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ASN Wikibase Occurrence # 178955
Last updated: 18 November 2018
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Date:23-AUG-2015
Time:11:27 LT
Type:Silhouette image of generic DHC2 model; specific model in this crash may look slightly different
de Havilland Canada DHC-2 Beaver
Owner/operator:Air Saguenay
Registration: C-FKRJ
C/n / msn: 1210 (1956)
Fatalities:Fatalities: 6 / Occupants: 6
Other fatalities:0
Aircraft damage: Written off (damaged beyond repair)
Category:Accident
Location:6 km N of Bergeronnes, Quebec -   Canada
Phase: En route
Nature:Non Scheduled Passenger
Departure airport:Lac Long, Tadoussac
Destination airport:Lac Long, Tadoussac
Investigating agency: TSB Canada
Narrative:
Air Saguenay, in partnership with Aviation du Fjord and in collaboration with Croisières AML, had been conducting sightseeing flights in the region of Tadoussac, Quebec, departing from Lac Long, Quebec, for 3 years. Air Saguenay operated the aircraft, while Aviation du Fjord handled ticket sales and flight monitoring.
Flights usually lasted about 20 minutes and consisted of a loop during which the aircraft would fly over the Saguenay–St. Lawrence Marine Park, which is a whale-watching site, and then over the mouth of the Fjord du Saguenay before turning inland to allow tourists to observe the region's topography, flora, and, occasionally, wildlife.
On the morning of the accident, at about 08:00, at the Lac Long water aerodrome, the pilot carried out pre-flight preparations for the first sightseeing flight, which was scheduled for 09:00. The pilot did not report any discrepancies after carrying out these preparations.
The pilot completed 3 flights without incident before the occurrence flight. At about 11:00, the 5 passengers boarded the floatplane. The pilot started the engine of C-FKRJ, leaving the dock at 11:02 and taking off at 11:04.
After takeoff, C-FKRJ climbed to 2000 feet above sea level (ASL), then headed south above the Saguenay–St. Lawrence Marine Park, flying over this area from 11:07 to 11:16. It then passed above the mouth of the Fjord du Saguenay before turning north and leaving the restricted zone of the marine park.
C-FKRJ then descended to an altitude of approximately 1100 feet ASL, approaching hilltops with an elevation of about 1000 feet ASL. Just south of the town of Sacré-Cœur, Quebec, the aircraft turned toward the northeast and flew over the hills at about 100 feet above ground level (AGL) before turning back toward Lac Long. As the aircraft was flying over a hilltop at about 110 feet AGL, the pilot initiated a steep left turn. C-FKRJ stalled aerodynamically mid-turn, which caused the aircraft to enter an incipient spin. At 11:27, the aircraft descended vertically and struck a rocky outcrop on top of a hill.

Findings as to causes and contributing factors
1. The pilot performed manoeuvres with a reduced safety margin at low altitudes. As a result, these flights involved a level of risk that was unnecessary to attain the objectives of sightseeing flights.
2. With no restrictions on manoeuvres and no minimum altitude prescribed by the company prior to flight, the pilot flew according to his own limits and made a steep turn at approximately 110 feet above ground level.
3. When the pilot made a steep left turn, aerodynamic stalling ensued, causing an incipient spin at an altitude insufficient to allow control of the aircraft to be regained prior to vertical collision with the terrain.
4. The absence of an angle-of-attack indicator system and an impending stall warning device deprived the pilot of the last line of defence against loss of control of the aircraft.

Sources:

http://www.bst-tsb.gc.ca/eng/rapports-reports/aviation/2015/a15q0120/a15q0120.asp


Revision history:

Date/timeContributorUpdates
24-Aug-2015 04:09 thaimax Added
24-Aug-2015 04:10 Anon. Updated [Aircraft type]
24-Aug-2015 04:12 harro Updated [Aircraft type, Total fatalities, Source, Narrative]
24-Aug-2015 07:21 TB Updated [Aircraft type, Other fatalities, Location]
24-Aug-2015 16:33 Geno Updated [Total fatalities, Departure airport, Destination airport, Narrative]
24-Aug-2015 19:04 fortinf4 Updated [Registration]
24-Aug-2015 19:09 fortinf4 Updated [Cn]
24-Aug-2015 22:02 Geno Updated [Time, Source, Damage]
02-Sep-2015 13:18 FLYINGBROTHER1 Updated [Time, Damage]
08-Sep-2017 16:59 harro Updated [Time, Source, Narrative]

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