Accidents & Incidents

Investigations & Reports

A Failure in Propeller Design and Certification Resulted in the Loss of an EMB-120 in 1991

Accidents & Incidents, Design & Certification, Fixed Wing, Safety Management

In 1991 a minor modification, changing a surface treatment, triggered accelerated wear and a catastrophic propeller failure. The FAA conducted a Special Certification Review. A failsafe design and certification rule changes followed.

A Failure in Propeller Design and Certification Resulted in the Loss of an EMB-120 in 1991 Read Post »

Engine Failure after Inadvertently Being Put Back into Service Incomplete

Accidents & Incidents, Helicopters, Human Factors / Performance, Maintenance / Continuing Airworthiness / CAMOs, Special Mission Aircraft

An AGB module was inadvertently sent for overhaul. Work commenced before it was realised. The module was then sent back u/s but the log card entry was changed subsequently to serviceable not realising a filter was missing. The pilot made an excellent autorotation though.

Engine Failure after Inadvertently Being Put Back into Service Incomplete Read Post »

AS350B2 Accident After Vibration from Unrecorded Maintenance

Accidents & Incidents, Airfields / Heliports / Helidecks, Helicopters, Human Factors / Performance, Maintenance / Continuing Airworthiness / CAMOs, Safety Management

Four days before the accident the MRBs had been removed and re-installed. No RTB was done. While ground running at a remote site, increasing vibration triggered the pilot to lift off. NR was low and the helicopter tumbled down a slope.

AS350B2 Accident After Vibration from Unrecorded Maintenance Read Post »

Meeting Your Waterloo: Competence Assessment and Remembering the Lessons of Past Accidents

Accidents & Incidents, Human Factors / Performance, Maintenance / Continuing Airworthiness / CAMOs, Safety Culture, Safety Management

No one was injured in this low speed derailment after signal maintenance errors but investigators expressed concern that the lessons from the fatal triple collision at Clapham in 1988 may have been forgotten.

Meeting Your Waterloo: Competence Assessment and Remembering the Lessons of Past Accidents Read Post »

MC-12W Loss of Control Orbiting Over Afghanistan: Lessons in Training and Urgent Operational Requirements

Accidents & Incidents, Design & Certification, Fixed Wing, Human Factors / Performance, Military / Defence, Safety Management, Special Mission Aircraft

A very low experience on type flight crew had been paired together. Surprisingly little comment is made by investigators of insufficient certification testing of the modified aircraft and the failure to act after 4 prior ‘near catastrophic’ stall events.

MC-12W Loss of Control Orbiting Over Afghanistan: Lessons in Training and Urgent Operational Requirements Read Post »

RCMP AS350B3 Left Uncovered During Snowfall Fatally Loses Power on Take Off

Accidents & Incidents, Helicopters, Human Factors / Performance, Safety Management, Special Mission Aircraft

The engine intake was left uncovered during a lunch break, when it had started to snow. This allowed ice to form that broke away and damaged the engine. Turns out similar happened at a US HEMS operator within 12 months.

RCMP AS350B3 Left Uncovered During Snowfall Fatally Loses Power on Take Off Read Post »

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