Airframe event involving a Piper PA-31-350, VH-XLB, Young Aerodrome, New South Wales, on 8 July 1998

Summary

When the landing gear was selected up after takeoff, the right main landing gear failed to retract. The pilot in command then diverted to Cootamundra where a normal landing was carried out. The investigation is continuing.

Occurrence summary

Investigation number 199802614
Occurrence date 08/07/1998
Location Young Aerodrome
State New South Wales
Report release date 05/08/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Occurrence class Incident

Aircraft details

Manufacturer Piper Aircraft Corp
Model PA-31-350
Registration VH-XLB
Sector Piston
Departure point Young NSW
Destination Cowra NSW
Damage Nil

Hard landing involving a Beagle A61, VH-WFM, Coldstream (ALA), Victoria, on 5 July 1998

Summary

The owner/pilot of the Beagle Terrier aircraft, having successfully completed a biennial flight review, departed for a local flight involving formation and scenic flying. The forecast and actual wind at the time was from the north at 15 to 20 kts, gusting to 35 kts.

The pilot reported that flight conditions were "quite rough". At the completion of local flying, the pilot manoeuvred the aircraft for a landing, configuring it with full flap and an approach speed of 50 kt. A witness to the approach observed that the aircraft was being flown very slowly when it was about 400 ft above the strip. When about 50 ft above the strip the aircraft developed a high rate of sink that the pilot was unable to arrest. The aircraft landed heavily, right wing low, breaking the right main landing gear and causing substantial damage to the engine, propeller and lower fuselage. It was subsequently determined that the aircraft was not set up properly for an approach under the prevailing weather conditions. The pilot had not adequately considered of the effects of the gusting wind, or the low-level wind shear, even though he was aware of the forecast winds and prevailing conditions.

The Beagle Terrier was a development of the Auster series of aircraft which had a reputation for being able to be flown slowly. Over the years, there have been many accidents, some fatal, as a result of pilots losing control while flying too slowly, at too low an altitude, to effect a safe recovery. With the Beagle Terrier version of the Auster, the danger of flying too slowly is magnified because the aircraft is heavier than other Auster models. When flying speed is lost the Beagle Terrier abruptly achieves a very high rate of descent, as was experienced on the day of the accident. Because of the unexpected abrupt increase in the rate of descent, the pilot did not have enough time to assess the problem and apply power to recover before the aircraft landed heavily. Local safety action As a result of this and other similar occurrences the Antique Aeroplane Association of Australia prepared a "Safety Alert" to warn its members of the inherent problems with low and slow flight, particularly in Auster and Beagle Terrier aircraft. The "Safety Alert" was published in the association's magazine "Rag and Tube".

Occurrence summary

Investigation number 199802584
Occurrence date 05/07/1998
Location Coldstream (ALA)
State Victoria
Report release date 17/12/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Hard landing
Occurrence class Accident

Aircraft details

Manufacturer Beagle Aircraft Ltd
Model A61
Registration VH-WFM
Sector Piston
Departure point Coldstream Vic.
Destination Coldstream Vic.
Damage Substantial

Wheels up landing involving a Beech Aircraft Corp E55, VH-INP, Jandakot Aerodrome, Western Australia, on 4 July 1998

Summary

The pilot advised ATC that he was experiencing difficulties in obtaining normal extension of the landing gear and requested emergency services to be alerted for the landing. During the landing roll, the right main landing gear collapsed. The pilot and passengers evacuated the aircraft safely. Examination of the aircraft revealed that the right main landing gear retract/extend rod assembly was bent in two places.

The rigged length of the rod was critical to the correct "down" locking of the main landing gear, with any rod misalignment resulting in the possibility of landing gear collapse when weight was placed upon it. In addition to rod damage which occurred at the time of the gear collapse, there was evidence of some pre-existing damage. Such damage could result from the inadvertent placement of weight upon the landing gear whilst not correctly "down and locked".It was not possible to determine when this particular damage occurred.

Occurrence summary

Investigation number 199802551
Occurrence date 04/07/1998
Location Jandakot Aerodrome
State Western Australia
Report release date 25/11/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Wheels up landing
Occurrence class Accident

Aircraft details

Manufacturer Beech Aircraft Corp
Model E55
Registration VH-INP
Sector Piston
Departure point Dongara WA
Destination Jandakot WA
Damage Substantial

Loss of separation involving a Airbus A320-211, VH-HYJ and Boeing 737-376, VH-TAX, 370 km east of Perth Aerodrome, Western Australia, on 5 July 1998

Summary

Four high-capacity air transport passenger aircraft were en route to Perth under the control of the Melbourne Sector 1 controller, using procedural control methods. Two aircraft were on air route L513 and the other two aircraft were on air route Q76/J68. The routes converged and aircraft at the same level or not longitudinally separated would be in lateral conflict at the Perth 150 NM position for the routes. The aircraft were occupying FL270, FL280 and FL290. Aircraft on the same routes were separated by the minimum vertical separation standard of 1,000 ft.

However, the aircraft's estimates for the 150 NM Perth positions were within an eight minute period which did not provide a longitudinal separation standard. The controller elected to descend VH-TAX, a Boeing 737, which was at FL280 on route Q76/J68 to FL260 prior to the 150 NM position, to maintain separation with an aircraft at the same level on route L513. The crew descended to FL260 as instructed. Subsequently, the sector 1 controller was queried by another controller as to the separation standard used to maintain separation with VH-HYJ, an Airbus A320, which was on route Q76/J68 at FL270. The controller had descended TAX through the level of HYJ without an appropriate longitudinal standard being applied between the aircraft. There was a breakdown of separation.

The lack of a longitudinal standard between TAX and HYJ had been recognised by the previous sector controller. This controller had annotated the flight progress strips for HYJ to provide a prompt for distance checks. The sector 1 controller was nearing the end of his shift, during which he had worked the last three hours alone. To accommodate training commitments for other controllers and for his own purposes the controller's shifts had been swapped on a number of occasions. The number of recent shifts worked, the time of day and the fact that the controller was nearing the end of his shift probably combined to provide an environment in which he became less vigilant in the scanning of the flight progress strips. Consequently, he did not appreciate that there was not a longitudinal separation standard between the aircraft.

Occurrence summary

Investigation number 199802560
Occurrence date 05/07/1998
Location 370 km east of Perth Aerodrome
State Western Australia
Report release date 17/12/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Loss of separation
Occurrence class Incident

Aircraft details

Manufacturer Airbus
Model A320-211
Registration VH-HYJ
Sector Jet
Operation type Air Transport High Capacity
Departure point Sydney NSW
Destination Perth WA
Damage Nil

Aircraft details

Manufacturer The Boeing Company
Model 737-376
Registration VH-TAX
Sector Jet
Operation type Air Transport High Capacity
Departure point Adelaide SA
Destination Perth WA
Damage Nil

Collision with terrain involving a Robinson R22 Beta, VH-BFA, Brunette Downs (ALA), Northern Territory, on 1 July 1998

Summary

The wind at the time was reported to be from the south-east at 15 to 20 kt with gusts to 25 kts. The pilot had flown away from a mob of cattle at 50 kts in a south-westerly direction across the wind, to check on some other animals. He then reduced speed and turned left into wind at a height of about 15 ft above ground level. As he was rolling out of the turn, the helicopter sank to the ground. The helicopter cartwheeled forward and came to rest inverted. The aircraft was within weight and balance limits for the flight and was reported to have been operating normally before the accident. The pilot reported having flown 6.4 hours that day.

Occurrence summary

Investigation number 199802512
Occurrence date 01/07/1998
Location Brunette Downs (ALA)
State Northern Territory
Report release date 14/07/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Collision with terrain
Occurrence class Accident

Aircraft details

Manufacturer Robinson Helicopter Co
Model R22 Beta
Registration VH-BFA
Sector Helicopter
Departure point Brunette Downs NT
Destination Brunette Downs NT
Damage Substantial

Air/pressurisation involving a Boeing 767-338ER, VH-OGG, Ho Chi Minh, on 30 June 1998

Summary

The take-off was rejected at speed of approximately 30 kts due to EICAS message 'L ENG BLEED'. The operator advised that the right pack flow control shut-off valve was replaced due to suspected faulty electrical connector. Subsequent leak and BITE checks confirmed normal operation.

