Crash of an ATR72-212 on Mt Dena: 66 killed

Date & Time: Feb 18, 2018 at 0931 LT
Type of aircraft:
Operator:
Registration:
EP-ATS
Flight Phase:
Survivors:
No
Site:
Schedule:
Tehran – Yasuj
MSN:
391
YOM:
1993
Flight number:
EP3704
Location:
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
60
Pax fatalities:
Other fatalities:
Total fatalities:
66
Captain / Total flying hours:
17926
Captain / Total hours on type:
12519.00
Copilot / Total flying hours:
1880
Copilot / Total hours on type:
197
Aircraft flight hours:
28857
Aircraft flight cycles:
28497
Circumstances:
Iranian ATR72 aircraft registered EP-ATS operated by Iran Aseman Airlines was assigned to perform a domestic scheduled passenger flight from Tehran to Yasuj on 07:55 local time. The aircraft took off from Tehran Mehrabad International Airport (0III) at 04:35 UTC. (08:05 LMT) and the flight was the first flight of the day for aircraft and the crew. The cruise flight was conducted at FL210 on airway W144 and no abnormal situation was reported by the crew and the flight was continued on Tehran ACC frequency till the time the first officer requested latest weather information of the destination by contact to Yasuj tower then requested to leave FL210 to FL170 from Tehran ACC. When the aircraft was descending to FL170 and crew calling YSJ tower the aircraft descending was continued to altitude of 15000 ft. The aircraft was approved to join overhead of the airport and perform “circling NDB approach “to land on RWY 31 at the destination aerodrome. Finally the aircraft collided with a peak lee of DENA Mountains about 8.5 miles at North far from the airport and involved accident on 06:01 UTC. The aircraft was completely destroyed as a result of collision with the mountain at the altitude of approximately 13,300 ft.
Probable cause:
The accident was happened due to many chains of considered causes but the “Human Factor” had main roll for the conclusion of the scenario. The Cockpit Crew action which has caused dangerous conditions for the flight is considered as main cause. Based on provided evidences, the errors of cockpit crew were as follows:
- Continuing to the Yasouj airport for landing against Operation manual of the Company, due to low altitude ceiling of the cloud and related cloud mass. They should divert to alternate airport,
- Descending to unauthorized altitude below minimum of the route and MSA,
- Lack of enough CRM during flight,
- Failure to complete the stall recovery (flap setting, max RPM),
- Inappropriate use of Autopilot after Stall condition,
- Inadequate anticipation for bad weather based on OM (Clouds, Turbulence, and Icing ...),
- Quick action to switch off anti-ice system and AOA,
- Failure to follow the Check lists and standard call out by both pilots.
Contributing Factors:
The contributive factors to this accident include but are not limited to the following:
- The airline was not capable to detect systematic defectives about :
- Effectiveness of crew training about Meteorology, OM, SOP,
- Enough operational supervision on pilot behaviors,
- The lack of SIGMET about Mountain Wave or Severe Mountain wave,
- Unclear procedure for stall recovery in FCOM,
- Lack of warning in aircraft manuals by manufacturer for flight crew awareness about mountain wave.
- Lack of APM System to alert crew about performance degradation.
Other Deficiencies and Short Comes:
In the process of the accident investigation, some detailed deficiencies and short comes were found and should be considered as latent conditions by related authorities:
- AD accomplishment and related monitoring,
- Sanction on aviation industries and effect on Flight safety,
- Non-standard communication between ATC and crew,
- Unclear definition of the Fully Qualified Pilot and qualified copilot in Aircrew regulation.
- Weather forecast (TAF) in the airports based on annex 3 procedure in the Civil Aviation Organization for approving alternative method of compliance for aircraft AD,s
- Search and rescue Coordination with local authorities for aviation accidents,
- Time setting of aircraft flight data recording(FDR) either by technician or pilots.
Final Report:

Crash of a Rockwell Grand Commander 690 near Zāhedān: 7 killed

Date & Time: Oct 12, 2014 at 1920 LT
Registration:
1405
Flight Type:
Survivors:
No
Site:
Schedule:
Tehran - Zahedan
MSN:
690-11075
YOM:
1972
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
4
Pax fatalities:
Other fatalities:
Total fatalities:
7
Circumstances:
The twin engine aircraft was flying to Zahedan with a crew of three (two pilots and a flight attendant) and four passengers, among them General Mahmoud Sadeqi, a senior police officer who was travelling to Zahedan to investigate the circumstances of a recent attack that killed four police officers. While approaching Zahedan by night, the crew failed to realize his altitude was too low when the airplane struck the slope of a mountain located in the Sabzpushan Heights, north of the airport. The wreckage was found the following morning. All seven occupants were killed. A day later, Iranian Authorities said the accident was caused by technical flaws, darkness and the pilot’s unfamiliarity with the region.

Crash of a HESA IrAn-140-100 in Tehran: 40 killed

Date & Time: Aug 10, 2014 at 0921 LT
Type of aircraft:
Operator:
Registration:
EP-GPA
Flight Phase:
Survivors:
No
Schedule:
Tehran – Tabas
MSN:
90-05
YOM:
2008
Flight number:
SPN5915
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
42
Pax fatalities:
Other fatalities:
Total fatalities:
40
Captain / Total flying hours:
9478
Captain / Total hours on type:
2000.00
Copilot / Total flying hours:
572
Copilot / Total hours on type:
400
Aircraft flight hours:
1405
Aircraft flight cycles:
1058
Circumstances:
On August 10,2014, at 04:52 UTC daylight time, an AN-140-100 aircraft , Iranian registration EP-GPA ( MSN 90-05), operated by Sepahan Airlines flight # 5915, experienced engine number 2 shutdown just about 2 seconds before lift-off and crashed shortly after take-off nearby Mehrabad International Airport (THR), TEHRAN; IR. Of IRAN; the aircraft was on lift off from runway 29L. The airplane was completely destroyed by impact forces and post-crash fire. Fatality incorporates 34 of the 40 passengers; 4 of the 4 flight attendants, and 2 of the 2 flight crewmembers. The 11 passengers received serious injuries, which finally as a result of that accident there are 40 fatalities and 8 passengers recovered from injury. Sepahan Airline was operating under the provisions of CAO.IRI operational requirement for commercial air transport. Before the accident flight the airplane dispatch from Isfahan and arrived at Tehran about 03:30. The dispatcher and PIC perform the load calculation using the aircraft FM performance charts. Because of load limitation for 15° flap position, load sheet change and re-write with 10° flap position and re-calculated MTOM. The aircraft was enrouted to Airport Tabbas Visual meteorological conditions (VMC) prevailed, and an instrument flight rules (IFR) flight plan was filed. Figure 1 below is a map showing the location of the accident and the aircraft flight path. Figure 2 shows THR runway 29L SID and figure 3 show timeline of event in the flight path. According to overview of flight crew performance, it is indicated that the crewmembers were provided with the flight release paperwork, which included weather information, notices to airmen (NOTAM), and the flight plan.
Probable cause:
The accident investigation team determined that the main cause of this accident was combination of:
1. Electronic engine control (SAY-2000) failure simultaneously with engine No: 2 shutdown, just about 2 seconds before aircraft lift-off.
2. AFM Confusing performance chart resulted the pilots relying on performance calculation that, significantly over-estimate the aircraft MTOM.
Contributing Factors to the accident were:
1. Aircraft flight manual unclear procedure, including the procedure for calculating maximum allowable take-off weight, VR and V2 and ambiguity in the climb segment definition and applications.
2. Crew performance, including:
- PIC rotated the aircraft at the speed of about 219 km/h (whereas 224 km/h is the speed recommended by the AFM table 4.2.3),
- The crew failed to perform the manual propeller feathering procedure for the failed engine,
- The PIC's decision to fly with the aircraft, notwithstanding, had about 190 kgf overweight,
- Aircraft fuel was about 500 kg more than required fuel for the accident flight.
3. The appearance of negative thrust from the unfeathered propeller blades at takeoff were not considered during the aircraft certification tests, as it was considered improbable. However, in
the accident flight the negative thrust did appear and affected the flight performance.
Final Report:

Crash of a Boeing 727-286 in Orūmīyeh: 78 killed

Date & Time: Jan 9, 2011 at 1945 LT
Type of aircraft:
Operator:
Registration:
EP-IRP
Survivors:
Yes
Schedule:
Tehran - Orumiyeh
MSN:
20945/1048
YOM:
1974
Flight number:
IR277
Country:
Region:
Crew on board:
9
Crew fatalities:
Pax on board:
96
Pax fatalities:
Other fatalities:
Total fatalities:
78
Aircraft flight hours:
9019
Circumstances:
The aircraft departed Tehran-Mehrabad Airport at 1815LT with a delay of more than two hours due to poor weather conditions at destination. While descending to Orūmīyeh Airport by night, the crew encountered poor weather conditions with snow falls, visibility 800 metres and three ceilings at 1,500, 2,000 and 6,000 feet. After the crew was unable to intercept the ILS, the decision to initiate a go-around procedure was taken. Approaching the stall speed, the stick shaker activated and the aircraft probably encountered icing conditions. In a left bank angle estimated between 26 and 40°, the engine n°3 and 1 failed. At an altitude of 600 feet and at a speed of 96 knots, the flaps were retracted, causing the aircraft to stall and to impact the ground. The aircraft broke in three but there was no fire. 70 passengers and 8 crew members were killed while 27 other occupants were injured, some seriously.
Probable cause:
Bad weather conditions for the aircraft and inappropriate actions by cockpit crew to confront the situation is the main cause of the accident. The following contributing factors were identified:
- The old technology of aircraft systems,
- Absence of a suitable simulator for adverse weather conditions,
- Failure to correctly follow the operating manual by the flight crew,
- Inadequate cockpit resources management (CRM).

Crash of a Fokker 100 in Tabriz

Date & Time: Aug 26, 2010 at 2245 LT
Type of aircraft:
Operator:
Registration:
EP-ASL
Survivors:
Yes
Schedule:
Tehran - Tabriz
MSN:
11432
YOM:
1992
Flight number:
EP773
Country:
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
103
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Following an uneventful flight from Tehran, the crew started the descent to Tabriz and was informed by ATC that visibility was low due to heavy rain falls. After landing on runway 30R (3,556 metres long), the aircraft was unable to stop within the remaining distance. It overran and rolled for about 500 metres before coming to rest in a ditch. All 110 occupants were rescued, among them two passengers were slightly injured. The aircraft was damaged beyond repair as the nose was destroyed and the bulkhead severely damaged.

Crash of an Ilyushin II-76MD Simorgh in Varamin: 7 killed

Date & Time: Sep 22, 2009 at 0930 LT
Type of aircraft:
Operator:
Registration:
5-8208
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Tehran - Tehran
MSN:
00834 84542
YOM:
1988
Country:
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
7
Circumstances:
The crew departed Tehran-Mehrabad Airport for a local training mission. While cruising south of the capital city, the crew declared an emergency following an engine failure and elected to return. During the emergency descent to runway 29L, the radome located on the roof detached and hit the tail. Out of control, the aircraft crashed in an open field located near Varamin. The aircraft disintegrated on impact and all seven occupants were killed. It is believed that the radome detached because the aircraft' speed exceeded its certification during the emergency descent.

Incident with a Boeing 707-3J9C in Ahwaz

Date & Time: Aug 3, 2009 at 1000 LT
Type of aircraft:
Operator:
Registration:
EP-SHK
Flight Phase:
Survivors:
Yes
Schedule:
Ahwaz - Tehran
MSN:
21128/917
YOM:
1976
Flight number:
IRZ124
Location:
Country:
Region:
Crew on board:
12
Crew fatalities:
Pax on board:
162
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Shortly after take off from Ahwaz Airport, while in initial climb, the engine n°2 suffered an uncontained failure. The crew informed ATC about the situation and was cleared for an immediate return. The aircraft landed safely 10 minutes later and was stopped on the main runway. All 174 occupants were rescued, among them two passengers were slightly injured. The aircraft was considered as damaged beyond repair as n°1 engine and the left wing were also damaged due to debris from the n°2 engine's compressor.
Probable cause:
It appears that a stage of the high pressure compressor in the n°2 engine disintegrated during initial climb. Elements punctured the nacelle and hit the left wing and the n°1 engine. After the n°2 engine failed, the n°1 engine lost power.

