The departure was from runway 27. Prior to take off the crew were told to "maintain heading 260." After take-off, the crew initiated a right turn. This was observed by the Melbourne Departures controller and the turn was stopped on a heading of 310. There was no loss of separation.

Significant Factor

The following factor was considered relevant to the development of the incident:

1. Aircraft flight crew error over implementation of after take-off heading instruction.

During the take-off run on runway 34 the first officer, who was flying the aircraft, called "failure" at approximately 120 knots. This was below V1, and the captain rejected the take-off. The Master Caution Air Conditioning lights were illuminated. The auxiliary power unit bleed air was supplying the left pack which was running in high mode. The pack tripped off as a result of high temperatures.

Autobrake was used in the rejected take-off selection and operated until down to a slow speed in the deceleration. The outboard left main wheel tyre deflated due to overheating. Both left main gear wheels and the left outboard brake unit were subsequently changed. Take-off should not be rejected from high speed for a Master Caution. However, when the first officer responded by calling "failure" the captain was obliged to reject the take-off.

Significant Factors

1. Master Caution Air Conditioning lights illuminated during the take-off roll.

2. The first officer incorrectly called "failure" for the caution light illumination.

3. The captain was obliged to reject the take off on the basis of the first officers call.

The aircraft took off in company with another Cessna 152. Whilst turning to avoid higher terrain north of Kooralbyn, the pilot lost sight of the other aircraft against the setting sun. He rolled his aircraft to maintain physical separation from the other aircraft. In the process he lost control of his aircraft.

The pilot next noticed the ground rushing up to meet him and rolled off bank and pulled back on the elevator control. The aircraft passed underneath a powerline and the left wing tip struck the lower of the three wires. The collision with the wire caused the aircraft to flick roll through approximately 180 degrees. The aircraft narrowly missed the ground and trees before the pilot regained control.

Despite the obvious visual damage and control difficulties the pilot elected to fly the aircraft to Archerfield. An emergency was not declared, and the aircraft was landed safely at the destination.

Post flight inspection revealed that about one and a half metres of the leading edge was stripped of the metal skin back to the front spar.

The pilot was not endorsed to fly in formation with other aircraft.

Shortly after commencing descent from 6,000 ft, the pilot reported that the right engine began to run roughly, which was followed soon after by a loud bang and the appearance of flames around the engine. The pilot shut down the engine, feathered the propeller and turned off the fuel, magnetos and alternator. However, these actions had no effect on the intensity of the fire.

Because it was still dark at ground level, the pilot elected to continue the 40 km to the planned destination. The intensity of the fire appeared to diminish as the flight continued and finally self-extinguished just prior to landing.

Inspection of the engine found that the #1 piston to crankshaft connecting rod had separated at the crankshaft end and had broken a hole through the lower forward crankcase. Engine oil being drawn through the broken section of the crankcase ignited when it came into contact with the hot exhaust manifold. The ensuing fire, being fuelled by a quantity of oil from the crankcase, caused substantial damage to the engine cowls, engine bay, lower right wing and landing gear door panels.

Metallurgical examination of all of the connecting rods and bearing shells from the engine revealed that the #1 connecting rod had failed as a result of fatigue which had initiated at multiple sites on both sides of the connecting rod.

The examination found the presence of aluminium oxide particles in the engine lubrication system. It was concluded that these particles had acted abrasively on the bearing shells which resulted in the breakdown of the hydrodynamic oil film during engine operation. This in turn caused overheating and the eventual breakup of the bearing shells.

The engine had been in service for a total of 4,623 hours and was overhauled 427 hours prior to the failure.

Aluminium oxide beads of the type found in the engine are used in most maintenance workshops and overhaul facilities as a bead blasting medium.

The overhaul facility which carried out the last overhaul of the failed engine advised that they do not use any form of bead blasting to clean internal engine components or crankcases. The facility did use aluminium beads in their bead blast machine, but it was used only to clean external engine parts.

It was not determined how the aluminium oxide beads entered the oil system.

SIGNIFICANT FACTORS

1. Aluminium particles were introduced into the engine lubrication system at an undetermined stage of its life.

2. The aluminium particles interfered with the proper lubrication of the connecting rod bearings.

3. The engine failed as a result of overheating of the bearing shells which led to the breakup of the #1 connecting rod.

4. The fire resulted from the released engine oil being ignited by hot engine components.

The pilot made a normal approach for landing on runway 23. He selected the landing gear down and obtained three green lights.

On the landing roll the nose gear leg collapsed.

Later, retraction checks were carried out on the aircraft. These did not reveal any defects in the system. The reason for the collapse of the nose gear leg has not been established.

Significant Factors

The following factors were considered relevant to the development of the accident:

1. The nose gear leg collapsed for undetermined reasons.

The aircraft was cleared via Kinglake and Epping for a landing on runway 27 at Melbourne. The aircraft proceeded south of the cleared track and did not comply with heading change instructions from Melbourne Tower to get the aircraft back on track. The aircraft was transferred back to approach control where it was vectored and descended for a landing on runway 34. There was no breakdown in separation.

Investigation determined that on the approach to Melbourne there was confusion in the cockpit between the two crew members. En route the captain had asked the first officer to request runway 34. This had not been done. From some distance out the captain was planning to land on runway 34 but the first officer was basing his actions on a landing on runway 27. It was established that the ILS selectors were tuned to 109.3 which is the runway 27 ILS frequency but it was not established exactly how communication between the captain and the first officer broke down to the extent that they both thought they were going to land on different runways.

Significant Factors

The following factors were considered relevant to the development of the incident:

• There was confusion between the captain and the first officer as to which runway they were going to land on.

The helicopter departed Waste Point helipad at about 0925 to resupply huts with rations and fuel, and to undertake feral animal control. Apart from the cargo, a second crewmember and a passenger were carried.

The aircraft approached the first hut (Tin Hut) in clear sky conditions with nil wind. The pilot said he carried out an aerial inspection of the landing area before commencing a landing towards the north. As the aircraft turned onto final approach at an altitude of about 6000 feet, with speed reducing to 20 knots, the engine lost power and the main rotor RPM drooped below the green arc. With about 100 metres left to run to the landing area, and unable to increase engine power, the pilot attempted an autorotation approach. The helicopter landed heavily and bounced before the tail rotor struck the ground. At the time of the accident the aircraft was being flown at about maximum gross weight. Manufacturer information indicated that the aircraft should have been capable of hovering in ground effect with regard to the ambient altitude/temperature conditions.

The engine was subsequently removed from the aircraft and bench tested. No operational problems were revealed. The fuel control unit was then removed from the engine and tested. The test revealed that the fuel control unit had a slower than acceptable acceleration response time. This was due to contamination of the fuel control unit with what appeared to be sand. It is considered likely that in a marginal situation of high gross weight and altitude, any delay in fuel control response for increased engine power may have resulted in a considerable loss of height whilst the fuel control unit was responding to demand.

The reason why the fuel control unit was contaminated could not be positively determined. The fuel control filter was serviceable and should have prevented the passage of grit into the fuel control unit. However, prior to engine start with the aircraft boost pump operating, fuel from the aircraft fuel supply can bypass the fuel pump and filter. Such contamination of the fuel supply need only have happened once, leaving the fuel control unit contaminated in such a way as to only become apparent at some later stage when engine response was critical.

The aircraft was conducting a vertical take-off near a McDonalds Restaurant as part of a fund raising activity. At about 300 feet the right rear cabin door detached from the aircraft whilst being closed by a crew member.

Investigation revealed that the door lower track was cracked and deformed and the upper track had slight deformation sufficient to allow the door to separate from the aircraft. The first section of the crack in the lower track was discoloured indicating it had been present for some time.

Maintenance procedures have been amended to include a detailed inspection of the door and attaching hardware into the five weekly routine servicing schedule.

PK-GIB was tracking from Taroom to Udiko. JA8182 was tracking from Rockhampton to Armidale. Both aircraft were cruising at flight level 370 (F370). The tracks cross at approximately 60 nautical miles (nm) east of Taroom. PK-GIB was instructed to descend to F350 and to be established at that level by 20nm east of Taroom.

Due to language problems between the controller and the Indonesian crew, the controller was later not certain whether the crew had understood the clearance to be level at F350 by 20nm (the lateral separation point) or 30nm east of Taroom. After some further discussion, the controller finally established that the aircraft had not levelled at F350 until 41nm east of Taroom thereby compromising procedural separation standards.

An experienced instructor was conducting a routine flight proficiency check on a pilot from his company. During a practice emergency, where a jammed tail rotor pedal was simulated, the pilot being checked allowed one skid to contact the ground while the aircraft was yawing to the left. Control was regained and a further hour of flying was completed. Post flight inspection revealed that the tail boom had been creased as a result of the ground contact.