Occurrence summary

Investigation number 199802489
Occurrence date 30/06/1998
Location Ho Chi Minh
State International
Report release date 09/07/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Air/pressurisation
Occurrence class Incident

Aircraft details

Manufacturer The Boeing Company
Model 767-338ER
Registration VH-OGG
Sector Jet
Operation type Air Transport High Capacity
Departure point Ho Chi Minh Vietnam
Destination Sydney NSW
Damage Nil

Passenger related involving a Boeing 737-377, VH-CZK, Coolangatta Aerodrome, Queensland, on 9 June 1998

Summary

During the flight from Sydney to Coolangatta the aircraft encountered unexpected turbulence. The Purser, who was on the flight deck at the time, returned to the cabin, fastened her seat belt, and made an announcement for passengers to secure their seat belts. The pilot reported that the turbulence was unforecast and occurred in clear conditions, lasting for about two minutes. A child, who was in a rear toilet at the time, was injured. The child described being unable to brace herself against the force of the turbulence and being thrown about the toilet, hitting her head on a tap. She suffered soft tissue injuries, bruising around the lower left rib area and concussion. 

he seat belt sign was not on when the child entered the toilet, but had been turned on at the onset of the turbulence. Two cabin crew, who were in the rear galley at the time, reported that the turbulence was so sudden and severe, that they were unable to take their seats. They braced themselves against the galley and a rear exit door. At that time the child opened the toilet door, and one of the flight attendants, believing it was safer for the child to remain in the toilet, told her to go back in and hold on to the rail. The flight attendant managed to get to his seat and fasten his seat belt. When the turbulence subsided he took the child to her mother.

Despite developments in technology and procedures designed to detect and avoid clear air turbulence, aircraft continue to encounter hazardous conditions resulting in injuries. Following a number of recent severe injuries and a passenger fatality due to the effects of in-flight turbulence, the international airline industry is increasing its efforts to educate passengers as to the seriousness of the problem. Methods to protect passengers and crew when turbulence events occur are also being examined.

SAFETY ACTION

As an outcome from a recent turbulence incident in which passengers and crew were injured during a flight from Japan to Sydney, the operator now requires passengers to have their seat belts fastened while seated.

Occurrence summary

Investigation number 199802488
Occurrence date 09/06/1998
Location Coolangatta Aerodrome
State Queensland
Report release date 07/08/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Occurrence class Incident
Highest injury level Minor

Aircraft details

Manufacturer The Boeing Company
Model 737-377
Registration VH-CZK
Sector Jet
Operation type Air Transport High Capacity
Departure point Sydney NSW
Destination Coolangattta Qld
Damage Nil

Warning devices involving a Boeing 767-277, VH-RMG, Hamilton Island Aerodrome, Queensland, on 25 June 1998

Summary

The slat asymmetry warning message illuminated as the crew were configuring the aircraft to land. The approach was discontinued, and the aircraft was then cleared to 1500 ft to carry out the appropriate safety checks. A decision was taken to divert to Brisbane, where engineering assistance was available. The flight landed at Brisbane without further incident. The aircraft was able to depart for the intended destination a short time later after ground checks determined the original slat asymmetry warning to be spurious.

Occurrence summary

Investigation number 199802468
Occurrence date 25/06/1998
Location Hamilton Island Aerodrome
State Queensland
Report release date 15/07/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Warning devices
Occurrence class Incident

Aircraft details

Manufacturer The Boeing Company
Model 767-277
Registration VH-RMG
Sector Jet
Operation type Air Transport High Capacity
Departure point Sydney NSW
Destination Hamilton Island Qld
Damage Nil

Near collision involving a Saab SF-340A, VH-KEQ and Saab SF-340B, VH-EKH, 28 km south-west of Wagga Wagga VOR, New South Wales, on 21 June 1998

Summary

The crew of VH-KEQ contacted Melbourne Centre at their descent point, 30 NM south of Wagga Wagga and were advised that there was no IFR traffic. The crew completed their pre-descent checklist, briefed for a runway 05 VOR/DME approach and commenced to descend. At 28 NM Wagga and descending through 8,000 ft, the crew broadcast their position on the Wagga MBZ frequency. They received a response from the Wagga Aerodrome Frequency Response Unit, that indicated the frequency had not been used within the preceding five minutes.

