot reported commencing an NDB approach, and would call again at a specified time. This was the last message received from the pilot. Witnesses on the ground at Wollongong, and on a yacht 20 nautical miles to the east of Wollongong reported hearing an aircraft flying at approximately 1000 to 2000 feet in the low cloud and rain. There were no other known aircraft in the area. Later that day a helicopter discovered wreckage debris in the sea, which was confirmed as being from the aircraft. The search was discontinued due to very poor weather and visibility, and cancelled two weeks later when further efforts failed to locate any trace of the aircraft.
Probable cause:
The reason why the aircraft flew into the sea could not be determined.
Final Report:

Crash of a Piper PA-31-310 Navajo off Stanwell Park: 3 killed

Date & Time: Nov 1, 1988 at 1740 LT
Type of aircraft:
Registration:
VH-DAP
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Nowra - Nowra
MSN:
31-364
YOM:
1968
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
The aircraft had been modified by the installation of an air driven winch for the purpose of towing gunnery targets and was operating in conjunction with a warship for scheduled sea/air gunnery practise. Weather conditions in the area were reported as overcast at 4000 feet, wind 060 degrees / 15-20 knots and visibility of 15-20 kilometres. At about 1717 hours the aircraft was instructed to commence carrying out gunnery tracking runs at an altitude of 1000 feet with the sleeve target not deployed. Between 1720 and 1735 hours the aircraft carried out two such runs from the west and east. The aircraft then tracked to the south, away from the ship, to a distance of about 10 kilometres. At about 1738 the aircraft was instructed to turn inbound for a run from astern. At about 1739 hours the pilot reported engine problems and about one minute later advised "I've got problems, Mayday, I'm going in". Crewmen stationed near the stern of the ship, reported seeing the aircraft dive into the sea. The warship was immediately turned back towards the crash position. Other warships and aircraft were also ordered to the crash position. The only wreckage sighted was at the crash datum and was believed to have been a section of wing. This wreckage was located about two metres below the surface and sank before it could be recovered. The approximate depth of water at the crash position is 450 fathoms. No trace of the aircraft or its occupants has been discovered to date.
Probable cause:
The subsequent investigation established that the flight crew were properly qualified to conduct the flight, and that the aircraft was appropriately certified and maintained. The flight was conducted in accordance with the conditions of the operating contract. At the time of the occurrence the aircraft had not deployed the sleeve target and no firing was being carried out. No evidence was found to suggest an in-flight structural failure or fire. The installation of the target towing equipment was not considered to have been a factor in the development of the accident. There was a loss of control of the aircraft following an apparent engine malfunction. The precise reasons for the accident have not been established.
The following factors were considered relevant to the development of the accident:
1. Apparent engine failure or malfunction.
2. Control of the aircraft was lost for reasons which have not been determined.
Final Report:

Crash of a De Havilland DHC-2 Beaver in Nandawar: 1 killed

Date & Time: Oct 31, 1988 at 0824 LT
Type of aircraft:
Registration:
VH-AAK
Flight Phase:
Survivors:
No
Schedule:
Nandawar - Nandawar
MSN:
137
YOM:
1951
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
The pilot had been conducting superphosphate spreading operations in the area two days prior to the accident and had completed approximately 60 trips during that operation. On the morning of the accident, he had just completed the sixth load when the outboard section of the right wing struck powerlines. The right wing was torn from its attachment points and separated from the aircraft. The aircraft then impacted the ground in a steep nose down attitude and came to rest 169 metres from the powerlines.
Probable cause:
A detailed examination of the aircraft and its systems failed to reveal any defect which could have contributed to the accident. The engine was operating at high power at the time of the impact. It is probable that the pilot forgot about the presence of the powerlines. It was noted that the pilot was not wearing a shoulder harness and that an unapproved modification had been made to the lap harness. The toggle fitted to the lap harness was a type approved for 9 to 12g applications only and therefore was not suitable for agricultural operations, which require equipment capable of withstanding 25g loads.
The following factor was considered relevant to the development of the accident:
1. The pilot did not see or avoid the powerline.
Final Report:

