Pará

The following findings were identified:
- The total weight of the aircraft upon departure from Belém Airport was 650 kilos above MTOW,
- The cargo was not stowed in the cabin but simply stored on the floor,
- The left engine was not providing power at impact and the aircraft entered a left turn and then an uncontrolled descent until impact with the ground,
- Failure of the left engine due to the presence of an aluminum part obstructing the fuel pipe. Metallographic analyzes confirmed that this aluminum part likely came from a thread of the fuel pump,
- Complacency of the crew who failed to follow the published procedures of the operator.

The following findings were identified:
- Lack of crew coordination,
- The captain was overconfident,
- The copilot showed a lack of self confidence,
- The environment developed in the cockpit on approach allowed the pilots to deviate from the operational tasks primarily related to mutual controls,
- Poor approach and landing planning which required a higher sink rate than normal,
- The crew failed to make an approach briefing,
- Insufficient application of controls,
- The crew completed an unstable approach,
- Weather conditions were below minimums,
- The runway was not equipped with a lighting system but only with PAPIs,
- The crew failed to initiate a go-around procedure as the landing was obviously missed.

The accident was the consequence of the following factors:
1) Adverse Weather Conditions - Contributed
Weather conditions were unfavorable at the destination location for visual flight. There was a layer of fog near the forest.
2) Poor Instruction - Contributed
The Commander was not qualified to fly that type of aircraft and was not instrument cleared.
3) Disabled Judge - Contributed
The pilots continued the flight, even knowing the adverse weather conditions at their destination.
4) Flight Indiscipline - Contributed
One of the pilots was not qualified to fly that aircraft and, in addition, there was intentional disobedience to the air traffic rules and regulations, regarding the non observance of the minimum IFR flight level in the industry.
5) Disabled Oversight - Contributed
There was poor oversight of the responsible company by letting an unqualified pilot operate the aircraft.
6) Weak Cabin Coordination - Contributed
IFR flight without complying with IMA 100-12 rules, conducted below the limits and outside the descent profile are indications that there was no planning/coordination in the operations performed in the cockpit.

The following findings were reported:
- There was a deficiency in the instruction received, since the crew did not perform emergency training on that type of aircraft, resulting in inadequate preparation for the engine failure situation, especially at low altitude,
- There are indications that the maintenance services were inadequate and contributed to the occurrence of engine failure, due to the possible occurrence of compressor stall,
- The company performed inadequate technical and operational oversight for not providing emergency situations for the crews of that type of aircraft involved in the accident.

The accident was the consequence of the following factors:
- Adverse weather conditions,
- Poor approach planning,
- Poor judgement,
- Poor flight discipline as the crew failed to follow ATC instructions,
- Influence of environment as the region was conducive to the formation of fog,
- The captain had sufficient rest time but his last sleep period was less than five hours,
- The captain was going through a period in which he showed boredom, aggressiveness and demotivation.

It is believed that the loss of control may have been the result of windshear that existed in the approach path of runway 06.
The following contributing factors were reported:
- The crew did not have sufficient training and experience to manage a windshear situation and thus, was unable to take the appropriate corrective actions,
- Poor crew coordination,
- The captain's experience on this type of aircraft was low,
- Poor supervision,
- Lack of safety culture by the operator.