Crash of a Boeing 737-33A in Manokwari

Date & Time: May 31, 2017 at 0851 LT
Type of aircraft:
Operator:
Registration:
PK-CJC
Survivors:
Yes
Schedule:
Ujung Pandang – Sorong – Manokwari
MSN:
24025/1556
YOM:
1988
Flight number:
SJY570
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
146
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
13371
Captain / Total hours on type:
3110.00
Copilot / Total flying hours:
5570
Copilot / Total hours on type:
2523
Aircraft flight hours:
60996
Circumstances:
On 31 May 2017, a Boeing 737-300 aircraft registration PK-CJC was being operated by PT. Sriwijaya Air as a scheduled passenger flight from Hasanuddin Airport (WAHH), Makassar, South Sulawesi to Rendani Airport (WAUU), Manokwari, West Papua, with one transit stop at Domine Eduard Osok Airport (WASS) Sorong, West Papua. The flight was uneventful since the first departure from Makassar until commencing the approach at Manokwari. At 0815 LT (2315 UTC), the aircraft departed Sorong to Manokwari. On board in the flight were two pilots, four flight attendants and 146 passengers. On this flight, the Second in Command (SIC) acted as Pilot Flying (PF) and the Pilot in Command (PIC) acted as Pilot Monitoring (PM). At 2331 UTC, the pilot made first contact to Rendani Tower controller and informed that the aircraft was descending from FL 230 (altitude 23,000 feet) and requested the weather information. The Rendani Tower controller informed to the pilot that the wind was calm, ground visibility 6 km, cloud FEW CB 1,400 feet, temperature and dew point 26/25°C. At 2336 UTC, Rendani Tower controller instructed to the pilot to descend to 11,000 feet and to report when on Visual Meteorological Condition (VMC). At 2338 UTC, the pilot informed that they were on VMC condition and passed altitude 13,000 feet while position was 32 Nm from ZQ NDB (Non-Directional Beacon). Rendani Tower controller instructed to fly maintain on visual condition, fly via overhead, descend to circuit altitude, join right downwind runway 35, and to report when overhead Manokwari. At 2344 UTC, the pilot reported that the aircraft was over Manokwari and Rendani Tower controller informed to the pilot that the visibility changed to 5 km. Two minutes later Rendani Tower controller instructed to the pilot to continue approach and to report on right base runway 35. At 2349 UTC, at approximately 600 feet, the PIC as PM took over control by called “I have control” and the SIC replied “You have control”. A few seconds later the pilot reported that the aircraft was on final runway 35, and Rendani Tower controller instructed to the pilot to report when the runway 35 insight. The pilot immediately replied that the runway was in sight and acknowledged by Rendani Tower controller who then issued landing clearance with additional information that the wind was calm and the runway condition wet. At approximately 550 feet, the PIC instructed the SIC turn on the wiper and reconfirmed to SIC that the runway was in sight. Between altitude 500 feet to 200 feet, the EGPWS aural warnings “Sink Rate” and “Pull Up” sounded. At 2350 UTC, the aircraft touched down and rolled on runway 35. The spoiler deployed and the pilot activated the thrust reversers. The crew did not feel significant deceleration. The aircraft stopped at approximate 20 meters from the end of runway pavement. After the aircraft stopped, the PIC commanded “Evacuate” through the Passenger Address (PA) system. The Rendani Tower Controller saw that the aircraft was overrun and activated the crash bell then informed the Airport Rescue and Fire Fighting (ARFF) that there was an aircraft overrun after landing on runway 35. All the flight crew and passengers evacuated the aircraft and transported to the terminal building safely.
Probable cause:
According to factual information during the investigation, the Komite Nasional Keselamatan Transportasi identified initial findings as follows:
1. The aircraft was airworthy prior to the accident, there was no report or record of aircraft system abnormality during the flight. The aircraft had a valid Certificate of Airworthiness (C of A) and Certificate of Registration (C of R).
2. The aircraft operator had a valid Air Operator Certificate (AOC) to conduct a scheduled passenger transport.
3. The crew held valid licenses and medical certificates.
4. The weather conditions during aircraft approach and landing was slight rain with cumulonimbus viewed nearby the airport, wind was calm and runway was wet.
5. In this flight Second in Command (SIC) acted as Pilot Flying (PF) and the Pilot in Command (PIC) acted as Pilot Monitoring (PM). The PIC took over control from the SIC during approach at altitude approximately 600 feet.
6. At approximate 550 feet, the PIC instructed the SIC to turn on the wiper and reconfirmed to SIC that the runway was in sight.
7. Between altitude 500 feet to 200 feet, the EGPWS aural warnings “Sink Rate” and “Pull Up” sounded.
8. The CCTV recorded water splash when aircraft on landing roll.
9. Several area of the runway warp in approximate 2 - 5 meters square meters with standing waters on the runway of Rendani Airport.
10. Several runway lights covered by grass with the height approximately of 30-40 cm.
11. Rendani Aerodrome Manual (AM) as general guidelines in the airport operation had not been approved by the DGCA at the time of accident.
12. Rendani Airport (WAUU), Fire fighting category III refer to AIP amended on April 2015.
Final Report:

