Accident and Serious Incident Reports: Nonrevenue Flights

Accident and Serious Incident Reports: Nonrevenue Flights

Definition

A selection of reports relating to accidents and serious incidents which involved non-revenue flights including for example:

  • Ferry or Positioning Flights
  • Function flights operated by line crews
  • Air display or 'exhibition' flying
  • Flights undertaken solely for crew training/familiarisation purposes

Accidents

On 4 October 2023, an Airbus A321 climbing out of London Stansted with the eighteen occupants all seated towards the front of the passenger cabin was discovered to have several missing or damaged windowpanes on the left side towards the rear. The aircraft returned to land where damage was also found to one of the horizontal stabilisers. The window panes fell out because of damage by infrared energy emitted from high-intensity lights during a filming event the previous day. Four previous similar events were identified but it was found that knowledge of them was not widespread in the aviation community.

On 4 March 2022, a Sikorsky S92A touching down on the designated landing site at a Plymouth hospital to deliver a recovered casualty subjected several people in an adjacent car park to significant downwash. Two were blown over sustaining serious injuries with one dying later the same day. Hospital management was found to have failed to effectively assess the risks of landing site operation and its communications with the operator to ensure safe site use. The landing site was not being operated in accordance with guidance applicable to more recently opened sites nor was it required to be.

On 23 July 2021, the takeoff roll of a Boeing 737-800 making an intersection departure from Yerevan on a non revenue positioning flight using reduced thrust in daylight exceeded the length of runway available by 81 metres but was undamaged and completed its intended flight. The Investigation found that the Onboard Performance Tool when preparing for departure had been wrongly configured but that when the crew realised there was insufficient runway length left to reject the takeoff, the thrust had not been increased and the response had been the commencement of a slow rotation 20 knots before the appropriate speed.

On 27 February 2023, an Embraer 190 was flaring for an imminent night touchdown on runway 04R at Boston in normal visibility when a Learjet 60 began takeoff from intersecting runway 09. As the Embraer descended through 30 feet AGL, the Learjet entered runway 04R, taking two seconds to cross it. The incursion had triggered an ATC alert and just after the crossing, the Embraer was instructed to go around and did so from around 10 feet AGL. The Investigation found that the Learjet crew correctly read back their line up and wait clearance but then took off without clearance.

On 13 November 2018, a Boeing 737-800 on approach to Hong Kong at night received a late landing clearance for runway 07L in good visibility. The aircraft touched down without the crew seeing that a Bombardier Global 5000 that had just landed ahead of them had not cleared the runway. Minimum on-runway separation was just over 1000 metres. It was found that the controller had not recognised that the runway was still engaged, but noted that the business jet had taken significantly longer than normal to clear the runway after landing.

On 22 April 2019, a Eurocopter-Kawasaki BK-117C-1 helicopter was being positioned for an aeromedical evacuation the following day when it was unintentionally flown into the sea at night. The three crew members were able to evacuate from the partially submerged aircraft before it sank. The accident was attributed to the single pilot’s loss of situational awareness due to loss of visual depth perception when using night vision goggles. The relevant aircraft operator procedures and the applicable regulatory requirements were both found be inadequate relative to the operational risk which the flight involved.

On 24 October 2021, a Shorts SD360 intending to land at the international airport serving Ndola did so at the recently closed old international airport after visually navigating there in hazy conditions whilst unknowingly in contact with ATC at the very recently opened new airport which had taken the same name and radio frequencies as the old one. The Investigation found multiple aspects of the airport changeover and re-designation had been mismanaged, particularly but not only failure to publish new flight procedures for both airports and ensure that NOTAM communication of the changes internationally had been effective.

On 14 September 2021 the crew of a Saab S340B being used for type conversion training purposes were unable to cross start the left engine after it had been temporarily shut down to demonstrate single engine handling performance because the right starter-generator failed. A MAYDAY was declared and after prompt electrical load shedding, sufficient battery power remained to complete a successful diversion. The starter-generator failure was suspected to be attributable to its use whilst in service with a previous operator to support multiple starts at intervals which were insufficient to allow the unit to cool.

On 28 April 2018, a Dassault Falcon F900B came into close proximity with a Beech B36T Bonanza at the uncontrolled VFR-only aerodrome at Bremgarten during its tailwind approach to runway 23 made without contacting the designated Flight Information frequency as the other aircraft was on approach to runway-in-use 05 and in contact with Flight Information. The Beech pilot took avoiding action by turning north and climbing in order to avoid a collision. The Falcon 900 crew had not prepared for the approach which was then unstabilised with late gear extension and multiple EGPWS ‘SINK RATE’ warnings annunciated.

On 3 December 2020, a Dassault Falcon 900 lost directional control and any braking action after touchdown on the 60 metre wide runway at Kangerlussuaq, but as the speed reduced the crew were able to keep the aircraft on the runway. Once stopped, an external inspection found that three of the four mainwheel tyres had deflated with corresponding resultant wheel and hydraulic system damage. Investigation found that a number of brake disks on the three affected wheels had been frozen preventing wheel rotation and attributed this to the crew failure to follow the recommended use of the brake heating system.

On 1 December 2021, a lightly loaded Boeing 737-800 became airborne near the end of the runway at Kuusamo with only engine run-up thrust set with only the abnormally low climb rate alerting the crew to their error. Serial failure by both pilots to follow relevant normal takeoff procedures followed after the type-experienced First Officer had been surprised when the aircraft began to move because his inexperience in brake use resulted in insufficient brake pressure being applied during the engine run-up. The Captain’s failure to notice the error was associated with allowing himself to be distracted by a non-urgent radio call.

On 14 March 2017, control of a Sikorsky S92A positioning in very poor visibility at 200 feet over the sea in accordance with an obstacle-marked FMS ground track in order to refuel at a coastally-located helipad was lost after it collided with late-sighted terrain ahead before crashing into the sea killing all on board. The Investigation attributed the accident to the lack of crew terrain awareness but found a context of inadequate safety management at the operator, the comprehensively ineffective regulatory oversight of the operation and confusion as to responsibility for State oversight of its contract with the operator.

On 30 August 2018, a Boeing 747-400F making a crosswind landing at Hong Kong which was well within limits veered and rolled abnormally immediately after touchdown and runway impact damaged the two right side engines. The Investigation found that the flight was an experienced Captain’s line check handling sector and concluded that a succession of inappropriate control inputs made at and immediately after touchdown which caused the damage may have been a consequence of the Check Captain’s indication just before touchdown that he was expecting a landing using an alternative technique to the one he was familiar with.

On 17 September 2020, a Bombardier Global 6000 which had completed a circling approach to land at Biggin Hill in day VMC touched down with an inappropriate pitch and roll attitude which caused the right wingtip to contact the runway surface. The Investigation found that the landing technique just before touchdown was not in accordance with the manufacturer’s crosswind landing technique although the roll rate achieved could not be accounted for by the roll control input alone and was probably increased by localised wind velocity variations despite the absence of any such variations being reported by ATC.

Related Articles

For all accident reports held on SKYbrary, see the main section on Accident Reports.

SKYbrary Partners:

Safety knowledge contributed by: