Zone

Crash of a Cessna 208B Grand Caravan near Pickle Lake: 1 killed

Date & Time: Dec 11, 2015 at 0909 LT
Type of aircraft:
Operator:
Registration:
C-FKDL
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Pickle Lake – Angling Lake
MSN:
208B-0240
YOM:
1990
Flight number:
WSG127
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
2990
Captain / Total hours on type:
245.00
Aircraft flight hours:
36073
Aircraft flight cycles:
58324
Circumstances:
On 11 December 2015, the pilot of Wasaya Airways Limited Partnership (Wasaya) flight 127 (WSG127) reported for duty at the Wasaya hangar at Pickle Lake Airport (CYPL), Ontario, at about 0815. The air taxi flight was to be the first of 3 cargo trips in the Cessna 208B Caravan (registration C-FKDL, serial number 208B0240) planned from CYPL to Angling Lake / Wapekeka Airport (CKB6), Ontario. The first flight was planned to depart at 0900. The pilot went to the Wasaya apron and conducted a pre-flight inspection of C-FKDL while a ground crew was loading cargo. A Wasaya aircraft fuel-handling technician confirmed with the pilot that the planned fuel load was 600 pounds per wing of Jet A fuel. After completing the fueling, the technician used the cockpit fuel-quantity indicators to verify that the distribution was 600 pounds per wing. The pilot returned to the hangar and received a briefing from the station manager regarding the planned flights. The pilot was advised that the first officer assigned to the flight had been reassigned to other duties in order to increase the aircraft’s available payload and load a snowmobile on board. The pilot completed and signed a Wasaya flight dispatch clearance (FDC) form for WSG127, and filed a copy of it, along with the flight cargo manifests, in the designated location in the company operations room. The FDC for WSG127 showed that the flight was planned to be conducted under visual flight rules (VFR), under company flight-following, at an altitude of 5500 feet above sea level (ASL). Time en route was calculated to be 66 minutes, with fuel consumption of 413 pounds. The pilot returned to the aircraft on the apron. Loading and fueling were complete, and the pilot conducted a final walk-around inspection of C-FKDL. Before entering the cockpit, the pilot conducted an inspection of the upper wing surface. At 0854, the pilot started the engine of C-FKDL and conducted ground checks for several minutes. At 0858, the pilot advised on the mandatory frequency (MF), 122.2 megahertz (MHz), that WSG127 was taxiing for departure from Runway 09 at CYPL. WSG127 departed from Runway 09 at 0900, and, at 0901, the pilot reported on the MF that the flight was airborne. The flight climbed eastward for several miles and then turned left toward the track to CKB6. At about 3000 feet ASL, WSG127 briefly descended about 100 feet over 10 seconds, and then resumed climbing. At 0905, the pilot reported on the MF that WSG127 was clear of the MF zone. WSG127 intercepted the track to CKB6 and climbed northward until the flight reached a peak altitude of about 4600 feet ASL at 0908:41, and then began descending at 0908:46. At 0909:16, the flight made a sharp right turn of about 120° as it descended through about 4000 feet ASL. At 0909:39, the descent ended at about 2800 feet and the aircraft climbed to about 3000 feet ASL before again beginning to descend. At approximately 0910, WSG127 collided with trees and terrain at an elevation of 1460 feet ASL during daylight hours.
Probable cause:
Findings as to causes and contributing factors:
1. Although the aircraft was prohibited from flying in known or forecast icing conditions, Wasaya Airways Limited Partnership (Wasaya) flight 127 (WSG127) was dispatched into forecast icing conditions.
2. The high take-off weight of WSG127 increased the severity of degraded performance when the flight encountered icing conditions.
3. The pilot of WSG127 continued the flight in icing conditions for about 6 minutes, resulting in progressively degraded performance.
4. WSG127 experienced substantially degraded aircraft performance as a result of ice accumulation, resulting in aerodynamic stall, loss of control, and collision with terrain.
5. The Type C pilot self-dispatch procedures and practices in use at Wasaya at the time of the occurrence did not ensure that operational risk was managed to an acceptable level.
6. Wasaya had not implemented all of the mitigation strategies from its January 2015 risk assessment of Cessna 208B operations in known or forecast icing conditions, and the company remained exposed to some unmitigated hazards that had been identified in the risk assessment.
7. There was a company norm of dispatching Cessna 208B flights into forecast icing conditions, although 4 of Wasaya’s 5 Cessna 208B aircraft were prohibited from operating in these conditions.