Crash of a Cessna 208 Caravan I near Oksibil: 1 killed

Date & Time: Apr 12, 2017 at 1240 LT
Type of aircraft:
Operator:
Registration:
PK-FSO
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Tanah Merah – Oksibil
MSN:
208-0313
YOM:
1999
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
4236
Captain / Total hours on type:
2552.00
Aircraft flight hours:
6226
Aircraft flight cycles:
9371
Circumstances:
On 12 April 2017, a Cessna C208 aircraft registered PK-FSO was being operated by PT. Spirit Avia Sentosa (FlyingSAS) for unscheduled cargo flight. The flights of the day scheduled for the aircraft were Mopah Airport (WAKK) – Tanah Merah Airport (WAKT) – Oksibil Airport (WAJO) – Tanah Merah – Oksibil – Tanah Merah. The estimated time departure of first flight from Mopah Airport to Tanah Merah was 0800 LT and the flight departed at 0848 LT, on board the aircraft were two pilots and seven passengers. The aircraft arrived in Tanah Merah at about 0943 LT. At 1012 LT, the flight departed from Tanah Merah to Oksibil. About 10 Nm from Oksibil the pilot contacted the Oksibil tower controller to get air traffic services and landed at 1044 LT. The flight then departed from Oksibil to Tanah Merah at 1058 LT and arrived about 1126 LT. These flights were single pilot operation. At 1144 LT on daylight condition, the aircraft departed Tanah Merah with intended cruising altitude of 7,000 feet. Prior to departure, there was no report or record of aircraft system malfunction. On board the aircraft was one pilot, 1,225 kg of general cargo and 800 pounds of fuel which was sufficient for about 3 hours of flight time. After departure, the pilot advised Tanah Merah tower controller of the estimate time arrival at Oksibil would be 1224 LT. At 1149 LT, the pilot advised Tanah Merah tower controller that the aircraft position was about 10 Nm from Tanah Merah and passing altitude of 3,500 feet. The Tanah Merah tower controller acknowledged the message and advised the pilot to monitor radio communication on frequency 122.7 MHz for traffic monitoring. At about 29 Nm from Oksibil, the PK-FSO aircraft passed a Cessna 208B aircraft which was flying on opposite direction from Oksibil to Tanah Merah at altitude 6,000 feet. At this time, the aircraft ground speed recorded on the flight following system was about 164 knots. The Cessna 208B pilot advised to the pilot on radio frequency 122.7 MHz that the PK-FSO aircraft was in sight. The pilot responded that the aircraft was maintaining 7,000 feet on direct route to Oksibil. At 1230 LT, the Oksibil tower controller received phone call from the FlyingSAS officer at Jakarta which confirming whether the PK-FSO aircraft has landed on Oksibil. The Oksibil tower controller responded that there was no communication with the PK-FSO pilot. The Oksibil tower controller did not receive the flight plan for the second flight of the PK-FSO flight. Afterwards, the Oksibil tower controller called Tanah Merah tower controller confirming the PK-FSO flight and was informed that PK-FSO departed Tanah Merah to Oksibil at 1144 LT and the reported estimate time of arrival Oksibil was 1224 LT. At 1240 LT, the Oksibil tower controller received another phone call from the FlyingSAS officer at Jakarta which informed that the FlyingSAS flight following system received SOS signal (emergency signal) from PK-FSO aircraft and the last position recorded was on coordinate 04°48’47.7” S; 140°39’31.7” E which located approximately 6 Nm north of Oksibil. Afterwards, the Oksibil air traffic controller advised the occurrence to the Search and Rescue Agency. On 13 April 2017, at 0711 LT, the PK-FSO aircraft was found on ridge of Anem Mountain which located about 7 Nm north of Oksibil. The following figure showed the illustration of the aircraft track plotted on the Google earth refer to the known coordinates of Tanah Merah, Oksibil and the crash site.
Probable cause:
The possibility of the pilot being fatigue, physical and environment condition increased pilot sleepiness which might have made the pilot inadvertently falling asleep indicated by no pilot activity. The absence of GA-EGPWS aural alert and warning was unable to wake up the pilot.
Final Report:

Crash of an ATR72-600 in Semarang

Date & Time: Dec 25, 2016 at 1824 LT
Type of aircraft:
Operator:
Registration:
PK-WGW
Survivors:
Yes
Schedule:
Bandung – Semarang
MSN:
1234
YOM:
2015
Flight number:
IW1896
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
68
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
4065
Captain / Total hours on type:
3805.00
Copilot / Total flying hours:
3300
Copilot / Total hours on type:
3200
Aircraft flight hours:
3485
Aircraft flight cycles:
4104
Circumstances:
On 25 December 2016, an ATR 72-600 aircraft registered PK-WGW was being operated by PT. Wings Abadi Airlines (Wings Air) as a scheduled passenger flight from Husein Sastranegara International Airport (WICC), Bandung to Ahmad Yani International Airport (WAHS), Semarang with flight number WON 1896. On board the aircraft were two pilots, two flight attendants and 68 passengers. There was no report or record of aircraft system malfunction prior to the departure. The aircraft departed from Bandung at 1734 LT (1034 UTC). The Pilot in Command (PIC) acted as Pilot Flying (PF) and the Second in Command (SIC) acted as Pilot Monitoring (PM). The flight from departure until commenced for landing approach was uneventful. At 1112 UTC, at night condition, the air traffic controller of Semarang Approach unit (approach controller) informed to all traffic that the rain was falling over the airport and the pilot confirmed whether the rain was heavy and was replied that it was slight rain. At 1115 UTC, the flight held over waypoint KENDA for separation with another aircraft and maintained altitude of 4,000 feet. Two minutes later, the flight was approved to descend to altitude of 3,000 feet. At 1118 UTC, the approach controller issued clearance for RNAV approach to runway 13 and advised the pilot to report when leaving waypoint KENDA. One minute later, the pilot reported leaving waypoint KENDA and the approach controller instructed to continue approach and to contact to the air traffic controller of Semarang Tower unit (tower controller). At 1120 UTC, the pilot advised to the tower controller that the aircraft was on final and the runway was in sight. The tower controller instructed to continue the landing approach and advised that the surface wind direction was 190° with velocity of 15 knots, altimeter setting 1,008 mbs and the runway was wet. At 1121 UTC, the tower controller had visual contact to the aircraft and issued landing clearance, the pilot read back the clearance and requested to reduce the approach light intensity. The tower controller reduced the light intensity and confirmed whether the intensity was appropriate then the pilot affirmed. At 1124 UTC, the aircraft touched down and bounced. After the third bounce, the pilot attempted to go around and the aircraft touched the runway. The tower controller noticed that the red light on the right wing was lower than the green light on the left wing. The aircraft moved to the right from the runway centerline and stopped near taxiway D. The tower controller realized that the aircraft was not in normal condition and pressed the crass bell then informed the Airport Rescue and Fire Fighting (ARFF) personnel by phone that there was aircraft accident near the taxiway D. At 1126 UTC, the pilot advised the tower controller that the aircraft stopped on the runway and requested assistance. The tower controller acknowledged the message and advised the pilot to wait for the assistance. While waiting the assistance, the pilot kept the engines run to provide lighting in the cabin. At 1129 UTC, the tower controller advised the pilot to shut down the engines since the ARFF personnel had arrived near the aircraft to assist the evacuation. Passenger evacuation completed at approximately 10 minutes after the aircraft stopped.
Probable cause:
Contributing Factors:
- The visual illusion of aircraft higher than the real altitude resulted in late flare out which made the aircraft bounced.
- The unrecovered bounce resulted in abnormal landing attitude with vertical acceleration up to 6 g and collapsed the right main landing gear.
Final Report:

