Country
code

Special Region of Papua

Crash of a Cessna 208B Grand Caravan in Bilogai-Sugapa: 1 killed

Date & Time: Nov 23, 2011 at 0942 LT
Type of aircraft:
Operator:
Registration:
PK-VVG
Flight Type:
Survivors:
Yes
Schedule:
Nabire - Bilogai-Sugapa
MSN:
208B-1308
YOM:
2007
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
1859
Captain / Total hours on type:
1550.00
Copilot / Total flying hours:
690
Copilot / Total hours on type:
231
Aircraft flight hours:
4331
Aircraft flight cycles:
5375
Circumstances:
The flight route was Nabire to Bilogai as an unscheduled cargo flight. There were two pilots on board and the freight load was a mixture of food, palm oil, and cement. The aircraft departed from Nabire at 2355 UTC (0855 LT), the estimate time of arrival of Bilogai was 0045 UTC. At 0042 UTC the aircraft was reported above touchdown zone and the altitude recorded of 6,960 feet, direction 277 degrees and air speed 94 knots. The aircraft executed a go around due to an unauthorized person entering the shoulder of the runway 27, the aircraft then continued to climb and headed left. It was reported while the aircraft initially was climbing with the nose up but following lost altitude. During go around manoeuvre the aircraft attitude was in high nose up position, caused the angle of attack was too high and beyond a stall margins caused the aircraft stall. The aircraft bank to the right and crashed on a corn farm at coordinate S 03 44.58 E 137 0.96 and altitude about 6,550 feet with heading about 260 degrees. The aircraft was destroyed on impact with the ground. The captain seriously injured and still on seat in the aircraft wearing the shoulder harness. The second in command was fatally injured outside of the aircraft at the crashed site.
Probable cause:
FINDINGS :
• The aircraft was airworthy prior the accident and there was no evidence of system malfunction during the flight.
• The crew had valid license and medical certificate.
• There were no fences at the airport perimeter.
• There was a local plantation area nearby the runway.
• Unauthorized person entering the shoulder of the runway 27.
• There was no warning signal to alert if unauthorized persons entering the runway, especially during any aircraft Takeoff and Landing.
• The valley (gap) on the south side of the runway was too narrow for successful go around manoeuvre by a caravan aircraft.
• The aircraft most probably stalled due to very high angle of attack, when the aircraft was manoeuvre to avoid the surrounding terrain and bank to the right.
• The communication of incoming and outgoing Susi Air aircraft from and to Bilogai was only to Susi Air ground handling Agent at Sugapa.
CAUSES :
The aircraft was executed a Go Around due to a unauthorized person entering the shoulder of the runway 27, after go around, crew tried to avoid terrain impact, increasing the aircraft attitude more pitching up caused the angle of attack was higher and beyond a stall margins , finally stall just before impact.
Final Report:

Crash of a Pilatus PC-6/B2-H4 Turbo Porter near Yahatma: 3 killed

Date & Time: Sep 22, 2011 at 1313 LT
Operator:
Registration:
PK-UCE
Flight Phase:
Survivors:
No
Site:
Schedule:
Pagai - Wamena
MSN:
943
YOM:
2004
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
11312
Captain / Total hours on type:
2647.00
Aircraft flight hours:
5774
Aircraft flight cycles:
6662
Circumstances:
On 22 September 2011, a PC 6 Pilatus Porter aircraft, registration PK-UCE was being operated by Yayasan Jasa Aviasi Indonesia (YAJASI) departed from Pagai to Wamena. The aircraft departed at 0403 UTC1 (1303 LT) and estimated to arrive at Wamena was at 0436 UTC. Aircraft cruise at altitude of 10,000 feet and conducted under Visual Flight Rules (VFR) and followed the visual route via North Gap corridor, which one of visual route to Wamena. Prior to enter the North Gap corridor at time 0413 UTC, the pilot sent a message via a system they called AFFIS to the company Flight Following Officer at Sentani Airport, which was the operation base. The pilot also sent a blind transmission message through Wamena Tower radio frequency. This was local procedure, to submit the message consists of position, altitude and destination to make the other aircraft pilots aware each other. As in the intern YAJASI flight following procedure, pilot should send message when the flying passes the North Gap corridor. In this flight, until the normal elapsed time, the pilot did not send any message to their Flight Following Officer at Sentani that the flight has passed the North Gap corridor. Since there was no message nor radio contact from the pilot until the ETA in Wamena, the Flight Following Officer at Sentani informed to the other personnel at the operation base, and alarmed to the other YAJASI aircraft which were flying in that area to start search the PK-UCE. Some other aircrafts which were flying in the vicinity also contacted to search the PKUCE. PK-UCE was found in mountain location adjacent to Pass Valley airstrip. The accident site was at coordinate S 030 54’ 54.4’’, E 1390 02’ 24.3”, the aircraft was hit the trees and the ground where the elevation was about 7500 feet , the propeller blades was not on feather and bent rearward, the left wing was broken and the aircraft stopped on heading about 85°.
Probable cause:
The pilot decided to descend from the cruise altitude 10000 feet to penetrate the area of marginal weather was most likely not as what his perceive. The pilot avoided the cloud to the left of the VFR route guidance and most likely that the space available was less than the requirement stated for the Weather Minimum class F.
Final Report:

Crash of a Cessna 208B Grand Caravan near Notnare: 2 killed

Date & Time: Sep 9, 2011 at 1230 LT
Type of aircraft:
Operator:
Registration:
PK-VVE
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Wamena - Kenyam
MSN:
208B-1287
YOM:
2007
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
1546
Captain / Total hours on type:
1315.00
Copilot / Total flying hours:
927
Copilot / Total hours on type:
147
Aircraft flight hours:
3926
Aircraft flight cycles:
5267
Circumstances:
A Cessna 208B Grand Caravan I was destroyed when it crashed in the Yahukimo District, Indonesia. Both crew members were killed. The airplane was being operated on a non-scheduled cargo flight from Wamena Airport to Kenyam Aerodrome in Papua, Indonesia. The flight was being conducted under visual flight rules (VFR) and the pilot reported to ATC that the planned altitude was 9,500 feet. On board the aircraft were two pilots, a manifested load of diesel drums and grocery items, and a non-manifested load of 25 bags of rice weighing 827 lb (375 kg). The takeoff weight, based on the manifested cargo and the additional load of rice was estimated by the investigation to be 9,681 lb (4,391 Kg) which was 619 lb (281 Kg) above the certificated maximum takeoff weight. Also, the aircraft Centre of Gravity (C of G) was outside the certificated C of G envelope. The aircraft took off from Wamena runway 15 at 12:17 local time. The aircraft was then flown along a track toward Kenyam which was consistent with the route used by other company pilots and previously flown by the pilot in command. The additional loading contributed to a reduced rate of climb during the flight which resulted in the aircraft being below 10,000 ft as it approached the high terrain. This altitude was 1,500 ft lower than the altitude specified in the operator's route guide for operations between Wamena and Kenyam, and lower than the altitude flown by other company pilots when operating in the area, including three other flights on the day of the accident which overflew the high terrain between 11,200 and 12,500 ft. At 12:29:43, as the aircraft approached the high terrain at an altitude of 9,538 ft, the airspeed commenced decreasing which was accompanied by the average rate of climb increasing to about 390 fpm. It is probable that the pilots recognized the proximity of the terrain and attempted to improve the aircraft's angle of climb by decelerating towards the best angle of climb speed of 72 kts. The recorded data showed that 31 seconds after the airspeed started to decrease, the engine power varied with a maximum engine torque of 1,675 ft/lb being recorded at 12:30:30 with changes in the other engine parameters being consistent with a selection of a higher power setting. This is likely to have been associated with the pilot's attempts to improve terrain clearance. The recorded data then showed the aircraft in a descending right turn for about 6 seconds. The altitude reduced over a period of 4 seconds from 9,865 ft to 9,728 ft at an average rate of descent of about 2,000 fpm. This turn was likely to have been initiated to either avoid cloud or improve terrain clearance. The aircraft subsequently commenced to roll to the left at 12:30:35 with the left roll continuing for the following 14 seconds. It was likely that the left turn was initiated to avoid either cloud or terrain. During the left turn, the angle of bank reached a maximum value of 46° and the aircraft descended from 9,728 ft to 9,045 ft at a high rate of descent. The airspeed also increased from 92 kts to 122 kts during the descent. The engine power was reduced to idle soon after the aircraft commenced descending which was most likely due to the handling pilot attempting to recover from the high descent rate and increasing airspeed. The recorded data indicated that three EGPWS alerts activated during the descent. The aircraft had stopped descending at 12:30:50 and had commenced climbing with a reducing left angle of bank when the airplane impacted terrain at an elevation of 9,100 feet.
Probable cause:
Factors that contributed to the accident are as follows:
a. The aircraft was loaded to a weight in excess of the maximum certificated takeoff weight.
b. The aircraft climb performance was adversely affected by the aircraft being operated above the certificated maximum takeoff weight.
c. The aircraft approached high terrain along the proposed route at an altitude which was below that specified in the operator's route guide.
d. The aircraft entered a high rate of descent during a terrain avoidance maneuver.
e. Recovery from the abnormal flight path was not achieved before the aircraft collided with terrain.
Final Report:

Crash of a PZL-Mielec M-28-05PI in Mulia: 4 killed

Date & Time: Nov 2, 2009 at 1200 LT
Type of aircraft:
Operator:
Registration:
P-4202
Flight Type:
Survivors:
No
Site:
Schedule:
Jayapura – Mulia
MSN:
AJE003-04
YOM:
2004
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
4
Circumstances:
The twin engine aircraft departed Jayapura-Sentani Airport on a flight to Mulia, carrying four crew members and a load of logistics support dedicated to the Puncak Jaya Police Department. While approaching Mulia in marginal weather conditions, the aircraft struck the slope of a mountain located 33 km northwest of Mulia. The wreckage was found two days later and all four occupants were killed.
Probable cause:
Controlled flight into terrain.

Crash of a De Havilland DHC-6 Twin Otter 300 near Oksibil: 15 killed

Date & Time: Aug 2, 2009 at 1100 LT
Operator:
Registration:
PK-NVC
Flight Phase:
Survivors:
No
Site:
Schedule:
Jayapura - Oksibil
MSN:
626
YOM:
1979
Flight number:
MZ9760D
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
12
Pax fatalities:
Other fatalities:
Total fatalities:
15
Captain / Total flying hours:
8387
Captain / Total hours on type:
8387.00
Copilot / Total flying hours:
1207
Copilot / Total hours on type:
1207
Aircraft flight hours:
27336
Circumstances:
On the morning of Sunday, 2 August 2009, a de Havilland DHC-6 Twin Otter aircraft, registered PK-NVC, operated by PT. Merpati Nusantara Airlines as flight number MZ-7960D, departed from Sentani Airport, Jayapura for Oksibil Airport. The flight was planned in accordance with the visual flight rules (VFR). There were 15 persons on board; two pilots, one engineer, 10 adult passengers and two infants. The estimated flight time was 50 minutes. The fuel on board was sufficient for 2 hours and 50 minutes flight time. About 15 minutes prior to the estimated time of arrival at Oksibil the crew of another aircraft informed the Twin Otter crew that the weather in the Oksibil area was partly cloudy. There were no further reports of radio transmissions from the Twin Otter, and it did not arrive at Oksibil. A search was initiated at the time the aircraft would have run out of fuel. On the morning of 4 August 2009, searchers located the wreckage of the Twin Otter at an elevation of about 9,300 feet about 6 Nm from Oksibil. The aircraft was destroyed by impact forces, and all of the occupants were fatally injured.
Probable cause:
The pilots did not maintain visual flight procedures when flying below lowest safe altitude, and the aircraft was flown into cloud in the vicinity of gap north west of Oksibil. In conclusion, the accident was consistent with controlled flight into terrain.
Final Report:

Crash of a De Havilland DHC-6 Twin Otter 300 near Wamena: 3 killed

Date & Time: Jun 29, 2009 at 1601 LT
Operator:
Registration:
PK-BRO
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Dekai - Wamena
MSN:
756
YOM:
1981
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
The twin engine aircraft departed Dekai Airport at 1530LT on a cargo flight to Wamena, carrying three crew members and a load of 1,600 kilos of various goods. Between 1554LT and 1600LT, the crew was in contact with Wamena. At 1601LT, while cruising at an altitude of 9,600 feet in limited visibility, the aircraft collided with a mountain slope. The wreckage was found a day later about 19 km southeast from Wamena. The aircraft disintegrated on impact and all three occupants were killed.
Probable cause:
Controlled flight into terrain after the crew was flying under VFR mode in IMC conditions. IFR approach to Wamena are not possible, VFR only.