Crash of an Ilyushin II-62M in Mashhad: 16 killed

Date & Time: Jul 25, 2009 at 1805 LT
Type of aircraft:
Operator:
Registration:
UP-I6208
Survivors:
Yes
Schedule:
Tehran - Mashhad
MSN:
19 51 5 2 5
YOM:
1989
Flight number:
IRX1525
Country:
Region:
Crew on board:
17
Crew fatalities:
Pax on board:
156
Pax fatalities:
Other fatalities:
Total fatalities:
16
Captain / Total flying hours:
14200
Captain / Total hours on type:
1500.00
Copilot / Total flying hours:
8294
Copilot / Total hours on type:
1319
Aircraft flight hours:
13573
Aircraft flight cycles:
3987
Circumstances:
At July 24, 2009, Ilyushin aircraft, model IL-62M of DETA Airline with registration, UP-I6208 and flight IRX1525 of Aria Airline flight with 169 passengers from Mehrabad International Airport/ Tehran, and it has landed at 18:05 local time on RWY 13 L in Mashhad International Airport; then it has run off from end of the runway, without considerable reduction in aircraft speed and it collided with wall of the airport and it was stopped after approximately 185 m. The mentioned aircraft has been leased by Aria Airline as ACMI, according to contract No. 002/IL-62M/ACMI. Subsequently, the ground safety unit of the airport has attended in place of occurring accident, by breaking protective fences and barbed wires of the airport, and then they evacuated passengers and extinguished fire outside of aircraft by carrying out necessary actions. 16 people were killed, 11 crew members and five passengers. All other occupants were rescued, among them 30 were injured. Accident site inspection revealed that the aircraft position had coordinates N 36,218º E 59,666º, at a road in the vicinity of the aerodrome, 1km away from the RWY-31R threshold (130º MH or 133, 5º TH) of the Mashhad airport with the azimuth of 125º (true). Power line along the road was destroyed by the right aircraft wing. Wing fuel tanks of the right wing were damaged evidenced by fuel leaking. Main and emergency exits were open. An inflatable slide was dropped down from the port side. No evidences of fire on board and at the accident site were found. First tracks of intensive braking (black tire tracks) were found at the concrete at a distance of 550 m from the departure threshold of RWY31R. The track of the main gear wheels was going along the RWY in its left part, and diverging further to the right beyond the departure threshold. At about 100m away from the threshold at the end portion of the braking way, a net barrier was found (textile aerodrome emergency braking unit).The aircraft ran over the RWY when moving along the right side of the stop way, 300m long. Beyond the end of the RWY landing gear wheels track could be clearly seen passing over a rough partly grassed surface, and crossing a dirt road. At a distance of 100m from the RWY end, where the right gear crossed the road, a destroyed tire tube was found, which presumably belonged to the right gear front wheel. At a distance of 160m from the RWY end smashed approach lights were found, and after that point the gear wheel track started to diverge to the left from the RWY centerline. The front gear wheel track further merged with the left gear wheel track and extended joining the forward airframe track. At a distance of 320 m from the RWY end another line of broken approach lights were found. Airframe structures were found before the approach lights (along the aircraft way). From that point small aircraft structure pieces were found along the whole aircraft path. 40m past the destroyed approach lights line a ditch of 0,5…1m in depth was found (with an underground pipeline) which was crossing this area from the south to the north. The south-eastern part of the aerodrome was fenced with a brick wall of 2,5m high and 0,4m thick with a concrete strip foundation. It went along the RWY there. The aircraft collided with the fence at a distance of 820m from the departure threshold (520m past the stop way end) with a heading of 105 degrees. The fence was destroyed throughout 70m. Debris of the nose part of the airframe, cockpit, passenger seats, aircraft cabin parts were found behind the fence. Earlier aerodrome employees, police and medical services found at the site and evacuated crew bodies, as well as killed and injured passengers. After the collision with the fence the aircraft kept moving for 160 m with a heading of 105 degrees and came to a stop at the road.
Probable cause:
The following findings were identified:
- The crew was not trained &acquainted with flight conditions in the Iran territory with an Iranian instructor pilot and the operation unit of Aria Airline has acted so weak regarding those mentioned subjects.
- The approach speed of aircraft was higher than recommended available airport charts & aircraft weight, however it was controllable if the crew could proceed to land correctively.
- The crew had not done correct procedure according to the aircraft Standard Operation Procedure (SOP) to use related check lists. (Descend-Approach-Landing)
- There was lack of precise coordination between flight crew on their self responsibility during the approach and landing.
- The flight crew did not pay attention to EGPWS warning, and did not take corrective action.
- The crew did not use engine reverser and spoiler systems correctly to reduce aircraft speed during the landing and consequently it caused to loose long Runway distance.
- The flight crew had not good English language proficiency. And they were poor in England language conversation.
- The Capitan of the aircraft as the pilot in command had not sufficient force and efficient management in the cockpit. (lack of Cockpit Resource Management).
- There were unauthorized actions of flight engineer for shifting engine reversers as well as lack of mutual oversight by crew members in checklist accomplishment during approach and landing.
- The crew has had disagreement about “Go around” due to unsuitable landing situations.
- Presence of General Director of airline in the cockpit had adverse psychological effect on crew efficiency behaviors.
- The DETA airline did not use correct procedure to extend engines No; 1-2-4 life time from Ukrainian company (Aerotechservice co.) and the technical manager of ARIA airline did not control and
supervise the matter accordingly.