Crash of a Lockheed C-130H Hercules in Wamena: 13 killed

Date & Time: Dec 18, 2016 at 0609 LT
Type of aircraft:
Operator:
Registration:
A-1334
Flight Type:
Survivors:
No
Site:
Schedule:
Timika – Wamena
MSN:
4785
YOM:
1978
Country:
Region:
Crew on board:
12
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
13
Circumstances:
The four engine aircraft departed Timika-Moses Kilangin Airport at 0535LT bound for Wamena. While approaching Wamena, the crew encountered marginal weather conditions and the aircraft descended through several cloud layers when it impaxted a hilly terrain about four minutes before ETA at 0613LT. The aircraft was destroyed by impact forces and a post crash fire and all 13 occupants were killed. The wreckage was found less than 2 km southeast from runway 33 threshold.

Crash of a PZL-Mielec M28 Skytruck off Tanjung Pinang: 13 killed

Date & Time: Dec 3, 2016 at 1022 LT
Type of aircraft:
Operator:
Registration:
P-4201
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Pangkal Pinang – Batam
MSN:
AJE003-03
YOM:
2004
Country:
Region:
Crew on board:
5
Crew fatalities:
Pax on board:
8
Pax fatalities:
Other fatalities:
Total fatalities:
13
Circumstances:
The twin engine aircraft departed Pangkal Pinang Airport at 0924LT bound for the Hang Nadim Airport located on the Batam Island. En route, the aircraft disappeared from radar screens and crashed in the sea about 74 km southeast of Tanjun Pinang, in the Riau Islands. An hour later, around 1130LT, few debris and bodies were found by fishermen floating on water off Pulau Senayang. All 13 occupants were killed.

Crash of a Casa NC-212-MP Aviocar 200 in Pitu

Date & Time: Nov 27, 2016 at 1000 LT
Type of aircraft:
Operator:
Registration:
U-623
Flight Type:
Survivors:
Yes
Schedule:
Manado - Pitu
Country:
Region:
Crew on board:
5
Crew fatalities:
Pax on board:
9
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
After landing at Pitu-Leo Wattimena Airport, the twin engine aircraft went out of control and veered off runway to the right. The left main landing gear collapsed and the right wing broke at the root. All 14 occupants evacuated safely while the aircraft was damaged beyond repair.