Crash of a Pilatus PC-6/B2-H4 Turbo Porter near Mulia: 11 killed

Date & Time: Apr 17, 2009 at 1015 LT
Operator:
Registration:
PK-LTJ
Flight Phase:
Survivors:
No
Site:
Schedule:
Ilaga - Mulia
MSN:
959
YOM:
2008
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
9
Pax fatalities:
Other fatalities:
Total fatalities:
11
Captain / Total flying hours:
2664
Captain / Total hours on type:
1412.00
Aircraft flight hours:
542
Circumstances:
On the morning of 17 April 2009, a Pilatus PC-6/B2-H4 Turbo Porter aircraft, registered PK-LTJ, operated by PT. Mimika Air, charter flight from Ilaga to Mulia in the Puncak Jaya District of Papua. The Mimika Local Government owned the aircraft. There were 11 people on board; one pilot, one observer, and nine passengers comprised of eight adults and one infant. The aircraft was also carrying National Government election boxes. The flight in accordance with the visual flight rules was estimated to take 18 minutes. There was no record of communication with the aircraft during the flight. Two minutes after the estimated time of arrival, when the Porter had not arrived, a search was commenced. On 18 April, search aircraft located the wreckage of the Porter at an elevation of about 12,000 feet on Mt Gergaji. The location was on the direct track between Ilaga and Mulia. The aircraft impacted the ground in an inverted attitude, and was destroyed by the impact forces and the post-impact fire. All occupants were fatally injured. The weather in the valleys along the route was mostly clear, with cloud on the mountains. The route flown by the pilot was the direct track, which passed over a mountain range, with a high peak adjacent to, and west of the track at about the midway point, at 13,700 feet. The investigation determined that it was likely that the pilot had flown the aircraft into cloud and lost control of the aircraft in instrument meteorological conditions. The impact signature was consistent with uncontrolled flight at the time of impact. This probably resulted from the pilot becoming spatially disoriented after entering cloud.
Probable cause:
The pilot may not have had adequate knowledge of the route and weather conditions, and may have been relying on Global Positioning System navigation, and was attempting to climb on the direct track over Mt Gergaji. It was likely that the pilot became spatially disoriented after entering cloud while operating under visual flight procedures, leading to a loss of control and uncontrolled impact with terrain.
Final Report:

Crash of a BAe 146-300 in Wamena: 6 killed

Date & Time: Apr 9, 2009 at 0743 LT
Type of aircraft:
Operator:
Registration:
PK-BRD
Flight Type:
Survivors:
No
Schedule:
Jayapura - Wamena
MSN:
E3189
YOM:
1990
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
6
Captain / Total flying hours:
8305
Captain / Total hours on type:
958.00
Copilot / Total flying hours:
12389
Copilot / Total hours on type:
191
Aircraft flight hours:
22225
Circumstances:
On the morning of 9 April 2009, a British Aerospace BAe 146-300 aircraft, registered PK-BRD, was being operated by PT. Aviastar Mandiri Airlines as a scheduled passenger and cargo flight from Sentani Airport to Wamena Airport, Papua. The crew consisted of two pilots, two flight attendants, an engineer, and a load master. The aircraft performed a go-around from the initial landing approach on runway 15 at Wamena. The flight crew positioned the aircraft on a right downwind leg for another landing approach. As the aircraft was turned towards the final approach for the second landing approach at Wamena it impacted terrain and was destroyed. All of the occupants were fatally injured. The Enhanced Ground Proximity Warning System (EGPWS) manufacturer performed simulations using data from the flight recorders, and two separate terrain data sources. The manufacturer informed the investigation that “the GPWS/EGPWS alerts recorded in the CVR were issued as designed”. However the enhanced Look-Ahead function appeared to have been inhibited following the go around. There was no evidence from the CVR that the crew had deliberately inhibited the terrain function of the EGPWS. The investigation determined that the EGPWS issued appropriate warnings to the flight crew, in the GPWS mode. The pilot in command did not take appropriate remedial action in response to repeated EGPWS warnings. The investigation concluded that flight crew’s lack of awareness of the aircraft’s proximity with terrain, together with non conformance to the operator’s published operating procedures, resulted in the aircraft’s impact with terrain. As a consequence of this accident, the operator took safety action to address deficiencies in its documentation for missed approach procedures at Wamena. As a result of this accident, the National Transportation Safety Committee (NTSC) also issued safety recommendations to the operator and to the Directorate General Civil Aviation (DGCA) to ensure that relevant documented safety procedures are implemented. During the investigation, safety issues were identified concerning modification of aircraft and DGCA approval of those modifications. While those safety issues did not contribute to the accident, they nevertheless are safety deficiencies. Accordingly, the NTSC report includes recommendations to address those identified safety issues.
Probable cause:
The crew did not appear to have awareness of the aircraft’s proximity with terrain until impact with terrain was imminent. The flight crew did not act on the Enhanced Ground Proximity Warning System aural warnings, and did not conform to the operator’s published operating procedures. Together, those factors resulted in the aircraft’s impact with terrain.
Final Report:

