Loss of control involving an Extra EA 300, VH-OOE, Bankstown, New South Wales, on 4 March 1993

Summary

During the landing roll the right wheel brake failed to function. The pilot was unable to maintain directional control, resulting in a ground loop, during which slight damage to the left landing gear strut and right wingtip occurred.

Air in the right brake line rendered the right brake ineffective. It was not determined how the air was admitted to the system as no maintenance had been performed on the system since the aircraft had been delivered from the factory.

Occurrence summary

Investigation number 199300368
Occurrence date 04/03/1993
Location Bankstown
State New South Wales
Report release date 13/07/1993
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Landing gear/indication, Loss of control
Occurrence class Accident

Aircraft details

Manufacturer Extra-Flugzeugbau GmbH
Model EA 300
Registration VH-OOE
Sector Piston
Operation type Private
Departure point Bankstown NSW
Destination Bankstown NSW
Damage Substantial

ANSP info/procedural error involving a Boeing 737-377, VH-CZP, Hobart, Tasmania, on 29 January 1993

Summary

The pilot of the first aircraft in the sequence, from Australian Airlines, requested direct track from over Devonport to Hobart on the 320 radial. On co-ord with Hobart Air Traffic Control approval given for this and a second aircraft, this one from Ansett Airlines, to also track direct. The Sector 3 controller passed the clearance to the first aircraft but forgot to pass it to the second one. The second aircraft arrived in the Hobart area on the 301 radial, which was the original planned route, instead of the 320 radial as expected. No loss of separation occurred.

Occurrence summary

Investigation number 199300346
Occurrence date 29/01/1993
Location Hobart
State Tasmania
Report release date 29/06/1993
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category ANSP info/procedural error
Occurrence class Incident

Aircraft details

Manufacturer The Boeing Company
Model 737-377
Registration VH-CZP
Sector Jet
Operation type Air Transport High Capacity
Departure point Melbourne VIC
Destination Hobart TAS
Damage Nil

Operational event involving a Druine, Avion Roger D31, VH-PWH, Warracknabeal, Victoria, on 29 January 1993

Summary

The pilot inspected part of strip 17 and found it to be dry and firm. He took off on sealed strip 08. Later he landed on 17. Near the end of the landing roll the main wheels sank in a softer area and the aircraft overturned. This happened in an area the pilot had not checked on his inspection.

Occurrence summary

Investigation number 199300355
Occurrence date 29/01/1993
Location Warracknabeal
State Victoria
Report release date 26/05/1993
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Loss of control
Occurrence class Incident

Aircraft details

Model Druine, Avion Roger D31
Registration VH-PWH
Sector Piston
Operation type Private
Departure point Warracknabeal VIC
Destination Warracknabeal VIC
Damage Minor

Operational non-compliance involving a Bell Helicopter Co 206B, VH-EPQ, Richmond, NSW on 1 February 1993

Summary

VH-EPQ was cleared into the Richmond Control Zone on track to Riverstone, not above 500 feet on QNH. VH-EPQ was observed by the control tower supervisor proceeding north of Riverstone. When challenged by the tower controller, he reported 2 nautical miles (nm) south of Oakville. VH-EPQ proceeded to Oakville from Riverstone without a clearance, breaking down separation with Stal Thunder One on Tacan One final. No Holding instructions were given to VH-EPQ by the tower. The pilot of VH-EPQ was contacted and he said that he had complied with the terms of his clearance and that at no time was he anywhere near the C130 which he saw about 2000 feet above and one and a half to two miles away.

Occurrence summary

Investigation number 199300345
Occurrence date 01/02/1993
State New South Wales
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Operational non-compliance
Occurrence class Incident

Aircraft details

Manufacturer Bell Helicopter Co
Model 206B
Registration VH-EPQ
Sector Helicopter
Departure point BANKSTOWN
Destination OAKVILLE
Damage Nil

Collision on ground involving an Aerospatiale AS355F2, VH-PHM, 1 km south of Little Beach, New South Wales, on 5 March 1993

Summary

The Police rescue helicopter was being flown for the purpose of conducting the search for and rescue of a seriously injured rock fisherman in the MacMasters Beach area, south of Terrigal. It departed Bankstown at about 0555 ESuT and arrived at the command post at Little Beach at about 0620. Shortly after, a paramedic was embarked and a search initiated. The injured person was located about 650 metres south of the command post.

