Accidents and Incidents

This directory contains articles about particular Accidents and Incidents that are considered illustrative of the contemporary safety issues and recommended potential solutions. The information contained in the article summarising an individual accident or incident is derived from the published official investigation report, which may in each case be found on the SKYbrary bookshelf wherever possible in English as provided by the publishing Investigation Agency. A direct link to each official report is provided at the end of each summary article. The complete list of events is provided on this and the following pages in the order of the ICAO aircraft type designator in alphabetical order.

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Showing below 1385 results in range #101 to #200.

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A320 / F50, Adelaide Australia, 2016 On 17 August 2016, a Fokker F50 crossed an active runway at Adelaide ahead of an A320 which was about to land after both its pilots and the controller involved had made assumptions about the content of radio transmissions they were aware they had not fully heard. The Investigation found that the A320 crew had responded promptly to the potential conflict by initiating a low go around over the other aircraft and noted that stop bars were not installed at Adelaide. In addition, aircraft taxiing across active runways were not required to obtain their crossing clearances on the runway control frequency.

A320 / GLID, vicinity Memmingen Germany, 2015 On 6 April 2015, the crew of an A320 under radar control in Class E airspace and approaching 4000 feet made a very late sighting of a glider being flown by a student pilot which appeared ahead at a similar altitude. The glider pilot reported having seen a 'cone of light' coming towards him. Both aircraft took avoiding action as practicable and passed within a recorded 450 metres with the A320 passing an estimated 250 feet over the glider. The glider was not fitted with a transponder and was not required to be, and the controller had only secondary radar.

A320 / JAB4, vicinity Ballina NSW Australia, 2020 On 28 November 2020, in uncontrolled Class ‘G’ airspace, an Airbus A320 inbound to and in contact with Ballina and an en-route light aircraft tracking abeam Ballina both listening out on a shared Common Traffic Advisory Frequency (CTAF) did not recollect hearing potentially useful CTAF calls and converged on intersecting tracks with the light aircraft TCAS only selected to Mode ‘A’. The A320 received a TCAS TA but neither aircraft visually acquired the other until the minimum separation of 600 feet with no lateral separation occurred. Changes to the air traffic advisory radio service in the area were subsequently made.

A320 / SF34, vicinity London Stansted UK, 2019 On 12 February 2019, an Airbus A320 under the command of a Captain reportedly undergoing line training supervised by a Training Captain occupying the supernumerary crew seat was slow to follow ATC instructions after breaking off from an unstabilised approach at London Stansted caused by the First Officer’s mismanagement of the approach and lost separation at night as it crossed approximately 600 feet above a Saab 340B climbing after takeoff. The Investigation found that flight crew workload had been exacerbated after the Captain under supervision unnecessarily delayed taking over control and had then not done so in the prescribed way.

A320 / SW4, Calgary AB Canada, 2016 On 2 December 2016, the crew of an Airbus A320 passing 100 knots on takeoff at Calgary saw another aircraft crossing an intersection ahead but continued because they considered that, as the other aircraft was already more than half way across, it would be clear before they reached that point. The Investigation found that the GND Controller had cleared the other aircraft to cross after forgetting that the runway was active and under TWR control. It was concluded that the response of the ANSP SMS process to a history of identical controller errors and related reports had been inadequate.

A320 / Vehicle, London Gatwick UK, 2018 On 3 February 2018, a runway inspection vehicle was cleared onto the active runway at London Gatwick ahead of an aircraft which had just touched down and driven towards it having been cleared to do so because the aircraft crew’s confirmation that they would clear the runway before reaching the vehicle was considered by the controller as a clearance limit. The Investigation found that the associated runway inspection procedure had not been adequately risk-assessed and noted that many issues raised by it had still not been addressed by the time it was completed eighteen months later.

A320, Auckland New Zealand, 2017 On 27 October 2017, an Airbus A320 returned to Auckland after advice from ATC that the right engine may have been affected by ingestion of FOD during engine start - a clipboard and paper left just inside the right hand engine by an employee of the airline’s ground handling contractor acting as the aircraft loading supervisor. The subsequent inspection found paper throughout the engine and minor damage to an engine fan blade and the fan case attrition liner. The Dispatcher overseeing the departure said she had seen the clipboard inside the engine but assumed it would be retrieved before departure.

A320, Ballykelly Northern Ireland UK, 2006 On 29 March 2006, an Eirjet Airbus 320 was operating a scheduled passenger flight from Liverpool to Londonderry Airport in Northern Ireland for Ryanair in daylight. At 8nm from LDY, the operating crew reported that they were having problems with the ILS glideslope on approach to Runway 26. They judged that they were too high to carry out a safe landing from the ILS approach and requested permission from ATC to carry out a visual approach. The aircraft, with the commander as PF, then flew a right hand descending orbit followed by a visual circuit from which it landed. Upon landing, the crew were advised by Londonderry ATC, who had had the aircraft in sight when it called Finals and had then cleared it to land that they had, in fact, landed at Ballykelly airfield, a military helicopter base 5nm to the east-north-east of Londonderry.

A320, Basel-Mulhouse-Freiburg France, 2014 On 6 October 2014, an A320 crew requested, accepted and commenced an intersection takeoff at Basel using reduced thrust performance data based on the originally anticipated full length takeoff which would have given 65% more TODA. Recognition of the error and application of TOGA allowed the aircraft to get airborne just before the runway end but the Investigation found that a rejected take off from high speed would have resulted in an overrun and noted that despite changes to crew procedures after a similar event involving the same operator a year earlier, the relevant procedures were still conducive to error.

A320, Bilbao Spain, 2001 On 7th February 2001, an Iberia A320 was about to make a night touch down at Bilbao in light winds when it experienced unexpected windshear. The attempt to counter the effect of this by initiation of a go around failed because the automatic activation of AOA protection in accordance with design criteria which opposed the crew pitch input. The aircraft then hit the runway so hard that a go around was no longer possible. Severe airframe structural damage and evacuation injuries to some of the occupants followed. A mandatory modification to the software involved was subsequently introduced.

A320, Brasilia Brazil, 2015 On 8 April 2015, an Airbus A320 crew lost their previously-acquired and required visual reference for the intended landing runway at Brasilia but continued descent in heavy rain and delayed beginning a go around until the aircraft was only 40 feet above the runway threshold but had not reached it. A premature touchdown prior to the runway then occurred and the aircraft travelled over 30 metres on the ground before becoming airborne again. The Investigation was unable to establish any explanation for the failure to begin a go around once sufficient visual reference was no longer available.

