Crash of a Boeing 737-8F2 in Odessa

Date & Time: Nov 21, 2019 at 2055 LT
Type of aircraft:
Operator:
Registration:
TC-JGZ
Survivors:
Yes
Schedule:
Istanbul – Odessa
MSN:
35739/2654
YOM:
2008
Flight number:
TK467
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
136
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
6094
Captain / Total hours on type:
5608.00
Copilot / Total flying hours:
252
Copilot / Total hours on type:
175
Aircraft flight hours:
38464
Aircraft flight cycles:
22633
Circumstances:
On November 21, 2019, a regular THY2UT flight en-route Istanbul – Odesa at B737-800 aircraft, nationality and registration mark TC-JGZ of the Turkish Airlines, was performed by the aircraft crew consisting of the Pilot-in-Command (PIC), co-pilot and four flight attendants of the aircraft. In fact, the departure from Istanbul Airport was performed at 17:33. The actual aircraft landing took place at 18:55. According to the flight plan, the alternate aerodromes were Istanbul and Chișinău. There were 136 passengers and 2793 kg of luggage on board the aircraft. The PIC was a Pilot Flying, and the co-pilot was a Pilot Monitoring of the aircraft. The pre-flight briefing of the crew, according to its explanations, was carried out before departure from the Istanbul Airport, after which the PIC took the decision to perform the flight. The climb and level flight were performed in the normal mode. The landing approach was performed to the Runway16 with ILS system at a significant crosswind component of variable directions. At the final stage of approaching with ILS to Runway 16, the ATC controller of the aerodrome control tower (ATC Tower) gave the aircraft crew a clearance for landing. The aircraft crew confirmed the controller’s clearance and continued the landing approach. Subsequently, from a height of about 50 meters, the aircraft performed a go-around due to the aircraft non-stabilization before landing. Following the go-around, the aircraft headed to the holding area to wait for favorable values of wind force and direction. At 18:45, the PIC took the decision to carry out a repeated landing approach, reported of that to the ATC controller, who provided ATS in the Odesa Terminal Maneuvering Area (TMA.) At 18:51, the crew re-contacted the Tower controller and received the clearance to land. At 18:55, after touchdown, during the runway run, the aircraft began to deviate to the left and veered off of the runway to the left onto the cleared and graded area. After 550 m run on the soil, the aircraft returned to the runway with its right main landing gear and nose part (while moving on the soil, the nose landing gear collapsed) and came to rest at the distance of 1612 m from the runway entrance threshold. The crew performed an emergency evacuation of passengers from the aircraft. As a result of the accident, the aircraft suffered a significant damage to the nose part of the fuselage and left engine. None of the passengers or crew members was injured.
Probable cause:
The cause of the accident, i.e. runway excursion, which caused significant damage to the structural elements of the aircraft B-737-800 TC-JGZ of Turkish Airlines, which took place on 21.11.2019 during landing at «Odesa» Aerodrome, was failure to maintain the direction of the aircraft movement during the landing run in the conditions of a strong crosswind of variable directions.
Contributing Factors:
- Use by the crew of the landing approach method using the Touchdown in Crab technique, which is not recommended by FCTM B-737NG document for use on dry runways in the conditions of a strong crosswind;
- Untimely and insufficient actions of the crew to maintain the landing run direction;
- Presence of a significant cross component of the wind;
- Effect of an omnidirectional wind – from cross-headwind to cross-tailwind directions – during the landing run.
Final Report:

Crash of an Antonov AN-24RV in Donetsk: 5 killed

Date & Time: Feb 13, 2013 at 1809 LT
Type of aircraft:
Operator:
Registration:
UR-WRA
Survivors:
Yes
Schedule:
Odessa - Donetsk
MSN:
3 73 087 09
YOM:
1973
Flight number:
YG8971
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
44
Pax fatalities:
Other fatalities:
Total fatalities:
5
Captain / Total flying hours:
3245
Captain / Total hours on type:
560.00
Copilot / Total flying hours:
175
Aircraft flight hours:
51136
Aircraft flight cycles:
32645
Circumstances:
On final approach to Donetsk-Sergei Prokofiev Airport, during the last segment, the aircraft banked right to a angle of 48°, causing the right wing to struck the ground. The aircraft overturned and crashed in a grassy area to the left of runway 08, coming to rest upside down. Five passengers were killed while all other occupants were injured. The aircraft was destroyed. It was performing a charter flight from Odessa with 44 football fans on their way to a match between Shakhtar Donetsk and Borussia Dortmund. At the time of the accident, the visibility was poor due to the night and foggy conditions. The horizontal visibility was reported to be 250 metres with an RVR of 750 metres for runway 08 and vertical visibility of 200 feet.
Probable cause:
It was planned that an instructor should perform the flight with the crew but he did not show up, so the captain decided to do the flight without him. On final approach to Donetsk, the visibility was limited and the captain was authorized to descent until 1,000 feet on approach where he should establish a visual contact with runway 08 or the approach lights. At this decision height, he continued the approach without any calls to the rest of the crew despite he did not establish any visual contact with the runway. During the last segment, the aircraft banked right due to a too low approach speed of 103 knots, stalled and crashed. The crew failed to monitor the approach speed, and the captain decided to continue the approach despite the visibility was below minimums. At the decision height, he should abandon the approach for a go-around procedure.
Final Report:

Crash of a Cessna 421B Golden Eagle II in Alpine: 5 killed

Date & Time: Jul 4, 2010 at 0015 LT
Operator:
Registration:
N31AS
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Alpine - Odessa
MSN:
421B-0473
YOM:
1973
Crew on board:
2
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
5
Captain / Total flying hours:
1650
Captain / Total hours on type:
160.00
Aircraft flight hours:
2302
Circumstances:
The airplane impacted terrain shortly after takeoff. The wreckage distribution was consistent with a high airspeed, low angle-of-attack impact. Examination of the ground scars and wreckage indicated that the landing gear was down, the flaps were down, and the engines were operating at a high power setting at the time of impact. An examination of the airframe, engines, and related systems revealed no mechanical malfunctions or failures. According to the owner’s manual for the airplane, the flaps should have been retracted and the landing gear should have been brought up as soon as a climb profile was established. Based upon the location of the wreckage, the direction of the impact, and the location of the airport, it is likely that the airplane crashed within one or two minutes after takeoff. The extended landing gear and flaps degraded the climb performance of the airplane. The pilot held an airline transport pilot certificate and had recent night flight experience. Toxicological results were positive for azacyclonol and ibuprofen but were not at levels that would have affected his performance. According to family members, the pilot normally slept from 2230 or 2300 to 0700; the accident occurred at 0015. Although the investigation was unable to determine how long the pilot had been awake before the accident or his sleep schedule in the three days prior to the accident, it is possible that the pilot was fatigued, as the accident occurred at a time when the pilot was normally asleep. The company did not have, and was not required to have guidance or a policy addressing fatigue management.
Probable cause:
The degraded performance of the airplane due to the pilot not properly setting the flaps and retracting the landing gear after takeoff. Contributing to the accident was the pilot’s fatigue.
Final Report:

Crash of a Beechcraft H18 in Tatum: 1 killed

Date & Time: Jul 1, 2002 at 1315 LT
Type of aircraft:
Registration:
N835K
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Taos - Odessa
MSN:
BA-724
YOM:
1965
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
30000
Captain / Total hours on type:
500.00
Aircraft flight hours:
6466
Circumstances:
A witness reported hearing the distinctive sound of a radial engine just before the crash, and right after that a loud crashing noise. The witness observed a large cloud of dust forming, subsequently saw the plane parts scattering from west to east across the pasture, and then observed the fuselage come to rest. A second witness saw the airplane hit the ground and a cloud of dust form about one-quarter of a mile long and as high as a highline wire. The witness said that after the dust settled he saw scattered plane parts, a highline wire down, and a wing part spilling fuel. The witness also stated that the airplane was traveling from west to east and looked horizontal at impact At 12:59:57, approximately 10 minutes prior to the time of the accident, air traffic control radar identified a target 8 nautical miles northwest of the accident site at an altitude of 5,500 feet mean sea level (MSL). However, this target could not be positively identified as the accident airplane. A postmortem examination of the pilot by a Medical Investigator reported significant natural disease findings included coronary atherosclerosis (hardening and narrowing of the arteries), and chronic thyroiditis (inflammation of the thyroid gland). Both of these diseases can cause sudden cardiac problems including an arrhythmia or heart attack.
Probable cause:
The failure of the pilot to maintain clearance.
Final Report:

Crash of a Yakovlev Yak-42 near Katerini: 70 killed

Date & Time: Dec 17, 1997 at 2112 LT
Type of aircraft:
Operator:
Registration:
UR-42334
Flight Phase:
Survivors:
No
Site:
Schedule:
Lvov - Odessa - Thessaloniki
MSN:
26 06 164
YOM:
1986
Flight number:
AEW241
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
62
Pax fatalities:
Other fatalities:
Total fatalities:
70
Captain / Total flying hours:
9850
Captain / Total hours on type:
2300.00
Copilot / Total flying hours:
16210
Copilot / Total hours on type:
5350
Aircraft flight hours:
12008
Aircraft flight cycles:
6836
Circumstances:
AeroSvit Airlines Flight 241 was a scheduled service from Kiev, Ukraine to Thessaloniki, Greece with an en route stop at Odessa, Ukraine. The first leg of the flight was operated by a Boeing 737. Because of engine problems, an aircraft change had to be made at Odessa. The last leg of the flight was carried out using a Yakovlev 42 (UR-42334), which was being chartered from Lvovskie Avialinii. The flight crew had no previous experience in flying to Thessaloniki. The flight was dispatched from Odessa with the No 1 VHF/NAV receiver inoperative, which was contrary to the minimum equipment list (MEL), and took off at 17:23 hours UTC. The weather conditions at Thessaloniki Airport were above required approach and landing minima, however, darkness and an overcast cloud layer obscured awareness of mountainous terrain in the area. The flight was instructed by the approach controller to conduct the LAMBI1F standard arrival procedure and was cleared to execute a VOR-DME-ILS approach to runway 16. The aircraft did not follow the "19 DME arc" as required by the approach procedure, but proceeded directly to the THS NDB. It overshot the localizer course at least twice and the flight crew were unable to establish a stabilized approach. According to the CVR cockpit conversations, the flight crew was confused and uncertain with respect to the navigation aids and the information that was presented. During the approach there were no standard callouts made by the flight crew related to the glide slope, outer marker or minima. At 18:54 UTC the Thessaloniki Tower controller reported that they had passed the airport. The flight crew was unaware that they overflew the runway until they were informed by the controller. The flight crew then initiated a go-around but did not follow the published missed approach procedure, nor did they follow the instructions given by the ATC. Although instructed by ATC to proceed to, and enter the south holding pattern, the flight continued on a flight path to the west. The flight crew remained confused, disorganized, and disoriented during the missed approach and the subsequent clearances issued by ATC. They had lost situational and terrain awareness, and they were uncertain with respect to the radio navigation aids and the information that was presented. They also requested "route vectors" and "heading" twice although Thessaloniki Airport was a non-radar facility. The flight crew occasionally was confused in reading and reporting the correct distances on their DME equipment (miles to kilometers and vice versa) as their instruments displayed distances in kilometers. The flight crew in their effort to solve the navigational problem, often switched their focus from VOR/DME information to ADF, and vice versa. This, in conjunction with the VHF/NAV receiver malfunction, contributed greatly to the confusion in the cockpit and to the loss of orientation. At 19:12 UTC the GPWS sounded for 4 seconds. At the same time the approach controller radioed: "AEW number one, continue VOR-DME/ILS approach minima, continue and report approaching the outer marker". The crew replied: "Outer marker will be report`. After a while the approach controller asked: "AEW-241, do you have the field in sight?". At that time the GPWS sounded again. Shortly afterwards the aircraft impacted the side of Mount Pente Pigadia at 3300 feet. The wreckage was found at 10:30 hours, December 20. At the same date a Greek Air Force Lockheed Hercules, which was being used in the search, crashed, killing all 5 on board. On October 6, 2000 a trial began with two air traffic controllers being accused of many counts of manslaughter and of violating the transportation regulations. They were sentenced to five years imprisonment. In December 2002 a Thessaloniki appeals court reduced the sentences of two air traffic controllers to four years and four months each.
Probable cause:
Causes:
1. The failure of the flight crew to adequately plan and execute the approach and missed approach procedure for runway 16 at Makedonia airport.
2. The failure of the flight crew to properly utilize the Makedonia airport radio navigational aids and aircraft radio equipment / instruments and to interpret the information that was presented.
3. The failure of the flight crew to declare an emergency when they lost their orientation following the missed approach, despite numerous cues alerting them for the aforementioned situation.
4. The captain's failure to achieve maximum performance climb in response to the GPWS alarm signal, 30" prior to impact.
5. The lack of command presence, cockpit discipline and resource management which resulted in a disorganized, confused and ultimately dysfunctional flight crew.
6. The company's inadequate oversight, over their flight operations, that allowed for and resulted in scheduling one inadequately prepared and marginally qualified flight crew and an aircraft which did not comply with national and international airworthiness regulations (it had not been issued the Type Certificate with the corresponding Amendment for the international flights), to execute a regular passenger flight with No 1 VHF/NAV receiver inoperative.
Contributing Factors:
1. The inadequate training provided to the flight crew for cockpit resource management and international flight operations.
2. The dispatch of the aircraft with No 1 VHF/NAV receiver, inoperative, despite the restrictions provided in M.E.L. (Appendix 28, pages 14, 16).
3. The assignment of a marginally qualified instructor pilot to this specific flight who disrupted and substantially reduced the coordination and effectiveness of the flight crew.
4. The inaccurate display of the symbol (R) on the Jeppesen Sanderson Inc. chart 11-1, for runway 16, from which the flight crew, most probably, have formed the wrong impression that radar service was available in Makedonia airport.
5. The insufficient evaluation by the Approach Control, under the aforementioned circumstances, of the difficulties encountered by the flight crew in following procedures and clearances, which prevented the Controllers to offer any available assistance, by their own initiative, in order to prevent, probably, the accident.
Final Report:

Crash of a Let L-410UVP in Odessa

Date & Time: Oct 12, 1990 at 1100 LT
Type of aircraft:
Operator:
Registration:
CCCP-67331
Survivors:
Yes
MSN:
82 08 31
YOM:
1982
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
13
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
On final approach to Odessa-Central Airport, the captain mistakenly activated the reverse thrust on both engines. The aircraft entered an uncontrolled descent and struck the ground 22 meters short of runway threshold with a positive acceleration of 4,4 g. before coming to rest. All 15 occupants were rescued.

Crash of a PZL-Mielec AN-2R near Odessa

Date & Time: Aug 12, 1988
Type of aircraft:
Operator:
Registration:
CCCP-35677
Flight Phase:
Survivors:
Yes
MSN:
1G134-41
YOM:
1972
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Nine minutes after takeoff, while in cruising altitude, the engine failed. The crew attempted an emergency landing when the aircraft crashed in a pasture. There were no casualties.
Probable cause:
It was determined that the engine failure was the consequence of a mismanagement of fuel on part of the crew who positioned the fuel selector on the left main tank that was empty.

Crash of a Yakovlev Yak-40 in Berdyansk: 8 killed

Date & Time: Jun 19, 1987 at 1122 LT
Type of aircraft:
Operator:
Registration:
CCCP-87826
Survivors:
Yes
Schedule:
Odessa - Berdyansk
MSN:
9 24 18 24
YOM:
1972
Flight number:
SU528N
Country:
Region:
Crew on board:
5
Crew fatalities:
Pax on board:
24
Pax fatalities:
Other fatalities:
Total fatalities:
8
Circumstances:
Following an uneventful flight from Odessa, the crew started the approach and was cleared to descend to 1,200 meters. On final, weather conditions deteriorated with thunderstorm activity and heavy rain falls. Despite a limited visibility and the actual conditions, ATC cleared the aircraft to continue the approach and to land. The three engine aircraft passed over the threshold at a height of 40-50 meters and at an excessive speed of about 250 km/h. The aircraft landed too far down the runway and after touchdown on a wet surface, the crew started the braking maneuver but the aircraft was unable to stop within the remaining distance. It overran, rolled about 450 meters then struck two trees, crossed a road and came to rest in a field, bursting into flames. Two crew members and six passengers were killed while 21 other occupants were injured. The aircraft was destroyed by a post crash fire. At the time of the accident, weather conditions were below Airport minimums.
Probable cause:
It was determined that the accident was the consequence of the combination of the following factors:
- The crew decided to continue the approach in below minimum weather conditions at an excessive speed and above the glide, causing the aircraft to land too far down the runway,
- The crew failed to initiate a go-around procedure,
- ATC cleared the crew to land and failed to close the airport and to divert the flight to another suitable airport,
- Poor organization by Meteo services.

Crash of a PZL-Mielec AN-2R near Odessa

Date & Time: Jun 19, 1987
Type of aircraft:
Operator:
Registration:
CCCP-40806
Flight Phase:
MSN:
1G173-33
YOM:
1977
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
While engaged in a spraying mission, the single engine aircraft struck the ground and crashed. The exact circumstances of the accident remains unknown as well as the occupant's fate.
Probable cause:
It was determined that the crew accepted to complete a spraying mission over a field while this was not possible due to flying conditions.

Crash of a PZL-Mielec AN-2 in Odessa

Date & Time: Jun 16, 1984
Type of aircraft:
Operator:
Registration:
CCCP-02528
Flight Phase:
Survivors:
Yes
MSN:
1G121-12
YOM:
1970
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Shortly after takeoff, while climbing, the aircraft collided with a bird that got into the engine's air intake. The engine lost power, the airplane lost height and crashed. There were no casualties.
Probable cause:
Engine failure due to bird strike after takeoff.