Main Cause :
Considering those items in factual information and analysis, the main cause of this accident is “weak Cockpit management between the crew” to use correct landing techniques same as releasing Engine trust reversers – Engine shut down in unsuitable time - ….

Contributive Factors :
Some of contributive factors for this accident occurrence are noted as:
- The copilot and the flight engineer had self activity& decision without the (PIC) coordination.
- The cockpit crew was careless and not paying proper attention toward EGPWS warning.
- Psychological adverse effect on cockpit crew because of presence of General Director of Aria airline

Violation & other deficiencies:
The accident investigation team encountered some violations and deficiencies with ICAO Standards and Iran Local Authority regulation (CAO) which are descript as:
- Poor and in-sufficient supervision controlled of operation &technical manger of Aria Airline.
- The DETA airline has not used proper procedure to receive life time extension of engine and has not passed necessary information to Iranian and Kazakhstan Authorities.
- It has not been designed a headset for flight engineer to make more coordination between the crew, by the aircraft design bureau.
- The crew was not familiar with Iranian AIP completely.
- The total on board persons was not according to written load sheet.
Final Report:

Crash of a Fokker 100 in Tehran

Date & Time: Jan 19, 2009 at 1701 LT
Type of aircraft:
Operator:
Registration:
EP-CFN
Survivors:
Yes
Schedule:
Ardabil - Tehran
MSN:
11423
YOM:
1993
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
106
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
After landing on runway 29L at Tehran-Mehrabad Airport, the right main gear collapsed. The aircraft veered off runway to the right and came to rest. All 114 occupants were uninjured and the aircraft was damaged beyond repair.
Probable cause:
Failure of the right main gear upon landing for unknown reasons.

Crash of a Fokker 100 in Tehran

Date & Time: Jan 2, 2008 at 0732 LT
Type of aircraft:
Operator:
Registration:
EP-IDB
Flight Phase:
Survivors:
Yes
Schedule:
Tehran - Shiraz
MSN:
11299
YOM:
1990
Flight number:
IR235
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
105
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
30732
Aircraft flight cycles:
33933
Circumstances:
While preparing the flight at Tehran-Mehrabad Airport, the copilot proceeded with a walk around check of the airplane. As the OAT was near freezing level and there were some light snow showers, he requested a deicing. Nevertheless, as there were already a few number of aircraft waiting for deicing, the captain decided to takeoff without deicing. At 0731LT, the crew was cleared for takeoff and started the takeoff procedure. After liftoff, the aircraft started to roll to the left then to the right. Losing altitude, the left wing impacted ground and the aircraft crash landed, coming to rest and bursting into flames. All 113 occupants were rescued, among them 11 were seriously injured including four crew members.
Probable cause:
It was determined that the accident was the consequence of an aerodynamic stall after lift off due to a loss of lift because the wings were contaminated and that the aircraft had not been deiced prior to takeoff.
The following contributing factors were identified:
- Poor crew resources management,
- Poor flight preparation,
- Lack of knowledge about winter operations on part of the operator.