ASN Wikibase Occurrence # 166062
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Date: | Thursday 8 May 2014 |
Time: | 10:05 LT |
Type: | Diamond DA40NG Diamond Star |
Owner/operator: | Ulyanovsk Higher Civil Aviation School |
Registration: | RA-01726 |
MSN: | 40.N040 |
Fatalities: | Fatalities: 2 / Occupants: 2 |
Aircraft damage: | Destroyed |
Category: | Accident |
Location: | Near Krasny Gulyai settlement, Ulyanovsk region -
Russia
|
Phase: | Initial climb |
Nature: | Training |
Departure airport: | Ulyanovsk/Baratayevka Airport (ULV/UWLL) |
Destination airport: | Ulyanovsk/Baratayevka Airport (ULV/UWLL) |
Investigating agency: | MAK |
Confidence Rating: | Accident investigation report completed and information captured |
Narrative:The Ulyanovsk Civil Aviation School training plane crashed in a wooded area while instruction flying. Instructor and cadet died in the accident.
Reasons
The causes of the crash of DA 40 NG RA-10726 were:
The crew's erroneous shutdown of the engine while performing normal procedures after takeoff, as well as failure to recognize the cause of the special situation and, as a consequence, failure to take measures to start the engine;
the crew's loss of control over the flight regime, most probably when making a U-turn for an emergency landing, which resulted in the aircraft stalling, followed by stalling at an altitude insufficient for departure.
The accident was caused by:
- ergonomic deficiencies in the DA 40 NG aircraft cockpit equipment, consisting in the close location of the "FUEL PUMPS" and "ENGINE MASTER" switches and the lack of effective protection against unintentional shutdown of the main engine switch;
- disadvantages of flight training methodology in UVAU GA (I), expressed in the absence of clear regulation of the familiarization flight performance;
- high psycho-emotional stress of the cadet when performing his first flight as a crew member (additional growth could have been caused by breaking the established procedure of the flight task - skipping a number of procedures before takeoff), which led to erroneous engine shutdown;
- shortcomings in the instructor-instructor's methodological training, which led to failure to recognize the cause of the special situation and failure to take measures to start the engine.
The following are causally related to the aircraft accident:
- shortcomings in the documents regulating the flight operation of the aircraft:
the AFM DA 40 NG does not specify the procedure for determining a safe height ("Safe Height")
- to perform normal procedures after takeoff (including switching off the fuel pumps);
- the height of fuel pump shutdown after takeoff, as established by the institute's internal documents, was determined without taking into account the possibility of performing a forced landing with a failed engine;
- methodological deficiencies in the crew training programs for recognizing the signs of the aircraft approaching the stall mode and taking timely actions to bring the aircraft to operational flight modes;
- inoperability of the flight safety management system at UVAU GA (I), which contains mainly only general provisions, which did not allow to properly assess the risks when performing training flights and to take appropriate measures to reduce (eliminate) them.
Accident investigation:
|
| |
Investigating agency: | MAK |
Report number: | |
Status: | Investigation completed |
Duration: | |
Download report: | Final report |
|
Sources:
http://www.mchs.gov.ru/dop/operationalpage/summary/Operativnaja_informacija/item/744230/ http://lifenews.ru/news/132846 http://73online.ru/readnews/28867 https://gorod48.ru/topnews/240722/ https://mak-iac.org/russian/investigations/2014/da-40ng_ra-01726.html Revision history:
Date/time | Contributor | Updates |
08-May-2014 09:00 |
El_serj |
Added |
08-May-2014 09:01 |
Anon. |
Updated [Aircraft type, Total fatalities, Total occupants, Other fatalities, Plane category] |
08-May-2014 11:20 |
krasatpi |
Updated [Time, Nature, Departure airport, Destination airport, Source] |
08-May-2014 17:59 |
Anon. |
Updated [Aircraft type, Registration] |
14-May-2014 05:38 |
Hans Gruber |
Updated [Source] |
12-Oct-2022 19:17 |
harro |
Updated [Time, Cn, Phase, Departure airport, Destination airport, Narrative, Accident report] |
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