Crash of a De Havilland DHC-4T Caribou near Ilaga: 4 killed

Date & Time: Oct 31, 2016 at 0830 LT
Type of aircraft:
Registration:
PK-SWW
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Timika - Ilaga
MSN:
303
YOM:
1972
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
4
Captain / Total flying hours:
9336
Captain / Total hours on type:
38.00
Copilot / Total flying hours:
3636
Copilot / Total hours on type:
17
Aircraft flight hours:
2748
Aircraft flight cycles:
5953
Circumstances:
A DHC-4 Caribou aircraft, registered PK-SWW was being operated by Perkumpulan Penerbangan Alfa Indonesia, on 31 October 2016 on an unscheduled cargo flight from Moses Kilangin Airport Timika, with intended destination to Kaminggaru Aerodrome, Ilaga Papua. On board on this flight was 4 persons consisted of two pilots, one company engineer and one flight operation officer. At 2257 UTC, the aircraft departed Timika with intended cruising altitude of 12,500 feet and estimated time of arrival Ilaga at 2327 UTC. At 2323 UTC, the pilot made initial contact with Ilaga Aerodrome Flight Information Services (AFIS) officer and reported that the aircraft position was at Ilaga Pass and informed the estimate time of arrival Ilaga would be on 2327 UTC. Ilaga Aerodrome Flight Information Services (AFIS) officer advised to continue descend to circuit altitude and to report when position on downwind. At 2330 UTC, the AFIS officer called the pilot and was not replied. The AFIS officer asked pilot of another aircraft in the vicinity to contact the pilot of the DHC-4 Caribou aircraft and did not reply. At 0020 UTC, Sentani Aeronautical Information Service (AIS) officer declared the aircraft status as ALERFA. At 0022 UTC, Timika Tower controller received information from a pilot of an aircraft that Emergency Locator Transmitter (ELT) signal was detected approximately at 40 – 45 Nm with radial 060° from TMK VOR (Very High Frequency Omni Range) or approximately at coordinate 4°7’46” S; 137°38’11” E. This position was between Ilaga Pass and Jila Pass. At 0053 UTC, the aircraft declared as DETRESFA. On 1 November 2016, the aircraft wreckage was found on a ridge of mountain between Ilaga Pass and Jila Pass at coordinate 4°5’55.10” S; 137°38’47.60” E with altitude approximately of 13,000 feet. All occupants were fatally injured and the aircraft destroyed by impact force.
Probable cause:
Controlled flight into terrain.
Final Report:

Crash of a Learjet 31A in Jakarta

Date & Time: Sep 25, 2016 at 1946 LT
Type of aircraft:
Operator:
Registration:
PK-JKI
Flight Type:
Survivors:
Yes
Schedule:
Yogyakarta – Jakarta
MSN:
31-213
YOM:
2001
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The crew was performing an ambulance flight from Yogyakarta-Adisujipto Airport to Jakarta-Halim Perdanakusuma Airport on behalf of the Indonesian Red Cross (Palang Merah Indonesia), carrying one patient, two doctors, two accompanists and three crew members. The approach was completed by night and marginal weather conditions. After touchdown on runway 24, the aircraft skidded on a wet runway. After a course of 1,300 metres, it veered to the right and departed the runway surface. While contacting soft ground, the right main gear was torn off while the left main gear partially collapsed. Then the aircraft bounced and impacted the ground several times, causing the left wing to be bent. Eventually, the right engine partially detached from the pylon. All eight occupants were rescued and the aircraft was damaged beyond repair. There was no fire.