A320, Brisbane QLD Australia, 2020 On 23 October 2020, an Airbus A320 taking off from Brisbane became difficult to keep on the centreline as speed increased and takeoff was rejected from a low speed. It remained on the runway and messages indicating a malfunctioning right engine were then seen. The Investigation found that one engine had surged as thrust was applied due to damage caused by a screwdriver tip inadvertently left in the engine during routine maintenance and that the pilot flying had used the rudder when attempting to maintain directional control during the reject despite its known ineffectiveness for this purpose at low speeds.

A320, Bristol UK, 2019 On 23 March 2019, the crew of a fully-loaded Airbus A320 about to depart Bristol detected an abnormal noise from the nose landing gear as a towbarless tug was being attached. Inspection found that the aircraft nose gear had been impact-damaged rendering the aircraft no longer airworthy and the passengers were disembarked. The Investigation noted that tug driver training had been in progress and that the tug had not been correctly aligned with the nose wheels, possibly due to a momentary lapse in concentration causing the tug being aligned with the nose leg rather than the nose wheels.

A320, Brunei, 2014 On 7 July 2014, an Airbus A320 landing at Brunei departed the side of the runway almost immediately after touchdown and continued to gradually diverge from the runway axis until stopping after a ground run of approximately 1,050 metres. The Investigation concluded that the aircraft commander, having taken over control from the First Officer when the latter lost their previously-acquired prescribed visual reference below Decision Altitude due to a sudden-onset intense rain shower ahead, had then continued the approach without recognising that the only lights still visible to him were those at the right hand edge of the runway.

A320, Calicut India, 2019 On 20 June 2019, an Airbus A320 about to touchdown at night at Calicut drifted to the right once over the runway when the rain intensity suddenly increased and briefly left the runway before regaining it and completing the landing and taxi in. Runway edge lighting and the two main gear tyres were damaged. The Investigation attributed the excursion to loss of enough visual reference to maintain the centreline until touchdown followed by late recognition of the deviation and delayed response to it. The visibility reduction was considered to have created circumstances in which a go-around would have been advisable.

A320, Cochin India, 2011 On 29 August 2011, an Airbus A320 which had up to that point made a stabilised auto ILS approach at destination deviated from the runway centreline below 200 feet aal but continued to a night touchdown which occurred on the edge of the 3400 metre runway and was followed by exit from the side onto soft ground before eventually coming to a stop adjacent to the runway about a third of the way along it. The subsequent investigation attributed the event to poor crew performance in reduced visibility

A320, Dublin Ireland, 2017 On 27 September 2017, an Airbus A320 being manoeuvred off the departure gate at Dublin by tug was being pulled forward when the tow bar shear pin broke and the tug driver lost control. The tug then collided with the right engine causing significant damage. The tug driver and assisting ground crew were not injured. The Investigation concluded that although the shear pin failure was not attributable to any particular cause, the relative severity of the outcome was probably increased by the wet surface, a forward slope on the ramp and fact that an engine start was in progress.

A320, en route, north of Marseilles France, 2013 On 12 September 2013, pressurisation control failed in an A320 after a bleed air fault occurred following dispatch with one of the two pneumatic systems deactivated under MEL provisions. The Investigation found that the cause of the in-flight failure was addressed by an optional SB not yet incorporated. Also, relevant crew response SOPs lacking clarity and a delay in provision of a revised MEL procedure meant that use of the single system had not been optimal and after a necessary progressive descent to FL100 was delayed by inadequate ATC response, and ATC failure to respond to a PAN call required it to be upgraded to MAYDAY.

A320, en-route Alpes-de-Haute-Provence France, 2015 On 24 March 2015, after waiting for the Captain to leave the flight deck and preventing his return, a Germanwings A320 First Officer put his aircraft into a continuous descent from FL380 into terrain killing all 150 occupants. Investigation concluded the motive was suicide, noted a history of mental illness dating from before qualification as a pilot and found that prior to the crash he had been experiencing mental disorder with psychotic symptoms which had not been detected through the applicable process for medical certification of pilots. Conflict between the principles of medical confidentiality and wider public interest was identified.

A320, en-route Karimata Strait Indonesia, 2014 On 28 December 2014, an A320 crew took unapproved action in response to a repeating system caution shortly after levelling at FL320. The unexpected consequences degraded the flight control system and obliged manual control. Gross mishandling followed which led to a stall, descent at a high rate and sea surface impact with a 20º pitch attitude and a 50º angle of attack four minutes later. The Investigation noted the accident origin as a repetitive minor system fault but demonstrated that the subsequent loss of control followed a combination of explicitly inappropriate pilot action and the absence of appropriate pilot action.

A320, en-route, Denver CO USA, 2009 On 21 October 2009, an Airbus 320-200 being operated by Northwest Airlines on a scheduled passenger flight from San Diego to Minneapolis-St Paul, with the Captain as PF, overflew its destination at cruise level in VMC at night by more than 100 nm, after the two pilots had become distracted in conversation and lost situational awareness. They failed to maintain radio communications with a series of successive ATC units for well over an hour. After a routine inquiry from the cabin crew as to the expected arrival time, the flight crew realised what had happened and re-established ATC contact after which the flight was completed without further incident.

A320, en-route, east of Cork Ireland, 2017 On 2 November 2017, the flight crew of an Airbus A320 climbing out of Cork detected a “strong and persistent” burning smell and after declaring a MAYDAY returned to Cork where confusing instructions from the crew resulted in a combination of the intended precautionary rapid disembarkation and an emergency evacuation using escape slides. The Investigation highlighted the necessity of clear and unambiguous communications with passengers which distinguish these two options and in particular noted the limitations in currently mandated pre flight briefings for passengers seated at over wing emergency exits.

A320, en-route, east of Miyazaki Japan, 2018 On 27 August 2018, an Airbus A320 level at FL 300 encountered unanticipated turbulence which caused one of the cabin crew to fall and sustain what was belatedly diagnosed as spinal fracture. The Investigation found that the aircraft had flown through the decaying wake vortex from an almost opposite direction Boeing 747-400F at FL310 which had been observed to cross what was subsequently found to be 13.8 nm ahead of the A320 prior to the latter crossing its track 1 minute 40 seconds later that coincided with a very brief period in which vertical acceleration varied between +0.19g and +1.39g.

