Report on aircaft accident near Hamar airport Stafsberg 19 September 2017 with Van's Aircraft RV-4, LN-ABF

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Description

The commander had bought RV-4, LN-ABF one month before the accident, and by himself done familiarization on the aircraft model. He had only four hours of flight experience with the airplane. On the 19th of September 2017 the commander flew together with a passenger on a sightseeing trip from Hamar airport Stafsberg. Video recording from the tower building at Stafsberg shows that the airplane was on a long final to runway 15, but the flight descent profile was unstable. At an altitude of approximately 300 ft (AGL), 10 seconds before the accident, the airplane stalled. FFive seconds before the accident the airplane rolled to the right and ended up near completely inverted before it entered the initial phase of a spin with the belly down. Before the airplane hit the ground, damage on the wreckage indicates that the spin rotation decreased somewhat. The airplane rotated a total of 330 degrees before it hit the ground with a steep nose angle. Both persons on board deceased.

The Accident Investigation Board Norway (AIBN) considers that the commander had not acquired sufficient flight experience on RV-4, LN-ABF. This resulted in the commander not managing to avoid loss of control.

AIBN issues two safety recommendations in connection with this investigation.

In many cases current regulations permit pilots themselves to conduct familiarization on a new aircraft model. The AIBN considers that there should be specified requirements regarding content and scale when pilots themselves conduct familiarization on aircraft models.

The AIBN considers that the simplification in EASA and the national regulations is positive, but may also be negative for aviation safety. A change to a performance-based regulatory framework requires an adaptation for the involved parties and they must be aware of what the changes entail. The AIBN issues a safety recommendation in this connection.

The Aircraft Flight Manual for LN-ABF was not complete and the few pages that were on board the airplane were only as single sheets of paper. The authority approved flight manual and accompanying documents shall be carried on board during flight. In connection with annual aircraft certification there are currently no routines to verify that the flight manual is on board. The AIBN issues a second safety recommendation in this connection.

Safety recommendation

Safety recommendation SL No. 2018/16T

19 September 2017, LN-ABF crashed near Hamar airport Stafsberg. The AIBN considers that the simplification in EASA and the national regulations may be negative for aviation safety in some areas. AIBN does not advocate changes in today’s regulations that would result in a reversal of the simplification, but generally considers that a set criteria regarding the contents and duration of familiarization training for new aircraft models in order to assist pilots to fulfil the requirements in EASA OPS Part-NCO.GEN.105 should be enforced. If possible, a qualified flight instructor should be used, but if the pilot chooses to do a self-familiarization on a new aircraft model, the CAA should issue some criteria or requirements as an aid to this familiarization. Such criteria may consist of everything from studying the Pilot Operating Handbook (or equivalent), pre-flight inspection of the aircraft, engine start, taxing, operation of systems on board, take-off and landings in different wind conditions, steep turns, slow flights, stalls and climbs and descents in turns; to emergency procedures and so on. Furthermore the AIBN considers that the CAA with advantage could issue a form or a checklist to be signed subsequent to each item being successfully performed.

The Accident Investigation Board Norway recommends that the Civil Aviation Authority Norway consider whether the current policy, which opens for pilots to do a self-familiarization on new aircraft models within the same class of aircraft without of any documentation of having met a minimum regarding contents and duration, is acceptable from a flight safety point of view.

Safety recommendation SL No. 2018/17T

19 September 2017, LN-ABF crashed near Hamar airport Stafsberg. The Aircraft Flight Manual (AFM) found in LN-ABF was not complete. The few pages that were on board the airplane were only single sheets of paper. The approved flight manual and accompanying documents is the basis in connection with familiarization on new aircraft models and the AFM shall be carried on board during flight. In connection with annual aircraft certification, no routines currently exist to verify that the flight manual is on board .

The Accident Investigation Board Norway recommends the Civil Aviation Authority Norway to consider whether routines should be added to verify that the Aircraft Flight Manual exists on board in connection with annual aircraft certifications.

Location
Hamar airport Stafsberg, Norway (ENHA)
Occurrence date
19.09.2017
ICAO Location indicator
ENHA
Aircraft
Vans RV-4
Operator
Private
Registration
LN-ABF
County
Hedmark
Type of occurrence
Accident
Type of operation
Private
Category of operation
Light, aeroplane (< 5 700kg)
Aircraft category
Landplane, Single-engine, Piston engine
FIR/AOR
ENOS (Oslo ATCC)
Skriv ut
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