Crash of a Pilatus PC-6/B2-H4 Turbo Porter near Ndundu: 1 killed

Date & Time: Aug 9, 2008 at 2000 LT
Operator:
Registration:
PK-RCZ
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Wamena - Ndundu
MSN:
903
YOM:
1994
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
4624
Captain / Total hours on type:
2275.00
Aircraft flight hours:
6321
Circumstances:
On the Saturday 9 August 2008, a Pilatus Porter PC-6 B2-H4 aircraft, registered PK-RCZ, operated by AMA (Association of Mission Aviation) on a charter flight from Wamena, Papua, to Taive II, Papua departed at 1000 UTC. The aircraft was to pick up a medical patient from Taive II. After landing and unloading cargo at Taive II, the aircraft departed from Taive II for NduNdu, Papua, at 1106 with an estimated time of arrival of 1113. The flight was to be operated in accordance with the visual flight rules (VFR), remaining clear of cloud and navigating visually. When the aircraft had not arrived by 1213, the Wamena authorities decided to search for the aircraft. Three operators assisted the search; Association of Mission Aviation (AMA), Mission Aviation Fellowship (MAF), and Yajasi. They all reported hearing PK-RCZ’s emergency locator transmitter (ELT) signal, but were unable to reach the crash site due to the weather conditions. At 2020 (0520 local time on Sunday 10 August), the aircraft wreckage was found at an elevation of 6,400 feet at the coordinates 03° 26’ 08” S, 138° 21’ 58” E, in the area of NduNdu Pass, on the aircraft’s planned track. The crash site was about 200 feet to the left (east) of the southerly track across the Pass, on the slope of an 11,000 foot mountain. The coordinates and elevation of the lowest point in the NduNdu Pass were
03° 26’ 26” S, 138° 21’ 22” E and 5,700 feet. The pilot, the sole occupant, was fatally injured.
Probable cause:
The pilot continued the flight into cloud and did not initiate action to maintain visual flight conditions. The sector of the flight across the mountain pass was not conducted in conformance with the visual flight rules, and the pilot was did ensure that the aircraft remained clear of the terrain.
Final Report:

Ground fire of a Transall C-160NG in Wamena

Date & Time: Mar 6, 2008 at 0920 LT
Type of aircraft:
Operator:
Registration:
PK-VTQ
Flight Type:
Survivors:
Yes
Schedule:
Jayapura – Wamena
MSN:
F235
YOM:
1985
Country:
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
On 6 March 2008, a Transall C-160 aircraft, registered PK-VTQ, operated by PT. Manunggal Air, was on an unscheduled freight flight from Sentani Airport, Jayapura, to Wamena Airport, Papua. There were seven people on board; two pilots, two engineers, and three flight officers. The pilots reported that the approach and landing were normal. However, they told the investigators that both Beta lights did not illuminate during the landing roll, so they could not use reverse thrust. They reported that they used maximum brakes to slow the aircraft, and rolled through to the end of runway 15. During the 180-degree right turn at the end of the runway, they felt the left brakes grabbing, and had to use increased thrust on the left engine to assist the turn. After completing the turn, the pilots backtracked the aircraft towards taxiway “E”, about 450 meters from the departure end of runway 15. The air traffic controller informed the Transall crew that heavy smoke was coming from the left main wheels, and that they should proceed to taxiway “E” and stop on the taxiway. Before the aircraft entered taxiway “E”, the controller activated the crash alarm. The pilots stopped the aircraft on taxiway “E”, and the occupants disembarked and attempted to extinguish the wheel-bay fire with a hand held extinguisher. The airport rescue fire fighting service (RFFS) arrived at the aircraft 10 minutes after the aircraft came to a stop on taxiway “E”. It took a further 5 minutes to commence applying foam. The attempts to extinguish the fire were unsuccessful, and the fire destroyed the aircraft and its cargo of fuel in drums. Investigators found molten metal on the runway along the left wheel track for about 16 meters, about 100 meters from taxiway “E”, between taxiway “E” and the departure end of runway 15. There was also molten metal along the left wheel track on taxiway “E”.
Probable cause:
The aircraft’s left main wheels’ brakes overheated during the landing roll and a fire commenced in the brake assembly of one or more of the left main landing gear wheels. The evidence indicated that a brake cylinder and/or hydraulic line may have failed. It is likely that brake system hydraulic fluid under pressure, was the propellant that fed the fire. There was no Emergency Response Plan at Wamena. The RFFS delay in applying fire suppressant resulted in the fire engulfing the aircraft.
Final Report: