DA-40NG RA-01726 08.05.2014

Accident date08.05.2014
Investigation status
Aircraft registration numberRA-01726
Place of aircraft departure
Airport of departure
Intended destination
Intended Airport of arrival
Accident sitein the area of "Soldatskaya Tashla" aerodrome of the Ulyanovsk Region
Latitude
Longitude
Aircraft typeDA 40 NG
Serial №
Aircraft operator
Aircraft owner"Ulyanovskoye CA higher aviation school" Federal State Budgetary Educational Institution
The date of the completion of the investigation (report)23.04.2015
Number of fatalities2
Victims accuracy
Degree of aircraft destruction
Report

report_ra-01726.pdf (3.84 MB)

Aviation typeGA
Works type
Note

08 may 2014

     The accident with DA-40NG RA-01726 aircraft owned by "Ulyanovskoye CA higher aviation school" Federal State Budgetary Educational Institution occurred in the area of "Soldatskaya Tashla" aerodrome of the Ulyanovsk Region on May 8, 2014. According to the available information the pilot and a trainee on board were killed, the aircraft was destroyed.
     The Interstate Aviation Committee has formed the Investigation team of the accident in accordance with the Russian Aviation Legislation. The Investigation team started its work.
     

29 april 2015

     The Investigation team of the Interstate Aviation Committee has completed the investigation of the accident with Diamond DA 40 NG RA-01726 aircraft owned by FSBEI HPO "UVAU GA (I)" occurred in the area of Soldatskaya Tashla airfield on May 8, 2014.  
      The fatal accident with DA 40 NG RA-10726 aircraft was caused by:
      • erroneous engine failure by the crew during normal procedures after take-off as well as not recognition of the abnormal situation and as a result failure to start the engine;
      • loss of the flight mode monitoring by the crew most probably during turning for emergency landing that resulted in aircraft stall followed by transition into spin at the altitude insufficient for aircraft recovery.
      The accident was due to:
      • ergonomic shortcomings of the DA 40 NG aircraft cockpit equipment: close location of switches «FUEL PUMPS» and «ENGINE MASTER» and lack of effective protection from unintentional engine left-hand switch failure;
      • deficiencies in flight training procedure in VAU GA (I) such as the lack of the precise flight operation regulation;  
      • high psycho-emotional tension of the trainee performing first flight as the crew member (the additional increase of which could be caused by the violation of the specified procedure of the flight assignment – missing the number of procedures before take-off), resulted in erroneous engine failure;
      • deficiencies of the instructor in PIC's flight training procedure resulted in his disability to recognize the reason of the abnormal situation and start the engine.
      The following factors are in the causal connection with the aircraft accident:
      • irregularities of documents regulating flight operations:
      - the procedure of determining the safe altitude for performing normal operation after take-off (including fuel pumps cut-off) is not specified in AFM DA 40 NG;
      - the height of the fuel pump cut-off after take off specified by the institute internal documents is determined excluding the possibility of the emergency landing with failed engine;
      • methodical imperfection of crew members training programs in recognition of aircraft stall warning cues and timely actions on aircraft recovery to operational modes;
      • nonoperability of flight operation safety system in UVAU GA (I) that contains only general regulations that didn't allow to assess risks during training operations and take the appropriate measures to reduce (eliminate) them.
     
The appropriate safety recommendations based on the investigation results were developed.