Findings as to risk:
1. Without effective risk-management processes, aircraft may continue to be dispatched into forecast or known icing conditions that exceed the operating capabilities of the aircraft, increasing the risk of degraded aircraft performance or loss of control.
2. If pilots operating under self-dispatch do not have adequate tools to complete an operational risk assessment before releasing a flight, there is an increased likelihood that hazards will not be identified or adequately mitigated.
3. If aircraft that are not certified for flight in known or forecast icing conditions are dispatched into, and encounter, such conditions, there is an increased risk of degraded performance or loss of control.
4. If aircraft that are certified for flight in known or forecast icing conditions are dispatched into, and encounter, such conditions, at weights exceeding limitations, there is an increased risk of loss of control.
5. If flights are continued in known icing conditions in aircraft that are not certified to do so, there is an increased risk of degraded aircraft performance and loss of control.
6. If operators exceed aircraft manufacturers’ recommended ICEX II servicing intervals, there is an increased risk of degraded aircraft performance or loss of control resulting from greater accretion of ice on the leading-edge de-icing and propeller blade anti-icing boots.
7. If pilots do not receive the minimum required training, there is an increased risk that they will lack the necessary technical knowledge to operate aircraft safely.
8. If pilots are not provided with the information they need to calculate the aircraft’s centre of gravity accurately, they risk departing with their aircraft’s centre of gravity outside the limits, which can lead to loss of control.
9. If emergency locator transmitter antennas and cable connections are not robust enough to survive impact forces, potentially life-saving search-and-rescue operations may be impaired by the absence of a usable signal.

Other findings:
1. Wasaya’s use of a satellite aircraft flight-following system provided early warning of WSG127’s abnormal status and an accurate last known position for search-and-rescue operations.
2. The investigation could not determine whether the autopilot had been used by the pilot of WSG127 at any time during the flight.
Final Report:

Ground fire of an Avro 748-264-2A in Sandy Lake

Date & Time: Jun 12, 2012 at 1343 LT
Type of aircraft:
Operator:
Registration:
C-FTTW
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Pickle Lake – Sandy Lake
MSN:
1681
YOM:
1970
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The aircraft was parked on the ramp at Sandy Lake Airport. The flight crew had disembarked and were off-loading the cargo (JET A-1 jet fuel drums) from the aircraft to fuel tanks adjacent to the ramp. A fire broke out and the flight crew used the available fire extinguishers but the fire spread and consumed most of the aircraft that was totally destroyed. There were no injuries.
Probable cause:
A leak occurred in a hose downstream of the pumps (located on the ground beside the aircraft). The ambient wind blew vapors toward the pumps and a fire broke out. No official investigation was conducted by the TSB on this event.

Crash of a Cessna 208B Grand Caravan near Summer Beaver: 8 killed

Date & Time: Sep 11, 2003 at 2130 LT
Type of aircraft:
Operator:
Registration:
C-FKAB
Survivors:
No
Schedule:
Pickle Lake - Summer Beaver
MSN:
208B-0305
YOM:
1992
Flight number:
WSG125
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
7
Pax fatalities:
Other fatalities:
Total fatalities:
8
Captain / Total flying hours:
2351
Captain / Total hours on type:
946.00
Aircraft flight hours:
16770
Circumstances:
The aircraft departed Pickle Lake to Summer Beaver, Ontario, on a charter flight with seven passengers and one crew member. The flight proceeded on a direct routing to destination at 3500 feet above sea level under night visual flight conditions. On approaching Summer Beaver, the aircraft joined the circuit on a downwind leg for a landing on Runway 17. When the aircraft did not land, personnel at Summer Beaver contacted the Pickle Lake flight dispatch to inquire about the flight. The aircraft was declared missing following an unsuccessful radio search by the Pickle Lake flight dispatch staff. Search and rescue personnel found the wreckage in a wooded area three nautical miles northwest of Summer Beaver. The aircraft had been nearly consumed by a post-crash fire. All eight people on board had been fatally injured.
Probable cause:
Findings as to Causes and Contributing Factors:
The aircraft departed controlled flight and struck terrain for undetermined reasons.
Findings as to Risk:
The company's flight-following procedures for flights operating in remote areas were impractical and were not consistently applied; this could compromise timely search and rescue operations following an accident.
Other Findings:
The aircraft did not carry flight recorders. Lack of information about the cause of this accident affects TSB's ability to identify related safety deficiencies and to issue safety communications intended to prevent accidents that could occur under similar circumstances.
Final Report:

Crash of a De Havilland DHC-2 Beaver near Pickle Lake

Date & Time: Oct 2, 1999 at 1430 LT
Type of aircraft:
Operator:
Registration:
C-GZBQ
Flight Phase:
Survivors:
Yes
Schedule:
Big Trout Lake - Geraldton
MSN:
919
YOM:
1956
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1420
Captain / Total hours on type:
725.00
Aircraft flight hours:
13372
Circumstances:
The de Havilland DHC-2 Beaver seaplane departed from Big Trout Lake, Ontario, on a visual flight rules flight for Geraldton, Ontario, with a pilot and an aircraft maintenance engineer on board. After encountering adverse weather conditions en route to Geraldton, the pilot decided to divert to Pickle Lake, Ontario. At about 1430 central daylight time, the engine lost power at an altitude of about 300 feet above ground level while in the descent for Pickle Lake. The pilot turned the aircraft toward a nearby narrow river. In an attempt to restart the engine, the pilot confirmed that the fuel pressure was normal, the fuel selector was on the fullest tank (front), the throttle was at idle, the mixture was rich, and the ignition switch was on both, then he operated the wobble pump. When the engine did not restart, he switched to the centre fuel tank and operated the wobble pump again, but the engine still did not restart. He then switched back to the front tank and tried another restart, without success. He then landed the aircraft on the river at an estimated landing speed of about 40 to 45 mph. After the forced landing, the left wingtip collided with trees on the river bank, and the aircraft yawed to the left about 180 degrees and struck the river bank, breaking off the floats and the float struts. Impact with more trees on the river bank damaged the right wing and elevator. Both occupants were wearing lap belts with shoulder harnesses and were uninjured. The aircraft was substantially damaged. The pilot advised Thunder Bay flight service station by radio of the engine failure and crash and the crew were rescued two hours later.
Probable cause:
Findings as to Causes and Contributing Factors:
- The engine quit operating because the aircraft fuel system was contaminated with a large amount of water.
- The most likely source of the water contamination was the drums from which the aircraft was refuelled.
- A proper filter to prevent water contamination was not used when the aircraft was refuelled.
- The nose-level aircraft attitude when beached and the freezing of water probably prevented the water contamination from being drained from the front tank during the pilot's pre-flight checks.
Other Findings:
- The aircraft's maintenance records indicate that the aircraft was certified, equipped, and maintained in accordance with existing regulations and approved procedures.
- The use of the available shoulder harnesses probably prevented serious injury to the pilot and engineer.
Final Report:

Crash of an Avro 748-310-2A LFD in Kasabonika

Date & Time: Aug 6, 1998 at 1600 LT
Type of aircraft:
Operator:
Registration:
C-GTAD
Flight Type:
Survivors:
Yes
Schedule:
Pickle Lake - Kasabonika
MSN:
1750
YOM:
1977
Flight number:
WSG804
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
20600
Captain / Total hours on type:
6000.00
Copilot / Total flying hours:
3000
Copilot / Total hours on type:
500
Aircraft flight hours:
12310
Circumstances:
Wasaya Airways Ltd. Flight 804, a Hawker Siddeley 748-2A, serial number 1750, landed at Kasabonika, Ontario, on a freight flight from Pickle Lake, Ontario. During the landing roll, the aircraft could not be stopped and overran the runway by about 450 feet. The captain, the first officer and one of the freight handlers suffered minor injuries; the other freight handler was not injured. The aircraft was destroyed.
Probable cause:
The aircraft was landed at a point from which it could not be stopped under the prevailing conditions. Contributing to the occurrence were the lack of immediate propeller ground fine pitch and the choice of runway 03 as the landing runway. A possible contributing factor was the inappropriate information in the then-current runway analysis manual.
Final Report:

Crash of a Douglas C-47B-DK in Pickle Lake: 2 killed

Date & Time: May 11, 1987 at 1800 LT
Operator:
Registration:
C-FADD
Flight Type:
Survivors:
No
Schedule:
Big Trout Lake - Pickle Lake
MSN:
14879/26324
YOM:
1944
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Aircraft flight hours:
20284
Circumstances:
Douglas DC-3C C-FADD was returning to Pickle Lake from Big Trout Lake following delivery of a cargo of fuel. This was the third similar and last operation of the day. As the aircraft approached Pickle Lake, the pilot informed the company dispatch office that, prior to landing, he intended to carry out some local training for the benefit of the co-pilot who was scheduled to be upgraded to captain status the following month. The captain, a company training pilot, occupied the right seat. The aircraft entered a west to east holding pattern at the airport's NDB, descending in stages from 8,500 feet asl to 2,700 feet asl, the appropriate altitude for an instrument approach. The pilot transmitted that they would execute an NDB approach and subsequently reported during the procedure turn inbound to the airfield. About three minutes later, two other pilots flying in the vicinity observed the aircraft in a descent with the left wing folded upwards. The aircraft continued descending in an inverted attitude until it struck the ground.
Probable cause:
It was determined that the left wing failed under normal flight loads as a result of a fatigue crack in the centre section lower wing skin. Anomalies in the radiographs taken during mandatory non-destructive testing inspections were not correctly interpreted.

Crash of a De Havilland DHC-3 Otter near Pickle Lake

Date & Time: Sep 2, 1986
Type of aircraft:
Registration:
C-FBER
Flight Phase:
Flight Type:
Survivors:
Yes
MSN:
86
YOM:
1955
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Few minutes after takeoff from Pickle Lake, while in cruising altitude, the pilot hear a loud bang. The engine lost power then caught fire and failed. Unable to reach the nearest airport, the pilot attempted an emergency landing when the aircraft crashed in a swampy scrub, bursting into flames. Both occupants escaped uninjured while the aircraft was destroyed.
Probable cause:
The engine reduction gear assembly had failed as the result of lack of lubrication.

Crash of a De Havilland DHC-6 Twin Otter 300 in Big Trout Lake: 3 killed

Date & Time: Nov 1, 1979
Operator:
Registration:
C-GTJA
Survivors:
Yes
Schedule:
Pickle Lake - Big Trout Lake
MSN:
630
YOM:
1979
Flight number:
UH607
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
10
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
On final approach to Big Trout Lake Airport, the crew encountered poor weather conditions and limited visibility. On final, the twin engine airplane struck an NDB tower and crashed. Both pilots and a passenger were killed while nine other occupants were injured. At the time of the accident, the visibility was below minimums.

Crash of a De Havilland DHC-2 Beaver off Pickle Lake

Date & Time: May 12, 1977
Type of aircraft:
Registration:
C-GEZT
Flight Type:
Survivors:
Yes
MSN:
903
YOM:
1956
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Following the crash of a Patricia Air Transport DC-3 at Pickle Lake earlier that day, the operator dispatched a Beaver with a passenger and a pilot on an ambulance mission. While approaching Pickle Lake, the single engine aircraft went out of control and crashed under unknown circumstances into Pickle Lake about 5 km off the airfield. Both occupants were rescued.

Crash of a Douglas DC-3 in Pickle Lake: 1 killed

Date & Time: May 12, 1977
Type of aircraft:
Registration:
C-FBKV
Flight Phase:
Flight Type:
Survivors:
Yes
MSN:
4441
YOM:
1942
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
After takeoff from Pickle Lake Airport, an engine caught fire. The crew elected to make an emergency landing when the airplane crashed 5 km from the airfield. A pilot was seriously injured while the second occupant was killed. The crew was completing a cargo flight on behalf of Ontario Central Airlines.
Probable cause:
Engine fire after takeoff for unknown reasons.