A320, en-route, Kalmar County Sweden, 2009 On 2 March 2009, communication difficulties and inadequate operator procedures led to an Airbus A320-200 being de-iced inappropriately prior to departure from Vasteras and fumes entered the air conditioning system via the APU. Although steps were then taken before departure in an attempt to clear the contamination, it returned once airborne. The flight crew decided to don their oxygen masks and complete the flight to Poznan. Similar fumes in the passenger cabin led to only temporary effects which were alleviated by the use of therapeutic oxygen. The Investigation concluded that no health risks arose from exposure to the fumes involved.

A320, en-route, North East Spain 2006 On 28 May 2006, a Vueling Airbus A320 encountered sudden significant turbulence at FL325 and, during a temporary loss of control, was forced down to FL310 before recovery was achieved. Seven occupants sustained minor injuries and there was some internal damage caused by an unrestrained cabin service cart. The origin of the disturbance was found to have been wake vortices from an Airbus A340-300 which was 10nm ahead and 500 feet above on the same airway but the Investigation found that the crew response had been inappropriate and could have served to exacerbate the effects of the external disturbance.

A320, en-route, north of Marseilles France, 2017 On 17 November 2017, an Airbus A320 flight crew were both partially incapacitated by the effect of fumes described as acrid and stinging which they detected when following another smaller aircraft to the holding point at Geneva and then waiting in line behind it before taking off, the effect of which rapidly worsened en-route and necessitated a precautionary diversion to Marseilles. The very thorough subsequent Investigation was unable to determine the origin or nature of the fumes encountered but circumstantial evidence pointed tentatively towards ingestion of engine exhaust from the aircraft ahead in one or both A320 engines.

A320, en-route, north of Öland Sweden, 2011 On 5 March 2011, a Finnair Airbus A320 was westbound in the cruise in southern Swedish airspace after despatch with Engine 1 bleed air system inoperative when the Engine 2 bleed air system failed and an emergency descent was necessary. The Investigation found that the Engine 2 system had shut down due to overheating and that access to proactive and reactive procedures related to operations with only a single bleed air system available were deficient. The crew failure to make use of APU air to help sustain cabin pressurisation during flight completion was noted.

A320, en-route, north of Swansea UK, 2012 On 7 September 2012, the crew of an Aer Lingus Airbus A320-200 mis-set their descent clearance. When discovering this as the actual cleared level was being approached, the AP was disconnected and the unduly abrupt control input made led to an injury to one of the cabin crew. The original error was attributed to ineffective flight deck monitoring and the inappropriate corrective control input to insufficient appreciation of the aerodynamic handling aspects of flight at high altitude. A Safety Recommendation to the Operator to review relevant aspects of its flight crew training was made.

A320, en-route, northeast of Granada Spain, 2017 On 21 February 2017, an Airbus A320 despatched with the APU inoperative experienced successive failures of both air conditioning and pressurisation systems, the second of which occurred at FL300 and prompted the declaration of a MAYDAY and an emergency descent followed by an uneventful diversion to Alicante. The Investigation found that the cause of the dual failure was likely to have been the undetectable and undetected degradation of the aircraft bleed air regulation system and whilst noting a possibly contributory maintenance error recommended that a new scheduled maintenance task to check components in the aircraft type bleed system be established.

A320, en-route, northern Italy, 2016 On 15 August 2016, the cognitive condition of an Airbus A320 Captain deteriorated en-route to Riga and he assigned all flight tasks to the First Officer. When his condition deteriorated further, an off duty company First Officer travelling as a passenger was invited to occupy the flight deck supernumerary crew seat to assist. Once descent had commenced, the Captain and assisting First Officer swapped seats and the flight was thereafter completed without any further significant event. The Investigation concluded that the Captain’s serious physical and mental exhaustion had been the result of the combined effect of chronic fatigue and stress.

A320, en-route, northwest Greece, 2017 On 29 September 2017, the crew of an Airbus A320 detected a smell of burning plastic and simultaneously observed black smoke entering the flight deck near the right side rudder pedals. Completion of appropriate response procedures reduced the smoke and a diversion to Athens with a MAYDAY declared was without further event. The origin of the smoke and fumes was traced to the failure of the static inverter which was part of a batch which had been previously notified as faulty but not identified as such by the aircraft operator’s maintenance organisation which has since modified its relevant procedures.

A320, en-route, Sydney Australia, 2007 On 11 January 2007, an Air New Zealand Airbus A320 which had just departed Sydney Australia for Auckland, New Zealand was observed to have turned onto a heading contrary to the ATC-issued radar heading. When so advised by ATC, the crew checked the aircraft compasses and found that they were reading approximately 40 degrees off the correct heading.

A320, en-route, west southwest of Karachi Pakistan, 2018 On 5 March 2018, the crew of an Airbus A320 in descent towards Karachi observed a slow but continuous drop in cabin pressure which eventually triggered an excessive cabin altitude warning which led them to don oxygen masks, commence an emergency descent and declare a PAN to ATC until the situation had been normalised. The Investigation found that the cause was the processing of internally corrupted data in the active cabin pressure controller which had used a landing field elevation of over 10,000 feet. It noted that Airbus is developing a modified controller that will prevent erroneous data calculations occurring.

A320, Gold Coast QLD Australia, 2017 On 18 December 2017, an A320 crew found that only one thrust reverser deployed when the reversers were selected shortly after touchdown but were able to retain directional control. The Investigation found that the aircraft had been released to service in Adelaide with the affected engine reverser lockout pin in place. This error was found to have occurred in a context of multiple failures to follow required procedures during the line maintenance intervention involved for which no mitigating factors of any significance could be identified. A corrective action after a previous similar event at the same maintenance facility was also found not to have been fully implemented.

A320, Halifax NS Canada, 2015 On 29 March 2015, an Airbus A320 crew mismanaged the descent during a night non-precision approach at Halifax and continued below MDA without the mandatory autopilot disconnection until, with inadequate visual reference, the aircraft impacted terrain and obstructions 225 metres short of the runway. The aircraft was destroyed but there were no fatalities. The Investigation found that the crew did not monitor their descent against the required vertical profile, as there was no SOP requiring them to do so, and did not recognise in time that a go around was appropriate.

A320, Hamburg Germany, 2008 On 1 March 2008 an Airbus A320 being operated by Lufthansa on a scheduled passenger flight from Munich to Hamburg experienced high and variable wind velocity on short finals in good daylight visibility and during the attempt at landing on runway 23 with a strong crosswind component from the right, a bounced contact of the left main landing gear with the runway was followed by a left wing down attitude which resulted in the left wing tip touching the ground. A rejected landing was then flown and after radar vectoring, a second approach to runway 33 was made to a successful landing. No aircraft occupants were injured but the aircraft left wing tip was found to have been damaged by the runway contact. The track of the aircraft and spot wind velocities given by ATC at key points are shown on the illustration below.

A320, Harstad/Narvik Norway 2004 On 25 November 2004, a MyTravel Airways Airbus A320 departed the side of the runway at Harstad, Norway at a low speed after loss of directional control when thrust was applied for a night take off on a runway with below normal surface friction characteristics. It was found that the crew had failed to follow an SOP designed to ensure that any accumulated fan ice was shed prior to take off and also failed to apply take off thrust as prescribed, thus delaying their appreciation of the uneven thrust produced.

A320, Hiroshima Japan, 2015 On 14 April 2015, a night RNAV(GNSS) approach to Hiroshima by an Airbus A320 was continued below minima without the prescribed visual reference and subsequently touched down 325 metres before the runway after failing to transition to a go around initiated from a very low height. The aircraft hit a permitted ground installation, then slid onto the runway before veering off it and stopping. The aircraft sustained extensive damage and an emergency evacuation followed with 28 of the 81 occupants sustaining minor injuries. The Investigation noted the unchallenged gross violation of minima by the Captain.

A320, Jaipur India, 2014 On 5 January 2014, an Airbus A320 was unable to land at Delhi due to visibility below crew minima and during subsequent diversion to Jaipur, visibility there began to deteriorate rapidly. A Cat I ILS approach was continued below minima without any visual reference because there were no other alternates within the then-prevailing fuel endurance. The landing which followed was made in almost zero visibility and the aircraft sustained substantial damage after touching down to the left of the runway. The Investigation found that the other possible alternate on departure from Delhi had materially better weather but had been ignored.

A320, Khartoum Sudan, 2005 On 11 March 2005, an Airbus A321-200 operated by British Mediterranean Airways, executed two unstable approaches below applicable minima in a dust storm to land in Khartoum Airport, Sudan. The crew were attempting a third approach when they received information from ATC that visibility was below the minimum required for the approach and they decided to divert to Port Sudan where the A320 landed without further incident.

A320, Lisbon Portugal, 2015 On 19 May 2015, an Airbus A319 crew attempted to taxi into a nose-in parking position at Lisbon despite the fact that the APIS, although switched on, was clearly malfunctioning whilst not displaying an unequivocal ‘STOP’. The aircraft continued 6 metres past the applicable apron ground marking by which time it had hit the airbridge. The marshaller in attendance to oversee the arrival did not signal the aircraft or manually select the APIS ‘STOP’ instruction. The APIS had failed to detect the dark-liveried aircraft and the non-display of a steady ‘STOP’ indication was independently attributed to a pre-existing system fault.

A320, Lisbon Portugal, 2019 On 16 September 2019, an Airbus A320 departing Lisbon only became airborne 110 metres before the end of runway 21 and had a high speed rejected takeoff been required, it was likely to have overrun the runway. The Investigation found that both pilots had inadvertently calculated reduced thrust takeoff performance using the full 3705 metre runway length and then failed to identify their error before FMS entry. They also did not increase the thrust to TOGA on realising that the runway end was fast approaching. This was the operator’s third almost identical event at Lisbon in less than five months.

A320, London Heathrow UK, 2006 On 26 June 2006, after an uneventful pre-flight pushback of a British Airways Airbus A320-200 at London Heathrow Airport, the aircraft started moving under its own power and, shortly afterwards, collided with the tractor that had just performed the pushback, damaging both the right engine and the tractor.

A320, London Heathrow UK, 2021 On 9 June 2021, an Airbus A320 Captain performing a relatively light weight and therefore rapid-acceleration takeoff from London Heathrow recognised as the standard 100 knot call was imminent that he had no speed indication so announced and performed a high speed rejected takeoff. Subsequent maintenance inspection found that the left pitot mast was blocked by the nest of a seasonally active solitary flying insect, noting that the aircraft had previously been parked for 24 hours on a non-terminal stand. Similar events, including another rejected takeoff, then followed and a comprehensive combined Investigation found all were of similar origin.

A320, London Stansted UK, 2019 On 1 March 2019, an Airbus A320 left engine suffered a contained failure soon after takeoff thrust was set for a night departure from London Stansted but despite the absence of an instruction to cabin crew to begin an evacuation, they did so anyway just before the aircraft was going to be taxied clear of the runway with the Captain only aware when passengers were seen outside the aircraft. The Investigation found that an evacuation had been ordered by the senior member of the cabin crew after she was “overwhelmed” by the situation and believed her team members were “scared”.

A320, Los Angeles USA, 2005 On 21 September 2005, an Airbus A320 operated by Jet Blue Airways made a successful emergency landing at Los Angeles Airport, California, with the nose wheels cocked 90 degrees to the fore-aft position after an earlier fault on gear retraction.

A320, Macau SAR China, 2018 (1) On 28 August 2018, an Airbus A320 bounced touchdown in apparently benign conditions resulted in nose gear damage and debris ingestion into both engines, in one case sufficient to significantly reduce thrust. The gear could not be raised at go around and height loss with EGPWS and STALL warnings occurred when the malfunctioning engine was briefly set to idle. Recovery was followed by a MAYDAY diversion to Shenzen and an emergency evacuation. The Investigation attributed the initial hard touchdown to un-forecast severe very low level wind shear and most of the damage to the negative pitch attitude during the second post-bounce touchdown.

A320, Macau SAR China, 2018 (2) On 12 November 2018, an Airbus A320 took off from Macau in good daylight visibility whilst a same-direction runway inspection was in progress but became airborne well before reaching it. The conflict was not recognised until an aural conflict alert was activated, at which point the ATC Assistant took the microphone and instructed the vehicle to clear the runway. The Investigation found that the TWR Controller had forgotten that the vehicle was still on the runway until alerted by the audible alarm and had not checked either the flight progress board or the surface radar before issuing the takeoff clearance.

A320, Malé Maldives, 2018 On 7 September 2018, an Airbus A320 was inadvertently landed on an under- construction runway at Malé in daylight VMC but met no significant obstructions and sustained only minor damage. The Investigation attributed the error to confusion generated by a combination of pilot inattention to clearly relevant notification, controller distraction, the failure of the airport operator to follow required procedures and the failure of the safety regulator to ensure that sufficient arrangements to ensure safety were in place and complied with.

A320, Oslo Norway, 2010 On 25 February 2010, an Aeroflot Airbus A320-200 unintentionally made a daylight take off from Oslo in good visibility from the taxiway parallel to the runway for which take off clearance had been given. Because of the available distance and the absence of obstructions, the take off was otherwise uneventful. The Investigation identified contributory factors attributable to the airline, the airport and the ANSP.

A320, Paris Orly France, 2013 On 12 March 2013, a Tunis Air Airbus A320 landed on runway 08 at Paris Orly and, having slowed to just over 40 knots, were expecting, despite the covering of dry snow and some slush pre-notified and found on the runway, to vacate it without difficulty at the mid point. ATC then requested that the aircraft roll to the end of the runway before clearing. However, after a slight increase in speed, the crew were unable to subsequently slow the aircraft as the runway end approached and it overran at a low groundspeed before coming to a stop 4 seconds later.

A320, Perth Australia, 2018 On 14 August 2018, an Airbus A320 departed Perth without full removal of its main landing gear ground locks and the unsecured components fell unseen from the aircraft during taxi and takeoff, only being recovered after runway FOD reports. The Investigation identified multiple contributory factors including an inadequately-overseen recent transfer of despatch responsibilities, the absence of adequate ground lock use procedures, the absence of required metal lanyards linking the locking components not attached directly to each gear leg flag (as also found on other company aircraft) and pilot failure to confirm that all components were in the flight deck stowage.

A320, Phoenix AZ USA, 2002 On 28 August 2002, an America West Airbus A320 operating under an ADD for an inoperative left engine thrust reverser veered off the side of the runway during the landing roll at Phoenix AZ after the Captain mismanaged the thrust levers and lost directional control as a consequence of applying asymmetric thrust. Substantial damage occurred to the aircraft but most occupants were uninjured.

A320, Porto Portugal, 2013 On 1 October 2013, an Airbus A320 took off from a runway intersection at Porto which provided 1900 metres TORA using take off thrust that had been calculated for the full runway length of 3480 metres TORA. It became airborne 350 metres prior to the end of the runway but the subsequent Investigation concluded that it would not have been able to safely reject the take-off or continue it, had an engine failed at high speed. The event was attributed to distraction and the inappropriate formulation of the operating airline's procedures for the pre take-off phase of flight.

A320, Pristina Kosovo, 2017 On 1 December 2017, an Airbus A320 made an unintentional - and unrecognised - hard landing at Pristina. As the automated system for alerting outside-limits hard landings was only partially configured and output from the sole available channel was not available, the aircraft continued in service for a further eight sectors before an exceedance was confirmed and the aircraft grounded. The Investigation noted that whilst the aircraft Captain is responsible for recording potential hard landings, the aircraft operator involved should ensure that at least one of the available automated alerting channels is always functional in support of crew subjective judgement.

A320, Raipur India, 2016 On 14 December 2016, an Airbus A320 made a 2.5g initial runway contact when landing at Raipur after the trainee First Officer failed to flare the aircraft adequately and the Training Captain took over too late to prevent a bounce followed by a 3.2g final touchdown. The Investigation found that despite the Training Captain’s diligent coaching, the First Officer had failed to respond during the final stages of the approach and that the takeover of control should have occurred earlier so that the mishandled final stage of the approach could have been discontinued and go around flown.

A320, São Paulo Congonhas Brazil, 2007 On 17 July 2007, the commander of a TAM Airlines Airbus A320 being operated with one thrust reverser locked out was unable to stop the aircraft leaving the landing runway at Congonhas at speed and it hit buildings and was destroyed by the impact and fire which followed killing all on board and others on the ground. The investigation attributed the accident to pilot failure to realise that the thrust lever of the engine with the locked out reverser was above idle, which by design then prevented both the deployment of ground spoilers and the activation of the pre-selected autobrake.

A320, Sharjah UAE, 2018 On 18 September 2018, an Airbus A320 crewed by a Training Captain and a trainee Second Officer departing Sharjah was cleared for an intersection takeoff on runway 30 but turned onto the 12 direction and commenced takeoff with less than 1000 metres of runway ahead. On eventually recognising the error the Training Captain took control, set maximum thrust and the aircraft became airborne beyond the end of the runway and completed its international flight. The Investigation attributed the event to the pilots’ total absence of situational awareness noting that after issuing takeoff clearance, the controller did not monitor the aircraft.

A320, Singapore Changi Singapore, 2021 On 27 July 2021, an Airbus A320 departed uneventfully at night from runway 20L at Changi as cleared despite the crew observing that runway lighting was not as they expected. The Investigation concluded that the runway had been completely unlit and that it was likely that both the pilots and the controller involved had been affected by ‘expectation bias’ in respect of their perception that the lighting had been either as normal (the controller) or partially on (the pilots). Some issues with controller direct or display visibility of lighting status were also identified.

A320, Singapore, 2015 On 16 October 2015, the unlatched fan cowl doors of the left engine on an A320 fell from the aircraft during and soon after takeoff. The one which remained on the runway was not recovered for nearly an hour afterwards despite ATC awareness of engine panel loss during takeoff and as the runway remained in use, by the time it was recovered it had been reduced to small pieces. The Investigation attributed the failure to latch the cowls shut to line maintenance and the failure to detect the condition to inadequate inspection by both maintenance personnel and flight crew.

A320, Surat India, 2017 On 4 October 2017, an Airbus A320 slightly overran the end of runway 22 at Surat during an early morning daylight landing. A temporarily displaced landing threshold meant the runway length was only 1,905 metres rather than the 2,905 metre full length. The aircraft remained on a paved surface and was undamaged. Its crew did not report the excursion which was only discovered when broken runway lighting was subsequently discovered. The Investigation found that the non-precision approach made was unstable and that a prolonged float in the subsequent flare meant that only 600 metres of runway remained ahead at touchdown.

A320, Sydney Australia, 2019 On 1 August 2019, an Airbus A320 annunciated an abnormal gear status indication when retraction was attempted after takeoff. Soon afterwards, an aircraft part was observed by an aircraft following the same taxi route as the A320 and recovered. After completing relevant drills, the A320 returned and completed a landing with significant damage to the left main gear which was nevertheless locked down. The runway was vacated and passengers disembarked. The Investigation found that the cause of the problem was the cyclic fatigue of a pin linking the two parts of the left main gear torque link of manufacturing origin.

