The Australian Transport Safety Bureau (ATSB) is releasing its
Interim Factual report into the tailstrike involving Airbus
A340-500 aircraft, registered A6-ERG, during takeoff at Melbourne
Airport, Vic. on the evening of 20 March 2009. The aircraft was
being operated on a scheduled passenger flight from Melbourne to
Dubai in the United Arab Emirates. This report builds on the facts
advised in the report that was released on 30 April 2009 (ISBN
978-1-921602-43-6, available at
www.atsb.gov.au).
The investigation has determined that the pre-flight take-off
performance calculations were based on an incorrect take-off weight
that was inadvertently entered into the aircraft's portable flight
planning computer by the flight crew. Subsequent crosschecks did
not detect the incorrect entry and its effect on performance
planning, and the resulting take-off speeds and engine thrust
settings that were applied by the crew were insufficient for a
normal takeoff.
As a result of this accident, the aircraft operator has
undertaken a number of procedural, training and technical
initiatives across its fleet and operations; with a view to
minimising the risk of a recurrence. In addition, the aircraft
manufacturer has released a modified version of its cockpit
performance-planning tool and is developing a software package that
automatically checks the consistency of the flight data being
entered into the aircraft's flight computers by flight crews.
The investigation has found a number of similar take-off
performance-related incidents and accidents across a range of
aircraft types, locations and operators around the world. As a
result, the ATSB has initiated a safety research project to collate
those events and examine the factors involved. The findings of that
project will be released by the ATSB once completed.
The ATSB continues to work closely with the United Arab Emirates
General Civil Aviation Authority (GCAA), the French Bureau
d'Enquetes et d'Analyses (BEA), the operator and aircraft
manufacturer. Ongoing investigation effort will include the
examination of:
- computer-based flight performance planning
- human performance and organisational risk controls
- reduced thrust takeoffs and the use of erroneous take-off
performance data.
The remainder of the investigation is likely to take some
months. However, should any critical safety issues emerge that
require urgent attention, the ATSB will immediately bring such
issues to the attention of the relevant authorities who are best
placed to take prompt action to address those issues. In the
interim, the ATSB has drawn this interim report to the attention of
operators to remind them of the risks associated with calculating
and entering take-off performance information.
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