The helicopter was flown back to Little Beach, where a crewmember disembarked and returned to the location of the injured person. It then was landed on a nearby rock ledge near the water's edge, where both the paramedic and the observer left the helicopter to assist the fisherman. The helicopter then took off and moved away to minimise noise and rotor wash in the immediate area. The pilot reported that at that time the wind was calm, the visibility unlimited, and there was some wave action against the lower of two rock shelves. He asked the ground party by radio if a 'Stokes' litter was required for the retrieval of the fisherman but was advised by the paramedic that this would be unnecessary as the fisherman could be carried down to the rock shelf, close to the original landing point.

The helicopter was brought to a low hover to allow the patient and observer to board. After receiving a clearance to depart from the paramedic, who remained on the ground, the pilot commenced a take-off. At a skid height of about 12 ft above the rock shelf, the entire aircraft was engulfed by a very large wave. The take-off was aborted, and the helicopter was stabilised in a hover. Almost immediately, it was struck by a second wave, resulting in a double engine flameout. The helicopter was landed on the rock shelf, where it was then struck by a third wave, which rolled it onto its side and forced it against a low rock face. After the helicopter had come to rest, all three persons on board were able to escape, assisted by the paramedic.

The pilot reported that the sea state then returned to its original, relative calm. However, after a further 80 minutes, another series of very large waves struck the helicopter, resulting in further damage.

Significant Factors

1. Deceptive sea state.

2. Desirability of rescuing injured person with minimum delay.

Occurrence summary

Investigation number 199300342
Occurrence date 05/03/1993
Location 1 km south of Little Beach
State New South Wales
Report release date 14/09/1994
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Occurrence class Accident
Highest injury level Minor

Aircraft details

Manufacturer Aerospatiale Industries
Model AS355F2
Registration VH-PHM
Sector Helicopter
Operation type Aerial Work
Departure point 1 km S Little Beach NSW
Destination Little Beach NSW
Damage Destroyed

Infrastructure - ATM involving a Boeing 767-200, ZK-NBB, Melbourne, Victoria, on 11 February 1993

Summary

Melbourne air traffic control received co-ordination details on Air New Zealand Flight NZ114 from Perth air traffic control. This indicated the route shown on the flight progress strips held in Melbourne was different to tracking details co-ordinated from Perth. It was discovered that the Computer Aided Strip Printing System (CASPS), which automatically prints flight progress strips from the flight plan had made an error. This was partly due to a complicated route description in the plan message and a software error in the CASPS system. The strips should have been checked by the flight data officer against the flight plan. The error was not detected by the flight data officer.

Occurrence summary

Investigation number 199300343
Occurrence date 11/02/1993
Location Melbourne
State Victoria
Report release date 10/06/1993
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Occurrence class Incident

Aircraft details

Manufacturer The Boeing Company
Model 767-200
Registration ZK-NBB
Sector Jet
Operation type Air Transport High Capacity
Departure point Perth WA
Destination Auckland NZ
Damage Nil

Collision with terrain involving a Bell 47G-3B1, VH-KHY, Bindoon, Western Australia, on 28 February 1993

Summary

The aircraft was conducting joy-flights near a Rock Festival. The pilot aborted a take-off attempt when it became clear to him that he would not obtain translational lift in time to clear trees at the end of the selected take-off area. He chose to air-taxi to a more suitable pad. To get to the pad, he had to air-taxi between two large trees. Whilst passing between the trees the pilot concentrated on rotor clearance and did not notice a wind gust which moved the aircraft towards the tree on the left. The main rotor hit a branch, forcing the pilot to take immediate recovery action. The aircraft landed heavily.

Occurrence summary

Investigation number 199300338
Occurrence date 28/02/1993
Location Bindoon
State Western Australia
Report release date 26/05/1993
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Collision with terrain, Hard landing
Occurrence class Accident
Highest injury level Minor

Aircraft details

Manufacturer Bell Helicopter Co
Model 47G-3B1
Registration VH-KHY
Sector Helicopter
Operation type Charter
Departure point Bindoon WA
Destination Bindoon WA
Damage Substantial

Fuel exhaustion involving a Cessna 177A, VH-TXU, Birdwood, 55 km west of Port Macquarie, New South Wales, on 21 February 1993

Summary

The aircraft struck an obstacle during an attempted forced landing.

Inspection found that the engine had stopped when the fuel on board had been exhausted after 40 minutes flying. The pilot reported that the tanks were half full prior to departure. This should have been sufficient fuel for about two and a half hours flying. No evidence was found of any fuel leaks.

Occurrence summary

Investigation number 199300323
Occurrence date 21/02/1993
Location 55 km west of Port Macquarie
State New South Wales
Report release date 01/06/1993
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Collision with terrain, Forced/precautionary landing, Fuel exhaustion
Occurrence class Accident
Highest injury level Minor

Aircraft details

Manufacturer Cessna Aircraft Company
Model 177A
Registration VH-TXU
Sector Piston
Operation type Private
Departure point Port Macquarie NSW
Destination Birdwood NSW
Damage Substantial

Runway incursion involving a Boeing 737-476, VH-TJO and Partenavia P.68C-TC, VH-TCU, Sydney, New South Wales, on 26 February 1993

Summary

The Partenavia was being flown from Essendon to Sydney. During the final stage of the flight the aircraft was radar vectored for an approach and landing on runway 34, which was accomplished normally.

After landing, the aircraft vacated left into taxiway 'Alpha' and contacted Surface Movement Control (SMC), which cleared the aircraft to cross runway 34 via taxiway 'Hotel' and hold short of runway 07. Although this was acknowledged by the pilot, the aircraft continued past the holding point on taxiway 'Charlie' and infringed the runway 07 flight strip, despite being queried by SMC. When the pilot of the Partenavia recognised the aircraft had entered the flight strip he immediately carried out a 180 degree turn to vacate, during which the runway surface itself was slightly infringed.

In the meantime, a Boeing 737, VH-TJO, which had been cleared to take-off on runway 07, was instructed by the Aerodrome Controller (ADC) to stop immediately. This was accomplished safely from a reported speed of 100 knots. The aircraft was able to vacate the runway via taxiway 'Charlie'.

Occurrence summary

Investigation number 199300322
Occurrence date 26/02/1993
Location Sydney
State New South Wales
Report release date 14/08/1996
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Runway incursion
Occurrence class Incident

Aircraft details

Manufacturer Partenavia Costruzioni Aeronautiche S.p.A
Model P.68C-TC
Registration VH-TCU
Sector Piston
Operation type Private
Departure point Essendon
Destination Sydney
Damage Nil

Aircraft details

Manufacturer The Boeing Company
Model 737-476
Registration VH-TJO
Sector Jet
Operation type Air Transport High Capacity
Departure point Sydney
Destination Brisbane
Damage Nil

Animal strike involving a Beech Aircraft Corp 58, VH-EGM, The Monument, Queensland, on 1 March 1993

Summary

After touchdown, the pilot observed two kangaroos run onto the runway. He was unable to avoid the animals and one struck and collapsed the nosegear. The other struck the right flap.

Occurrence summary

Investigation number 199300336
Occurrence date 01/03/1993
Location The Monument
State Queensland
Report release date 30/08/1993
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Animal strike
Occurrence class Accident

Aircraft details

Manufacturer Beech Aircraft Corp
Model 58
Registration VH-EGM
Serial number TH-730
Sector Piston
Operation type Charter
Departure point Mt Isa QLD
Destination The Monument QLD
Damage Substantial