A320, Sylt Germany, 2017 On 30 September 2017, an Airbus A320 touched down late after an ILS approach to runway 32 at Sylt with a significant tailwind component being reported and failed to stop before overrunning the end of the runway and subsequently stopped on grass 80 metres beyond it. The Investigation noted that the calculated required landing distance was close to the landing distance available, the actual approach speed was 20 knots above the calculated one and that the aircraft had floated in the flare above a wet runway. It was concluded that the runway excursion was attributable to non-performance of a go-around.

A320, Tehran Mehrabad Iran, 2016 On 13 August 2016, an Airbus A320 departed the side of the runway at low speed during takeoff from Tehran Mehrabad and became immobilised in soft ground. The Investigation found that the Captain had not ensured that both engines were simultaneously stabilised before completing the setting of takeoff thrust and that his subsequent response to the resulting directional control difficulties had been inappropriate and decision to reject the takeoff too late to prevent the excursion. Poor CRM on the flight deck was identified as including but not limited to the First Officer’s early call to reject the takeoff being ignored.

A320, Toronto Canada, 2000 On 13 September 2000, an Airbus A320-200 being operated by Canadian airline Skyservice on a domestic passenger charter flight from Toronto to Edmonton was departing in day VMC when, after a “loud bang and shudder” during rotation, evidence of left engine malfunction occurred during initial climb and the flight crew declared an emergency and returned for an immediate overweight landing on the departure runway which necessitated navigation around several pieces of debris, later confirmed as the fan cowlings of the left engine. There were no injuries to the occupants.

A320, Toronto ON Canada, 2017 On 25 February 2017, an Airbus A320 left the side of the landing runway at Toronto when, for undetermined reasons, the Captain, as Pilot Flying, set up a drift to the right just before touchdown. This was then followed by a lateral runway excursion into wet grass in rain-reduced visibility which continued for 1,650 metres before the aircraft regained the runway and stopped. The Investigation noted that both the absence of runway centreline lighting and the aircraft operator’s policy of not activating the aircraft rain repellent system or applying the alternative hydrophobic windshield coating may have increased the excursion risk.

A320, Varadero Cuba, 2010 On 31 January 2010, an Airbus A320-200 being operated by the Canadian Airline Skyservice on a passenger flight from Toronto Canada to Varadero Cuba made a procedural night ILS approach to destination in heavy rain and, soon after touchdown on a flooded runway, drifted off the side and travelled parallel to it for a little over 500 metres before subsequently re-entering it at low speed. There were no injuries to the 186 occupants and the aircraft sustained only minor damage.

A320, vicinity Abu Dhabi UAE, 2012 On 16 November 2012, Captain of an A320 positioning for approach to Abu Dhabi at night became incapacitated due to a stroke. The First Officer took over control and declared a MAYDAY to ATC. The subsequent approach and landing were uneventful but since the First Officer was not authorised to taxi the aircraft, it was towed to the gate for passenger disembarkation. The investigation found that the Captain had an undiagnosed medical condition which predisposed him towards the formation of blood clots in arteries and veins.

A320, vicinity Addis Ababa Ethiopia, 2003 On 31 March 2003, an A320, operated by British Mediterranean AW, narrowly missed colliding with terrain during a non-precision approach to Addis Ababa, Ethiopia.

A320, vicinity Auckland New Zealand, 2012 On 20 June 2012, the right V2500 engine compressor of an Airbus A320 suddenly stalled on final approach. The crew reduced the right engine thrust to flight idle and completed the planned landing uneventfully. Extensive engine damage was subsequently discovered and the investigation conducted attributed this to continued use of the engine in accordance with required maintenance procedures following bird ingestion during the previous sector. No changes to procedures for deferral of a post bird strike boroscope inspection for one further flight in normal service were proposed but it was noted that awareness of operations under temporary alleviations was important.

A320, vicinity Bahrain Airport, Kingdom of Bahrain, 2000 On 23 August 2000, a Gulf Air Airbus A320 flew at speed into the sea during an intended dark night go around at Bahrain and all 143 occupants were killed. It was subsequently concluded that, although a number of factors created the scenario in which the accident could occur, the most plausible explanation for both the descent and the failure to recover from it was the focus on the airspeed indication at the expense of the ADI and the effect of somatogravic illusion on the recently promoted Captain which went unchallenged by his low-experience First Officer.

A320, vicinity Birmingham UK, 2019 On 26 August 2019, an Airbus A320 attempted two autopilot-engaged non-precision approaches at Birmingham in good weather before a third one was successful. Both were commenced late and continued when unstable prior to eventual go-arounds, for one of which the aircraft was mis-configured causing an ‘Alpha Floor’ protection activation. A third non-precision approach was then completed without further event. The Investigation noted an almost identical event involving the same operator four months later, observing that all three discontinued approaches appeared to have originated in confusion arising from a slight difference between the procedures of the aircraft operator and AIP plates.

A320, vicinity Delhi India, 2017 On 21 June 2017, an Airbus A320 number 2 engine began vibrating during the takeoff roll at Delhi after a bird strike. After continuing the takeoff, the Captain subsequently shut down the serviceable engine and set the malfunctioning one to TO/GA and it was several minutes before the error was recognised. After an attempted number 1 engine restart failed because an incorrect procedure was followed, a second attempt succeeded. By this time inattention to airspeed loss had led to ALPHA floor protection activation. Eventual recovery was followed by a return to land with the malfunctioning engine at flight idle.

A320, vicinity Dublin Ireland, 2015 On 3 October 2015, an Airbus A320 which had just taken off from Dublin experienced fumes from the air conditioning system in both flight deck and cabin. A 'PAN' was declared and the aircraft returned with both pilots making precautionary use of their oxygen masks. The Investigation found that routine engine pressure washes carried out prior to departure have been incorrectly performed and a contaminant was introduced into the bleed air supply to the air conditioning system as a result. The context for the error was found to be the absence of any engine wash procedure training for the Operator's engineers.

A320, vicinity Frankfurt Germany, 2001 On 21 March 2001 an Airbus A320-200, operated by Lufthansa, experienced a flight controls malfunctions shortly after take-off which resulted in loss of control and subsequent near terrain impact. The uncontrolled roll, due to the malfunction of the pilot flying's sidestick, was recovered by the other pilot and the aircraft safely returned to land in Frankfurt without further incident.

A320, vicinity Glasgow UK, 2008 An Airbus A322 being operated by British Airways on a scheduled passenger flight from London Heathrow to Glasgow was being radar vectored in day IMC towards an ILS approach to runway 23 at destination when an EGPWS Mode 2 Hard Warning was received and the prescribed response promptly initiated by the flight crew with a climb to MSA.

A320, vicinity Jaipur India, 2016 On 27 February 2016, an Airbus A320 making an into-sun visual approach to Jaipur in hazy conditions lined up on a road parallel to the intended landing runway and continued descent until an EGPWS ‘TOO LOW TERRAIN’ Alert occurred at 200 feet agl upon which a go-around was initiated. The Investigation found that although the First Officer had gained visual reference with both road and runway at 500 feet agl, the Captain had seen only the road and continued asking the First Officer to continue descent towards it despite the First Officer’s attempts to alert him to his error.

A320, vicinity Karachi Pakistan, 2020 On 22 May 2020, an Airbus A320 made an extremely high speed unstabilised ILS approach to runway 25L at Karachi and did not extend the landing gear for touchdown. It continued along the runway resting on both engines before getting airborne again with the crew announcing their intention to make another approach. Unfortunately, both engines failed due to the damage sustained and the aircraft crashed in a residential area near the airport and was destroyed by impact forces and a post-crash fire. 97 of the 99 occupants died and four persons on the ground were injured with one subsequently dying.

A320, vicinity LaGuardia New York USA, 2009 On 15 January 2009, a United Airlines Airbus A320-200 approaching 3000 feet agl in day VMC following take-off from New York La Guardia experienced an almost complete loss of thrust in both engines after encountering a flock of Canada Geese . In the absence of viable alternatives, the aircraft was successfully ditched in the Hudson River about. Of the 150 occupants, one flight attendant and four passengers were seriously injured and the aircraft was substantially damaged. The subsequent investigation led to the issue of 35 Safety Recommendations mainly relating to ditching, bird strike and low level dual engine failure.

A320, vicinity Liverpool UK, 2018 On 24 June 2018, the Captain of an Airbus A320 which had just departed Liverpool inadvertently selected flaps/slats up when “gear up” was called. The error was quickly recognised and corrective action taken but the Investigation was unable to determine why the error occurred or identify circumstances directly conducive to it. It noted that they had previously investigated four similar events to the same operator’s A320s which had occurred over a period of less than 18 months with the operator introducing a requirement for a “pause” before gear or flap selection to allow time for positive checking before selector movement.

A320, vicinity London Heathrow UK, 2019 On 23 September 2019, the flight crew of an Airbus A320 on approach to London Heathrow detected strong acrid fumes on the flight deck and after donning oxygen masks completed the approach and landing, exited the runway and shut down on a taxiway. After removing their masks, one pilot became incapacitated and the other unwell and both were taken to hospital. The other occupants, all unaffected, were disembarked to buses. The very comprehensive investigation was unable to establish the origin of the fumes but did identify a number of circumstantial factors which corresponded to those identified in previous similar events.

A320, vicinity Lyons Saint-Exupéry France, 2012 On 11 April 2012, a Hermes Airlines A320 commanded by a Training Captain who was also in charge of Air Operations for the airline was supervising a trainee Captain on a night passenger flight. The aircraft failed to establish on the Lyons ILS and, in IMC, descended sufficiently to activate both MSAW and EGPWS 'PULL UP' warnings which eventually prompted recovery. The Investigation concluded that application of both normal and emergency procedures had been inadequate and had led to highly degraded situational awareness for both pilots. The context for this was assessed as poor operational management at the airline.

A320, vicinity Melbourne Australia, 2007 On 21 July 2007, an Airbus A320-232 being operated by Australian Operator Jetstar Airways and on final approach to Melbourne after a passenger flight from Christchurch, New Zealand intended to make a go around after the required visual reference at Decision Altitude was not available, but the intended action was mis-managed such that safe control of the aircraft was temporarily lost. Recovery was achieved and there were no further abnormalities of flight during a second missed approach at Melbourne or the subsequent diversion to Avalon.

A320, vicinity Muscat Oman, 2019 On 28 January 2019, an Airbus A320 became unstabilised below 1000 feet when continuation of an ILS approach at Muscat with insufficient thrust resulted in increasing pitch which eventually triggered an automatic thrust intervention which facilitated completion of a normal landing. The Investigation found that having temporarily taken control from the First Officer due to failure to follow radar vectors to the ILS, the Captain had then handed control back with the First Officer unaware that the autothrust had been disconnected. The context for this was identified as a comprehensive failure to follow multiple operational procedures and practice meaningful CRM.

A320, vicinity Naha Okinawa Japan, 2014 On 28 April 2014, an Airbus A320 making a precision radar approach at Naha in IMC began descent from 1,000 feet QNH at 6nm from touchdown with the autopilot engaged and continued it until successive EGPWS 'PULL UP' Warnings occurred soon after the radar controller had advised four miles from touchdown. Minimum recorded radio height was 242 feet with neither the sea nor the runway in sight. The Investigation noted ineffective alerting by the First Officer, the radar controller's failure to notice the error until just before the EGPWS Warnings and the absence of MSAW annunciations at the controller's position.

A320, vicinity New York JFK NY USA, 2007 On 10 February 2007, smoke was observed coming from an overhead locker on an Airbus A320 which had just departed from New York JFK. It was successfully dealt by cabin crew fire extinguisher use whilst an emergency was declared and a precautionary air turn back made with the aircraft back on the ground six minutes later. The subsequent investigation attributed the fire to a short circuit of unexplained origin in one of a number of spare lithium batteries contained in a passenger's camera case, some packaged an some loose which had led to three of then sustaining fire damage.

A320, vicinity Oslo Norway, 2008 On 19 December 2008, an Aeroflot Airbus A320 descended significantly below its cleared and acknowledged altitude after the crew lost situational awareness at night whilst attempting to establish on the ILS at Oslo from an extreme intercept track after a late runway change and an unchallenged incorrect readback. The Investigation concluded that the response to the EGPWS warning which resulted had been “late and slow” but that the risk of CFIT was “present but not imminent”. The context for the event was considered to have been poor communications between ATC and the aircraft in respect of changes of landing runway.

A320, vicinity Paris CDG France, 2022 On 23 May 2022, an Airbus A320 came extremely close to collision with terrain as the crew commenced a go around they did not obtain any visual reference during a RNP approach at Paris CDG for which they were using baro-VNAV reference to fly to VNAV/LNAV minima. The corresponding ILS was out of service. The Investigation has not yet completely established the context for the event but this has been confirmed to include the use of an incorrect QNH which resulted in the approach being continued significantly below the procedure MDA. Six Interim Safety Recommendations have been issued.

A320, vicinity Perpignan France, 2008 On 27 November 2008, the crew of an XL Airways A320 on an airworthiness function flight following aircraft repainting lost control of the aircraft after fail to take the action necessary to recover from a full stall which had resulted from their continued airspeed reduction during a low speed handling test when Stall Protection System (SPS) activation did nor occur at the likely airspeed because two of the three angle of attack sensors were blocked by ice formed by water ingress during preparation for the repainting. This condition rendered angle of attack protection in normal law inoperative.

A320, vicinity Perth Australia, 2015 On 12 September 2015, an Airbus A320 autopilot and autothrust dropped out as it climbed out of Perth and multiple ECAM system messages were presented with intermittent differences in displayed airspeeds. During the subsequent turn back in Alternate Law, a stall warning was disregarded with no actual consequence. The Investigation attributed the problems to intermittently blocked pitot tubes but could not establish how this had occurred. It was also found that the priority for ECAM message display during the flight had been inappropriate and that the key procedure contained misleading information. These ECAM issues were subsequently addressed by the aircraft manufacturer.

A320, vicinity Rapid City SD USA, 2016 On 7 July 2016, an Airbus A320 crew cleared for a dusk visual approach to Rapid City mis-identified runway 13 at Ellsworth AFB as runway 14 at their intended destination and landed on it after recognising their error just before touchdown. The Investigation concluded that the crew had failed to use the available instrument approach guidance to ensure their final approach was made on the correct extended centreline and noted that it had only been possible to complete the wrong approach by flying an abnormally steep unstabilised final approach. Neither pilot was familiar with Rapid City Airport.

A320, vicinity Sochi Russia, 2006 On 3 May 2006, an Airbus 320 crew failed to correctly fly a night IMC go around at Sochi and the aircraft crashed into the sea and was destroyed. The Investigation found that the crew failed to reconfigure the aircraft for the go around and, after having difficulties with the performance of an auto go-around, had disconnected the autopilot. Inappropriate control inputs, including simultaneous (summed) sidestick inputs by both pilots were followed by an EGPWS PULL UP Warning. There was no recovery and about a minute into the go around, a steep descent into the sea at 285 knots occurred.

A320, vicinity Tallinn Estonia, 2018 On 28 February 2018, an Airbus A320 would not rotate for a touch-and-go takeoff and flightpath control remained temporarily problematic and the aircraft briefly settled back onto the runway with the gear in transit damaging both engines. A very steep climb was then followed by an equally steep descent to 600 feet agl with an EGPWS ‘PULL UP’ activation before recovery. Pitch control was regained using manual stabiliser trim but after both engines stopped during a MAYDAY turnback, an undershoot touchdown followed. The root cause of loss of primary pitch control was determined as unapproved oil in the stabiliser actuator.

A320, vicinity Tel Aviv Israel, 2012 On 3 April 2012, the crew of an Air France Airbus A320 came close to loosing control of their aircraft after accepting, inadequately preparing for and comprehensively mismanaging it during an RNAV VISUAL approach at Tel Aviv and during the subsequent attempt at a missed approach. The Investigation identified significant issues with crew understanding of automation - especially in respect of both the use of FMS modes and operations with the AP off but the A/T on - and highlighted the inadequate provision by the aircraft operator of both procedures and pilot training for this type of approach.

A320, vicinity Tokyo Haneda Japan, 2016 On 22 December 2016, an Airbus A320 cleared for a night approach to runway 16L at Haneda, which involved circling to the right from an initial VOR approach, instead turned left and began an approach to a closed but partially lit runway. ATC noticed and intervened to require a climb away for repositioning to the correct runway using radar vectors. The Investigation found that the context for the crew’s visual positioning error was their failure to adequately prepare for the approach before commencing it and that the new-on-type First Officer had not challenged the experienced Captain’s inappropriate actions and inactions.

A320/B734, vicinity London Gatwick UK, 2012 On 4 August 2012 an Easyjet Airbus A320 on approach to London Gatwick was given landing clearance in IMC for a runway occupied by a Boeing 737-400 waiting for take off which heard this transmission. Despite normal ground visibility and an unrestricted view of the runway, ATC failed to recognise their error and, after two unsuccessful attempts to advise them of it, the commander of the 737 instructed the A320 to go around which it did. Only upon hearing this did the controller realise what had happened.

A320/B738, vicinity Delhi India, 2013 On 2 September 2013, a B737 crew were not instructed to go around from their approach by ATC as it became increasingly obvious that an A320 departing the same runway would not be airborne in time for a landing clearance to be issued. They initiated a go around over the threshold and then twice came into conflict with the A320 as both climbed on similar tracks without ATC de-confliction, initially below the height where TCAS RAs are functional. Investigation attributed the conflict to ATC but the failure to effectively deal with the consequences jointly to ATC and both aircraft crews.

A320/B773, Dubai UAE, 2012 On March 20 2012 an Airbus A320 failed to taxi as instructed after vacating the landing runway 12L at Dubai and crossed the lit stop bar of an intersection access to runway 12R before stopping just in time to prevent a collision with a Boeing 777-300ER about to pass the intersection at very high speed on take off. Taxi clearance had been correctly given and acknowledged. The aircraft commander had extensive aircraft type experience but the inexperienced First Officer appeared to be undergoing early stage line training with a Safety Pilot present. No Final Report of the Investigation has been released and its status is unclear.

A320/E190/B712, vicinity Helsinki Finland, 2013 On 6 February 2013, ATC mismanagement of an Airbus A320 instructed to go around resulted in loss of separation in IMC against the Embraer 190 ahead which was obliged to initiate a go around when no landing clearance had been issued due to a Boeing 737-800 still on the runway after landing. Further ATC mismanagement then resulted in a second IMC loss of separation between the Embraer 190 and a Boeing 717 which had just take off from the parallel runway. Controller response to the STCA Alerts generated was found to be inadequate and ANSP procedures in need of improvement.

A321 / B734, Barcelona Spain, 2015 On 25 November 2015, an Airbus A321 taxiing for departure at Barcelona was cleared across an active runway in front of an approaching Boeing 737 with landing clearance on the same runway by a Ground Controller unaware that the runway was active. On reaching the lit stop bar protecting the runway, the crew queried their clearance and were told to hold position. Noting that the event had occurred at the time of a routine twice-daily runway configuration change and two previous very similar events in 2012 and 2014, further safety recommendations on risk management of runway configuration change were made.

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