The crew of KEQ continued their descent and contacted Melbourne Centre at 18 NM and advised they were transferring to the Wagga MBZ. The crew joined the 05 VOR/DME approach on the 10 DME arc and reported their intentions to Melbourne Centre, nominating a time for an operations normal call. Following this transmission, the crew of a second aircraft VH-EKH, broadcast their position 7 NM south west of Wagga, approaching 3,000 ft. They reported having conducted an overshoot from the runway 23 VOR/DME approach and requested that KEQ climb to 4,000 ft to facilitate separation. Both aircraft subsequently landed safely from the runway 05 VOR/DME approach.

At the time of the occurrence, the ATS Sector 2 and 8 positions were combined. The two crews' initial estimates for Wagga Wagga differed by 8 minutes and the controller's expectation was that the first SAAB would have already landed by the time the second SAAB transferred to the MBZ. The controller is reported to have recognised the conflict between the aircraft and had passed traffic information to the crew of EKH as they initiated a missed approach from the runway 23 VOR/DME procedure. Communication between the two crews was subsequently established on the area VHF frequency with EKH at 7 DME on the overshoot from runway 23 and KEQ on the 10 DME arc and inbound for runway 05. The controller did not pass traffic information to the crew of KEQ.

Following this occurrence, ATS team leaders briefed controllers on the importance of anticipating aircraft separation when issuing traffic information.

Occurrence summary

Investigation number 199802387
Occurrence date 21/06/1998
Location 28 km south-west of Wagga Wagga VOR
State New South Wales
Report release date 10/07/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Near collision
Occurrence class Incident

Aircraft details

Manufacturer Saab Aircraft Co.
Model SF-340A
Registration VH-KEQ
Sector Turboprop
Operation type Air Transport Low Capacity
Departure point Albury NSW
Destination Wagga Wagga NSW
Damage Nil

Aircraft details

Manufacturer Saab Aircraft Co.
Model SF-340B
Registration VH-EKH
Sector Turboprop
Operation type Air Transport Low Capacity
Departure point Sydney NSW
Destination Wagga Wagga NSW
Damage Nil

Collision with terrain involving a Cessna T210N, VH-EYZ, Mataranka, Northern Territory, on 23 June 1998

Summary

The flight was part of a private holiday tour with four adults and two children in the aircraft. The pilot was conducting an approach to land at a property airstrip. There was a headwind of about 20 kts on final approach and he was maintaining an airspeed of 80 kts. When the aircraft descended below the tree line just before landing it entered an area of windshear. The pilot noted an increase in speed at this time and said that the aircraft bounced a number of times after the initial touchdown.

He then elected to go around, applied full engine power, and retracted the flaps from 30 to 20 degrees. He then became concerned about clearing trees to the left of the strip as the aircraft had veered left during the go-around. The aircraft subsequently collided with the trees and impacted the ground heavily. The pilot and one passenger sustained minor injuries. There was no reported problem with the engine or the aircraft during the go-around. Post-accident examination of the aircraft indicated that, at impact, the flaps were in the process of retracting, and the landing gear was down.

Occurrence summary

Investigation number 199802344
Occurrence date 23/06/1998
Location Mataranka
State Northern Territory
Report release date 14/07/1998
Report status Final
Investigation type Occurrence Investigation
Investigation status Completed
Mode of transport Aviation
Aviation occurrence category Collision with terrain
Occurrence class Accident
Highest injury level Minor

Aircraft details

Manufacturer Cessna Aircraft Company
Model T210N
Registration VH-EYZ
Sector Piston
Departure point Daly Waters NT
Destination Mataranka NT
Damage Substantial