Crash of a Boeing 737-347 in Wamena

Date & Time: Sep 13, 2016 at 0733 LT
Type of aircraft:
Operator:
Registration:
PK-YSY
Flight Type:
Survivors:
Yes
Schedule:
Jayapura – Wamena
MSN:
23597/1287
YOM:
1986
Flight number:
TGN7321
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
23823
Captain / Total hours on type:
9627.00
Copilot / Total flying hours:
650
Copilot / Total hours on type:
480
Aircraft flight hours:
59420
Aircraft flight cycles:
48637
Circumstances:
On 13 September 2016, a Boeing 737-300 Freighter, registered PK-YSY was being operated by PT. Trigana Air Service on a scheduled cargo flight from Sentani Airport, Jayapura (WAJJ) to Wamena Airport, Wamena (WAVV), Papua, Indonesia. Approximately 2130 UTC, during the flight preparation, the pilot received weather information which stated that on the right base runway 15 of Wamena Airport, on the area of Mount Pikei, low cloud was observed with the cloud base was increasing from 200 to 1000 feet and the visibility was 3 km. At 2145 UTC, the aircraft departed Sentani Airport with flight number IL 7321 and cruised at altitude 18,000 feet. On board the aircraft was two pilots and one Flight Operation Officer (FOO) acted as loadmaster. The aircraft carried 14,913 kg of cargo. The Pilot in Command (PIC) acted as Pilot Flying (PF) while the Second in Command (SIC) acted as Pilot Monitoring (PM). There was no reported or recorded aircraft system abnormality during the flight until the time of occurrence. After passing point MALIO, the aircraft started to descend. The pilot observed the weather met the criteria of Visual Meteorological Condition (VMC). The pilots able to identify another Trigana flight from Sentani to Wamena in front of them. While passing altitude 13,500 feet, approximately over PASS VALLEY, the Wamena Tower controller instructed the pilot to report position over JIWIKA. When the aircraft position was over point JIWIKA, the Wamena Tower controller informed to the pilot that the flight was on sequence number three for landing and instructed the pilot to make orbit over point X, which located at 8 Nm from runway 15. The pilot made two orbits over Point X to make adequate separation with the aircraft ahead prior to received approach clearance. About 7,000 feet (about 2,000 feet above airport elevation), the pilot could not identify visual checkpoint mount PIKEI and attempted to identify a church which was a check point of right base runway 15. The pilot felt that the aircraft position was on right side of runway centerline. About 6,200 feet (about 1,000 feet above airport elevation), the PF reduced the rate of descend and continued the approach. The PM informed to the PF that runway was not in sight and advised to go around. The PF was confident that the aircraft could be landed safely as the aircraft ahead had landed. Approximately 5,600 feet altitude (about 500 feet above airport elevation) and about 2 Nm from runway threshold the PF was able to see the runway and increased the rate of descend. The pilot noticed that the Enhanced Ground Proximity Warning System (EGPWS) aural warning “SINK RATE” active and the PF reduced the rate of descend. While the aircraft passing threshold, the pilot felt the aircraft sunk and touched down at approximately 125 meters from the beginning runway 15. The Flight Data Recorder recorded the vertical acceleration was 3.25 g on touchdown at 2230 UTC. Both of main landings gear collapsed. The left main landing gear detached and found on runway. The engine and lower fuselage contacted to the runway surface. The aircraft veer to the right and stopped approximately 1,890 meters from the beginning of the runway 15. No one was injured on this occurrence and the aircraft had substantially damage. Both pilots and the load master evacuated the aircraft via the forward left main cargo door used a rope.
Probable cause:
Refer to the previous aircraft that was landed safely, the pilot confidence that a safe landing could be made and disregarding several conditions required for go around.
Final Report:

Crash of a Cessna 208B Grand Caravan EX in Lolat

Date & Time: Jun 14, 2016 at 0758 LT
Type of aircraft:
Operator:
Registration:
PK-RCK
Flight Type:
Survivors:
Yes
Schedule:
Wamena – Lolat
MSN:
208B-5149
YOM:
2014
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
53
Circumstances:
The single engine airplane departed Wamena Airport at 0739LT on a cargo flight to Lolat, carrying two passengers, one pilot and a load of building materials for a total weight of 1,190 kilos. On short final to Lolat Airfield, the aircraft impacted the roof of a wooded house and crashed, bursting into flames. All three occupants of the airplane evacuated safely while three people in the house were injured. The aircraft was totally destroyed by a post crash fire.