Human Factors / Performance

HF / Human Performance

SAR AS365N3 Flying Control Disconnect: BFU Investigation

Accidents & Incidents, Helicopters, Human Factors / Performance, Maintenance / Continuing Airworthiness / CAMOs, Offshore, Oil & Gas / IOGP / Energy, Safety Management, Special Mission Aircraft

The BFU investigated how flying controls of a SAR helicopter became disconnected. A nut was reused. Torque was insufficient. Lubrication was applied incorrectly. A cotter pin was likely omitted. The maintenance was also not signed off.

SAR AS365N3 Flying Control Disconnect: BFU Investigation Read Post »

Fatal Mi-8 Loss of Control – Inflight and Water Impact off Svalbard

Accidents & Incidents, FDM / Data Recorders, Helicopters, Human Factors / Performance, Offshore, Regulation, Safety Management, Survivability / Ditching

While on a VFR approach below minima to a mine site there was a loss of visual reference and a Loss of Control – Inflight. The helicopter impacted the water but neither aircraft nor occupants were equipped for sea survival. All 8 POB likely drowned or quickly succumb to hypothermia in 2°C water.

Fatal Mi-8 Loss of Control – Inflight and Water Impact off Svalbard Read Post »

Inadvertent Entry into IMC During Mountaintop HESLO

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

Possible self-induced commercial pressure and task fixation may have been factors in a HESLO accident involving a loss of visual reference at a mountain top site on lift 29 of 30, resulting in spatial disorientation and a partial loss of control say AIB Denmark.

Inadvertent Entry into IMC During Mountaintop HESLO Read Post »

ATR72 Survives Water Impact During Unstabilised Approach

Accidents & Incidents, Fixed Wing, Human Factors / Performance, Safety Management

A lucky escape for an ATR72 after the second unstabilised approach of the day into the same airport as the Commander insists on descending below MDA. After the first the crew decided to inhibit the TAWS as they misdiagnosed a failure. The Commander (PM) fought the controls when the Co-Pilot first tried to go around.

ATR72 Survives Water Impact During Unstabilised Approach Read Post »

CRJ-200 Landing Incident Highlighted US Maintenance Competency Inadequacies

Accidents & Incidents, Fixed Wing, Human Factors / Performance, Maintenance / Continuing Airworthiness / CAMOs, Regulation, Safety Management

A long delayed NTSB final report points to a series of maintenance standards and competency issues into this incident. Planned rulemaking to solve these was abandoned by FAA after 5 years.

CRJ-200 Landing Incident Highlighted US Maintenance Competency Inadequacies Read Post »

B767 Fire and Uncommanded Evacuation After Lockwire Omitted

Accidents & Incidents, Crises / Emergency Response / SAR, Fixed Wing, Human Factors / Performance, Maintenance / Continuing Airworthiness / CAMOs, Safety Management

A maintenance error when the aircraft was put into storage 3 years earlier resulted in a latent defect that caused a fireball. In the absence of communication from the flight crew a premature evacuation was initiated with one pax seriously injured by jet blast from the other, still running, engine.

B767 Fire and Uncommanded Evacuation After Lockwire Omitted Read Post »

Survival Flight Fatal Accident: Air Ambulance Operator’s Poor Safety Culture

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

A poor safety culture normalised rushed departure with inadequate preparation to do an air ambulance flight two other operators had turned down. The helicopter encountered snow and struck the ground during an Inadvertent IMC escape manoeuvre. Poor FAA oversight was contributory say NTSB.

Survival Flight Fatal Accident: Air Ambulance Operator’s Poor Safety Culture Read Post »

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