Crash of a Fletcher FU-24-950 near Werris Creek: 1 killed

Date & Time: Jul 19, 1988 at 1045 LT
Type of aircraft:
Operator:
Registration:
VH-HPP
Flight Phase:
Survivors:
No
Schedule:
Werris Creek - Werris Creek
MSN:
162
YOM:
1970
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
The pilot was conducting superphosphate spreading operations in fine and clear weather conditions. The paddock being treated sloped uphill, and there were heavily timbered peaks beyond the paddock. The pilot had spread the paddock the previous day under similar conditions. On this occasion the aircraft was apparently performing normally as the first swath run was completed, but the aircraft did not appear to gain any appreciable height as it approached the hills. It was then seen to adopt a steep nose-up attitude and commence a wingover type manoeuvre. During this manoeuvre the aircraft struck trees and then impacted the ground. A fierce fire broke out and engulfed the wreckage. The pilot, sole on board, was killed.
Probable cause:
Although the investigation was hampered by the extensive fire damage, no defect or malfunction was discovered which might have contributed to the accident. The reason the pilot, who had extensive agricultural experience, chose to conduct swath runs towards steeply rising ground was not determined. The wind direction had changed since the previous day, and the aircraft was likely to have been affected by downdrafts on the lee side of the hills. When the pilot realised the aircraft was not performing as expected, he evidently attempted to dump the remaining load and reverse the direction. However, there was insufficient aircraft performance available to successfully complete this manoeuvre.
Significant Factors:
The following factors were considered to be relevant to the development of the accident:
1. The pilot elected to conduct spreading runs towards steeply rising ground, when safer alternatives were available.
2. It was likely that downdraft conditions existed on the lee side of the hills.
3. The pilot evidently misjudged the climb performance of the aircraft.
4. The pilot delayed attempting a reversal of direction beyond the point where such a manoeuvre could be safely accomplished.
Final Report:

Crash of a Piper PA-31-350 Navajo Chieftain off Coffs Harbour: 3 killed

Date & Time: Apr 7, 1988 at 2113 LT
Operator:
Registration:
VH-AOX
Survivors:
Yes
Schedule:
Brisbane – Coolangatta – Coffs Harbour – Port Macquarie
MSN:
31-7552013
YOM:
1975
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
6
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
The aircraft was operating a scheduled service from Brisbane to Port Macquarie with planned intermediate stops at Coolangatta and Coffs Harbour. Weather conditions over the route were influenced by a widespread unstable airmass. The terminal forecast for Coffs Harbour indicated a surface wind of 360/15, visibility in excess of 10 km, 5 octas stratus at 1000 ft, 5 octas cumulus at 2000 ft. Thunderstorms, associated with visibility reduced to 2000 metres were also forecast for periods of up to 30 minutes. The actual weather conditions at Coffs Harbour were generally consistent with the terminal forecast. Runway 03 was in use throughout the evening. Coffs Harbour airport was equipped with NDB, VOR and domestic DME radio navigation aids. A VOR/DME procedure was published for runway 03 approaches. For aircraft not equipped with DME, a VOR or NDB approach was available using common tracking and minimum altitude criteria. Runway 03 was also equipped with a 6 stage T-VASIS and 3 stage runway lighting. All facilities were reported as functioning normally, with the exception of the VOR which was experiencing intermittent power failures due to the effects of heavy rain. The VOR was able to be reset manually from the Coffs Harbour control tower. Although the tower was scheduled to be unmanned before the arrival of VH-HOX, the duty air traffic controller elected to man the tower until the aircraft had landed. The controller also called out a technician to attend to the VOR. The aircraft was equipped with dual ILS/VOR and ADF receivers, plus International DME. Domestic DME equipment was not fitted to the aircraft, although required by ANO 20.8. After descending in the VOR/NDB holding pattern, the aircraft was cleared for an instrument approach. The pilot had been told of the intermittent operation of the VOR and had said he would revert to the NDB. At that time the weather conditions were fluctuating about the circling minima of 950 feet (QNH) and five km visibility. The controller advised the aircraft of a heavy shower to the south of the field. The aircraft subsequently completed the approach and the pilot reported "visual". The controller said he saw the lights of the aircraft in a position consistent with a right downwind leg for a landing on runway 03. The aircraft was then cleared to land. Shortly after, the controller saw the lights of the aircraft disappear briefly, consistent with the aircraft passing through a localised area of rain/cloud. The lights then reappeared briefly, as though the aircraft was turning onto finals, before disappearing. This was immediately followed by short series of "clicks" on the tower frequency. The aircraft was called immediately but failed to respond to any calls. The accident site was located about 1070 metres short of the landing threshold, and about 750 metres to the right of the extended runway centreline. The aircraft was found to have initially struck a nine metre high tree in a nose low attitude, steeply banked to the right, on a track of 050 degrees. After striking the tree with the outboard section of the right wing, the aircraft struck other trees before hitting the ground and overturning. A fire broke out shortly after the aircraft came to rest. As a result of his remaining on duty, the controller was able to provide immediate notification of the accident to the emergency services. This action facilitated the rescue of survivors.
Probable cause:
A subsequent examination of the aircraft structure, systems and components, found no evidence of any pre-existing defect or malfunction which could have contributed to the accident. The pilot was properly licenced and qualified to conduct the flight. Evidence was provided to show that the pilot had probably flown a total of 930 hours in the previous 365 days, thereby exceeding the ANO 48 limitation of 900 hours. Other breaches of Flight and Duty Limitations were found to have occurred during the previous 12 months, however, during the three months prior to the accident no significant breaches of ANO 48 were found which could have contributed to the accident. Specialist medical advice considered the 30 hour exceedence of the 900 hour limitation was not significant in this accident. Other specialist advice was obtained concerning the possibility of the aircraft being affected by low level windshear or a microburst during the final stage of the night circling approach. It was considered this was not a factor in the accident. Considerable evidence was presented during a subsequent Coroners' Inquest concerning allegations of irregular operating practices by the operator over a period of several years prior to the accident. Much of this evidence was only provided after the granting to witnesses of immunity from prosecution. Despite this, no new evidence was presented which related to the accident flight. The investigation concluded that, on the evidence available, the aircraft was turning onto a short right base leg when it entered a localised area of rain and low cloud. The pilot was required to look out of the right cockpit window to enable him to maintain visual reference with the approach end of the runway. It is considered probable that the pilot briefly diverted his attention from the flight instruments while attempting to maintain that visual reference as the aircraft passed through an area of reduced visibility. During that period the aircraft continued to roll to the right, resulting in an inadvertent loss of height. The pilot was unable to effect a recovery before the aircraft struck trees.
The following factors were considered relevant to the development of the accident:
1. Low cloudbase, with localised rain squalls and reduced visibility.
2. Low level, right hand, night circling approach.
3. Pilot lost visual reference at a critical stage of the approach.
4. Pilot did not initiate missed approach.
5. Pilot probably diverted attention from the flight instruments.
Final Report:

Crash of a Piper PA-60 Aerostar (Ted Smith 600) near Cassilis: 2 killed

Date & Time: Dec 22, 1987 at 1620 LT
Operator:
Registration:
VH-IGV
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Bankstown – Coolah
MSN:
60-0054-123
YOM:
1971
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
2
Circumstances:
The pilot was conducting a freight charter flight, and witness evidence confirmed that on DEPARTURE he was occupying the left-hand seat. The pilot was accompanied by a friend who was also a commercial pilot, but not endorsed on this type of aircraft. Approximately 18 minutes prior to the estimated time of arrival at the destination, the pilot reported leaving the cruising altitude of 6500 feet on descent. Several minutes after the descent report had been made, a witness about 50 kilometres from the destination reported seeing the aircraft pull-up into a very steep climb from an extremely low height with its wings level, and then become inverted. It then entered what was described by the witness as a spin or spiral dive, before impacting the ground in a near vertical descent. The pilot was found in the right-hand seat, and the passenger had been thrown clear of the wreckage. It was established that neither seat belt had been fastened at the time of the impact. Although it could not be determined which pilot was flying the aircraft at the time of the pull-up, medical evidence suggested that the pilot occupying the right-hand seat position was handling the controls at the time of ground impact. The weather at the time of the accident was fine and clear, with 10-15 knot winds.
Probable cause:
A thorough examination of the aircraft wreckage did not reveal any malfunction or mechanical failure which may have caused a sudden and severe loss of control. Investigation showed that at the
moment of impact the aircraft was in a near vertical descent, without any rotation about the vertical axis, and the wings were in a stalled condition. No reason was found which could have explained either the low flying, or the steep pull-up. During the investigation it was established that with this aircraft type, a considerable degree of sustained elevator force would need to be applied by a pilot in order to achieve the type of flight path reported by the witness. It is considered that such a control input would need to be deliberately executed.
Significant Factors:
It was considered that the following factors were relevant to the development of the accident:
1. The pilot, or passenger, performed what was apparently a deliberate steep pull-up from low-level. The reason for the pull-up was not established.
2. Loss of control occurred as a consequence of the aircraft becoming stalled.
3. There was insufficient height for the pilot to effect recovery following the loss of control.
Final Report:

Crash of a De Havilland DHC-2 Beaver near Walcha: 1 killed

Date & Time: Dec 22, 1986
Type of aircraft:
Operator:
Registration:
VH-AAY
Flight Phase:
Survivors:
No
Schedule:
Winterbourne - Winterbourne
MSN:
136
YOM:
1951
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
Superphosphate spreading was being carried out, with the aircraft uplifting one tonne loads about every 6 minutes. Fuel endurance with both tanks full was approximately 2 hours. The pilot was conducting his 25th takeoff for the day, about one hour after refuelling. Witnesses observed that the aircraft did not become airborne at the usual point, two-thirds of the way along the 675 metre strip. Lift-off finally occurred at the end of the strip, but almost immediately afterwards the aircraft clipped a fence. It was seen to sink slightly, before climbing at a steeper than normal angle until some 250 metres beyond the fence. At this point the nose dropped suddenly and the aircraft dived into rising ground in a steep nose down attitude. Fire broke out on impact and consumed much of the wreckage. The pilot, sole on board, was killed.
Probable cause:
Preliminary investigation revealed that the fuel selector was in the "off" position. This had been the first occasion that the pilot had flown this particular aircraft. The fuel selector in this aircraft was different to that in the other Beaver the pilot had operated. In the previous aircraft, rotating the fuel selector through 180 degrees anti-clockwise changed the selection from the rear to the forward fuel tanks. In the accident aircraft, a similar movement of the selector changed the selection from the rear tank to the "off" position. This difference had not been brought to the pilot's attention, and it was possible that he had not thoroughly familiarized himself with the aircraft prior to commencing operations. It was considered likely that the takeoff had been commenced with the fuel selector positioned to the almost empty rear tank. During the takeoff roll, the fuel low quantity bell and associated light had activated, and the pilot had changed the fuel selector by feel, while continuing with the takeoff. With the fuel supply turned off, the engine had failed from fuel starvation, and the aircraft had subsequently stalled at too low a height above the ground to permit recovery before impact.
Final Report:

Crash of a De Havilland DHC-4 Caribou in Camden

Date & Time: Jul 4, 1986
Type of aircraft:
Operator:
Registration:
A4-264
Flight Type:
Survivors:
Yes
Schedule:
Camden - Camden
MSN:
264
YOM:
1968
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The crew was completing a local training flight at Camden Airport. On final approach, the pilot-in-command initiated a go-around when the aircraft stalled and crashed. There were no casualties while the aircraft was damaged beyond repair.

Crash of a Piper PA-61 Aerostar (Ted Smith 601B) in Lismore: 1 killed

Date & Time: Mar 11, 1986 at 1659 LT
Operator:
Registration:
VH-CUO
Flight Type:
Survivors:
No
Schedule:
Coolangatta – Lismore
MSN:
61-0806-8062151
YOM:
1980
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
When the aircraft arrived in the destination area, another aircraft was also in the circuit. The pilots were in communication with each other, and arranged that VH-CUO would land after the other aircraft. However, the pilot of VH-CUO apparently misjudged the relative speeds of the two aircraft. He initiated a go-around from a position on final approach to runway 15, when there was evidently insufficient separation with the preceding aircraft to allow a normal landing. The aircraft remained at a low height above the ground, and the pilot broadcast a message that he intended to land in the opposite direction, on runway 33. The wind at the time was from the south-east at about 10 knots. Witnesses observed the aircraft as it tracked along the western side of the runway. The turn onto base leg was made at an angle of bank of about 60 degrees, and about three-quarters of the way around the turn, the nose of the aircraft dropped rapidly. The aircraft then dived steeply to the ground, and was destroyed by the impact and subsequent fire.
Probable cause:
The subsequent investigation did not reveal any defect or malfunction which might have affected the operation of the aircraft. The pilot was conducting an operation known as a "bank run", and there is pressure on pilots performing such runs to adhere to the prescribed schedules. The pilot's decision to perform a low level circuit and land downwind was considered to be related to his desire to arrive at the terminal as close as possible to the scheduled time. While conducting the circuit, the aircraft stalled during a turn at a height which was too low to allow the pilot to recover control before impact with the ground.
Final Report: