Aviation News, Headlines & Alerts
Category: <span>Public Notification</span>

LionAir Flight Updated

On the flight prior the LionAir accident flight on the Boeing Max registered as PK-LQP, an off-duty fully-qualified Boeing 737-MAX 8 pilot was traveling home on flight JT-43. The plane encountered problems similar to the next flight that crashed it (i.e. the LionAir accident flight from Denpasar to Jakarta.) The crew aboard the earlier flight managed to land the aircraft at the destination. Based on the crew’s entry in the AFML, the engineer at Jakarta flushed the left Pitot Air Data Module (ADM) and static ADM to rectify the reported IAS and ALT disagree and cleaned the electrical connector plug of the elevator feel computer. The aircraft was subsequently released to carry out flight JT610.(A different crew manned the fatal flight.) The pilot was interviewed by the Kantor Komite Nasional Keselamatan Transportasi–Ministry of Transportation of the Republic of Indonesia (KNKT). The KNKT committee is responsible for investigating and reporting air transportation system accidents, serious incidents and safety deficiencies involving air transportation system operations in Indonesia.

The KNKT estimates that the release of the final report for Lion B38M in August or September 2019.

The KNKT is cooperating with Ethiopian Authorities but will make no official comment. News media reports suggest that on the earlier LionAir flight, a third pilot had occupied the observer’s seat in the cockpit of flight JT-43 and that this pilot identified the automatic trim runaway issue at hand and initiated that the trim cut out switches be used.

The preliminary report on the LionAir crash is located HERE.

Update to “Cold Temperature Restricted Airports” list

Subject: Update to “Cold Temperature Restricted Airports” list located in Notice to Airmen Publication (NTAP) Graphic Notices. www/faa.gov/air_traffic/publications/notices.

Purpose: This publication provides operators with information related to cold temperature altitude restrictions. It contains the addition and subtraction of airports to the Cold Temperature Restricted Airports list located in the NTAP.

Background: In response to recognized safety concerns over cold weather altimetry errors, the Federal Aviation Administration (FAA) completed a risk analysis to determine if current Title 14 of the Code of Federal Regulations (14 CFR) Part 97 instrument approach procedures in the United States National Airspace System (NAS) are at risk during cold temperature operations. From this study the FAA published an NTAP providing pilots a list of airports, the affected segments and procedures needed to correct published altitudes at the restricted temperatures.

Discussion: Pilots may correct all altitudes from the initial approach fix (IAF) through the missed approach (MA) final holding altitude (All Segments Method). There will be a single temperature in Celsius (C) next to the snowflake ICON to indicate when this procedure will be required. Pilots wishing to use the All Segments Method and familiar with the NTAP procedure for applying a correction are not required to review the NTAP airport list for affected segments. Pilots wishing to continue correcting segment by segment must review the NTAP airports list for segment(s) affected (NTAP Segment(s) Method). The front matter in the FAA U.S Terminal Procedures Publication will also provide this information.

Added Airports

Idaho: Driggs-Reed Memorial (KDIJ) (-31C)

Maine: Greenville Muni (3B1) (-29C)

New Hampshire: Laconia Muni (KLCI) (-25C), Parlin Field (2B3) (-24C)

Pennsylvania: Washington County (KAFJ) (-27C)

South Dakota: Pine Ridge (KIEN) (-33C)

Washington: Richland (KRLD) (-19C)

Deleted Airports

Alaska: Perryville (PAPE), Togiak (PATG), Willow (PAUO), White Mountain (PAWM)

Colorado: Spanish Peaks Airfield (4V1), McElroy Airfield (20V), Walden-Jackson County (33V)

Maine: Eastern Slopes Rgnl (KIZG)

Maryland: Greater Cumberland Rgnl (KCBE)

Massachusetts: Walter J. Koladza (KGBR)

Minnesota: St Paul Downtown Holman Fld (KSTP), Tower Municipal (12D)

Montana: Cut Bank Intl (KCTB), Deer Lodge City County (38S)

Nevada: Carson (KCXP), Minden-Tahoe (KMEV)

New Hampshire: Dillant-Hopkins (KEEN)

New Mexico: Taos Rgnl (KSKX)

New York: Dansville (KDSV), Massena Intl-Richards Field (KMSS), Hamilton Muni (KVGC), Cortland County-Chase Field (N03), Randall (06N), Schenectady County (KSCH)

North Dakota: Watford City Muni (S25)

Oregon: Astoria Rgnl (KAST)

Pennsylvania: Seamans Field (9N3)

The current T-XX°C/XX°F icon will be changed to T-XX°C.

This change will be done incrementally on airport approach plates. The icon indicates a cold temperature altitude correction will be required on an approach when the reported temperature is, “at or below” the temperature specified for that airport. During this process, pilots may see temperatures on the current approach plates that are different than the temperature listed in the NTAP. The NTAP temperature is the updated temperature. Pilots may use the temperature published in the current TPP to make corrections if warmer than the NTAP listed temperature.

Pilots must understand they will be responsible for applying altitude corrections and must advise Air Traffic Control (ATC) when these corrections are to be made on any segment other than the final segment. Air Traffic Control is not responsible for making any altitude corrections and/or advising pilots that an altitude correction is required at a restricted airport.

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#MH17 Public Statements


On the evening of July 17, the Federal Aviation Administration issued a Notice to Airman (NOTAM) prohibiting U.S. flight operations until further notice, in the airspace over eastern Ukraine, due to recent events and the potential for continued hazardous activities. The restricted area includes the entire Simferopol and Dnepropetrovsk flight information regions (FIRs). This action expands a prohibition of U.S. flight operations issued by the FAA in April, over the Crimean region of Ukraine and adjacent areas of the Black Sea and the Sea of Azov. No scheduled U.S. airlines are currently flying routes through this airspace.

The NOTAM reads:



ICAO Monitoring Loss of Malaysia Airlines Flight MH17
?The International Civil Aviation Organization (ICAO) expresses its deep regrets following the loss of the passengers and crew aboard Malaysia Airlines Flight MH17. ICAO is closely monitoring reports on this tragic incident and is coordinating with all relevant parties.

ICAO recently issued a State letter advising States and their air operators of a potentially unsafe situation arising from the presence of more than one air traffic services provider in the Simferopol Flight Information Region (FIR). The loss of MH17 occurred outside of the Simferopol FIR and ICAO stands ready to support the accident investigation upon request.


From Malaysia Airlines

Friday, July 18, 04:15 AM SGT +0800 Statement by Prime Minister Najib Razak: Malaysian Airlines flight 17
Yesterday evening, I was informed of the terrible and deeply shocking news that a Malaysia Airlines jet went down in eastern Ukraine.

Malaysia Airlines has confirmed that the jet was Malaysia Airlines flight 17, which was on a scheduled flight from Amsterdam to Kuala Lumpur.

The flight departed Amsterdam at 12.15pm, local time. It was scheduled to arrive in Kuala Lumpur at 6.10 am, local, Malaysian time.

The aircraft was a Boeing 777-200.

The aircraft’s flight route was declared safe by the International Civil Aviation Organisation.

And International Air Transportation Association has stated that the airspace the aircraft was traversing was not subject to restrictions.

Malaysia Airlines has confirmed that the aircraft did not make a distress call.

The flight was carrying a total number of 295 people – comprising 280 passengers and 15 crew members.

Malaysia Airlines is in the process of notifying the next-of-kin of the passengers and crew. All possible care will be provided to the next-of-kin.

The Government of Malaysia is dispatching a special flight to Kiev, carrying a Special Malaysia Disaster Assistance and Rescue Team, as well as a medical team.

According to information provided by Kiev Air Traffic Control, the location of the plane’s emergency locator beacon is 48 degrees 7 minutes and 23 seconds North; and 38 degrees 31 minutes and 33 seconds East.

The Ukrainian authorities believe that the plane was shot down.

At this early stage, however, Malaysia is unable to verify the cause of this tragedy.

But we must – and we will – find out precisely what happened to this flight.

No stone can be left unturned.

If it transpires that the plane was indeed shot down, we insist that the perpetrators must swiftly be brought to justice.

Emergency operations centres have been established. In the last few hours, Malaysian officials have been in constant contact with their counterparts in Ukraine and elsewhere.

And I will be speaking to a number of world leaders over the coming hours.

I have had several conversations with the Prime Minister of the Netherlands.

I have also spoken to the President of Ukraine. He has pledged that there will be a full, thorough and independent investigation, and Malaysian officials will be invited to take part.

The Ukrainian president also confirmed that his government will negotiate with rebels in the east of the country, in order to establish a humanitarian corridor to the crash site.

Just now, I received a call from President Obama.

He and I both agreed that the investigation must not be hindered in anyway.

An international team must have full access to the crash site.

And no one should interfere with the area, or move any debris, including the black box.

This is a tragic day, in what has already been a tragic year, for Malaysia.

As we work to understand what happened, our thoughts and prayers are with the family and friends of those onboard the flight.

I cannot imagine what they must be going through at this painful time.

The flight’s passengers and crew came from many different countries.

But today, regardless of nationality, we are all united in grief.


Friday, July 18, 12:30 AM SGT +0800 Media Statement 1: MH17 Incident
Media Statement 1: MH17 Incident

Malaysia Airlines confirms it received notification from Ukrainian ATC that it had lost contact with flight MH17 at 1415 (GMT) at 30km from Tamak waypoint, approximately 50km from the Russia-Ukraine border.

Flight MH17 operated on a Boeing 777 departed Amsterdam at 12.15pm (Amsterdam local time) and was estimated to arrive at Kuala Lumpur International Airport at 6.10 am (Malaysia local time) the next day.

The flight was carrying 280 passengers and 15 crew onboard.

More details to follow.


Statement by Prime Minister Mark Rutte in response to the Ukraine air disaster
News item | 17-07-2014

I am deeply shocked by the dramatic reports of the air disaster involving Malaysia Airlines flight MH17 from Amsterdam to Kuala Lumpur over Ukrainian territory. Much remains unclear as regards the cause and circumstances of the crash and those on board the aircraft. I have just spoken to the Ukrainian president.

I am now on my way back to the Netherlands to monitor and address the situation from The Hague.

Our thoughts are with those who were on board the aircraft and their family and friends.

Statement Minister Opstelten on flight MH17
News item | 17-07-2014

Response by Minister Opstelten the messages about the crash of flight MH17.

I am deeply shocked by the tragic news about the crash of flight MH17 from Malaysian Airlines from Amsterdam to Kuala Lumpur over Ukrainian territory. Here are casualties from many countries, while there are also many Dutch.

My thoughts are with all the relatives and friends of the people who were in that plane and who are now in limbo.

The images that you and I have seen are of course terrible. But still many are unclear about the facts and circumstances.

There is obviously researched. Once the situation gives cause to reveal additional information. Malaysian Airlines gives an explanation as soon as possible so I understand now.

I am aware that this research can never go fast enough, but everyone does at this time every effort to inform family and friends. As well as possible For relatives of passengers of flight MH17 is as soon as possible a phone announced by Schiphol for more information and care. Is directly communicated. Once known

Here I must leave it at that, I’m going back to be informed by my team. Closer to me

Second statement of Prime Minister Mark Rutte on flight MH17.

It has taken place in Ukraine where MH17 flight, en route from Amsterdam to Kuala Lumpur, crashed. Terrible disaster On board were 283 passengers and 15 crew members. Among the passengers were at least 154 Dutch.

The worst case scenario has become reality. We are struck by one of the largest aviation disasters in Dutch history.

The Netherlands is shocked by this tragic event.

Our thoughts go out to the families, who are facing. With an intense sadness

We live very with them.

The relatives of the victims to the extent known to be informed.

There is still much uncertainty about the exact cause of the disaster.

Believe me that we are doing everything to find out. The facts as soon as possible

Also everything is being done to repatriate the deceased. Asap

Survivors and relatives of victims in a special issue of Foreign Affairs rightly. The number is: 070-3487770

There is currently a consular assistance team en route to Kiev to strengthen. NL embassy

There is also a team of the Dutch Embassy in Malaysia present at the airport in Kuala Lumpur to accommodate. Relatives there

You’ll have lots of questions, I understand very well, but many questions we can not answer at this time.

Tomorrow we hope to have more information available and you will be informed about naturally.

Embraer Issues Worldwide Alert after VA Found Fault in Aircraft’s Bolts

EmbraerEmbraer has issued a worldwide alert after heavy maintenance carried out by Virgin Australia on June 26-26 pointed out a fault in the engine-holding bolts of Embraer 190 aircrafts.

Out of 17 Embraer 190 aircraft present in the fleet, 9 had issues with the bolts which hold the aircraft’s engine in the engine pylon, attached to the wing.

The airline grounded all 9 aircrafts for repairs and informed the Brazilian manufacturing company of the issue. Embraer then issued an alert service bulletin to all the airlines operating Embraer 190 aircrafts. The Civil Aviation Safety Authority was also informed about the problem.

A statement released by Virgin Australia airlines said, “These aircraft have since undergone the necessary precautionary repairs and have since returned to service… At Virgin Australia, the safety of our aircraft is our highest priority and we have been in regular dialogue with Embraer regarding this alert.”

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Press Release: Airline Consumer Complaints Down From Previous Year

WASHINGTON – Airline consumer complaints filed with DOT’s Aviation Consumer Protection Division during the first nine months of this year were down 14.1 percent from the first nine months of 2012, according to the U.S. Department of Transportation’s Air Travel Consumer Report released today.
From January to September 2013, the Department received 10,439 consumer complaints, down from the total of 12,153 filed during the first nine months of 2012. In September, the Department received 1,008 complaints about airline service from consumers, down 6.8 percent from the 1,081 complaints filed in September 2012 and down 23.5 percent from the 1,318 received in August 2013.

The consumer report also includes data on tarmac delays, on-time performance, cancellations, chronically delayed flights, and the causes of flight delays filed with the Department’s Bureau of Transportation Statistics (BTS) by the reporting carriers. In addition, the consumer report contains information on airline bumping, mishandled baggage reports filed by consumers with the carriers, and disability and discrimination complaints received by DOT’s Aviation Consumer Protection Division. The consumer report also includes reports of incidents involving the loss, death, or injury of pets traveling by air, as required to be filed by U.S. carriers.

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DOT Fines US Airways for Failure to Provide Wheelchair Assistance to Passengers with Disabilities

WASHINGTON – The U.S. Department of Transportation (DOT) today fined US Airways $1.2 million for failing to provide adequate wheelchair assistance to passengers in Philadelphia and Charlotte, N.C. The fine is one of the largest ever assessed by DOT in a disability case.

“All air travelers deserve to be treated equally and with respect, and this includes persons in wheelchairs and other passengers with disabilities,” said U.S. Transportation Secretary Anthony Foxx. “We will continue to make sure that airlines comply with our rules and treat their passengers fairly.”

Under DOT’s rules implementing the Air Carrier Access Act, airlines are required to provide free, prompt wheelchair assistance upon request to passengers with disabilities. This includes helping passengers to move between gates and make connections to other flights.
In one of its periodic reviews of airline compliance with DOT rules, the Department’s Aviation Enforcement Office found that US Airways committed a significant number of violations of the requirements for wheelchair assistance during 2011 and 2012 at Philadelphia International Airport and Charlotte Douglas International Airport. As part of its review, the Enforcement Office examined approximately 300 complaints filed by passengers with the airline and DOT relating to incidents at Philadelphia and Charlotte, which covered only a sample of complaints filed over two years against US Airways for the two airports. The airline’s use of a combination of electric carts and wheelchairs to carry passengers between gates required frequent transfers and led to long delays. Some passengers missed connections because of the delays or were left unattended for long periods of time.

Of the $1.2 million fine, US Airways may use up to $500,000 for improvements in its service to passengers with disabilities that are beyond what DOT rules require. These include hiring managers to ensure the quality of the airline’s disability services in Philadelphia and Charlotte, creating a telephone line to assist these passengers, purchasing tablets and other equipment to monitor assistance requests, providing compensation to passengers with disability-related complaints, and programming the airline’s computers so that boarding passes identify passengers who request special services.

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The National Transportation Safety Board announced today that it has issued a Final Rule to implement several changes to its Rules of Practice applicable to aviation certificate enforcement appeals. This final rule responds to public comments received by the NTSB as a result of an interim final rule (IFR) it issued last October. The NTSB issued the IFR after the enactment of the Pilot’s Bill of Rights legislation and it became effective upon its publication in the Federal Register on October 16, 2012.

Under the Pilot’s Bill of Rights: (1) the Federal Aviation Administration (FAA) must disclose its enforcement investigative report (EIR) to the FAA certificate holder in an aviation certificate enforcement case; (2) NTSB administrative law judges must apply the Federal Rules of Civil Procedure and Federal Rules of Evidence in enforcement cases; and (3) litigants now have the option of appealing the NTSB’s final orders to either a Federal district court or a Federal court of appeals. The IFR implemented these Pilot’s Bill of Rights requirements. Under the IFR, an FAA certificate holder is permitted to submit a motion to dismiss an FAA complaint if the FAA fails to disclose releasable portions of its EIR. The NTSB received 10 comments in response to the IFR. The Final Rule describes these comments in detail, as most of the comments provided substantive feedback and suggestions.

In considering the IFR comments, the NTSB determined it should include a proposal to extend the EIR availability requirement in the Pilot’s Bill of Rights to emergency enforcement cases. As a result, the NTSB is also publishing a new Notice of Proposed Rulemaking (NPRM) in conjunction with publication of the Final Rule in the Federal Register.

Both the Final Rule and NPRM are available at http://www.gpo.gov/fdsys/pkg/FR-2013-09-19/pdf/2013-22634.pdf (Final Rule) and http://www.gpo.gov/fdsys/pkg/FR-2013-09-19/pdf/2013-22633.pdf (NPRM). The public may submit comments to the NPRM, concerning the proposal to require the FAA to make available the EIR in emergency enforcement cases, via www.regulations.gov, Docket No. NTSB-GC-2011-0001, or via postal mail or facsimile, addressed to the NTSB Office of General Counsel. Comments should be submitted no later than October 21, 2013. The Final Rule is immediately effective.

See the bill below

In George’s Point of View

Time to take note of the final rule. The public can submit their opinion at http://www.regulations.gov, Docket No. NTSB-GC-2011-0001, or via postal mail or facsimile, addressed to the NTSB Office of General Counsel.

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The National Transportation Safety Board is devoting two days at its Training Center to offer guidance to aviation public affairs professionals on how to most effectively manage emergency communications following a major aircraft accident or incident.

The training will be offered on October 24-25, 2013, at the NTSB Training Center in Ashburn, Virginia, (near Washington, D.C.) and is aimed at communications professionals working with airports, airlines, air charter operators and corporations with aviation departments.

NTSB specialists will explain the process by which investigation-related information is verified and released to the news media and the family members of those affected by a major accident.

Members of the national news media will be there to discuss how they cover aviation accidents and how social media is changing how breaking news is disseminated and consumed. Aviation communications professionals will provide case studies highlighting best practices and lessons learned during previous aircraft incidents and accidents.

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NTSB Issues 9 New Safety Recommendations

NTSB Issues Nine New Safety Recommendations as a Result of Its Investigation of the 8/26/2011 Crash of a Eurocopter AS350 B2 Near Mosby, Missouri

May 6, 2013 The National Transportation Safety Board Issues the Following Recommendations to the Following Organizations:

  • Prohibit flight crewmembers in 14 Code of Federal Regulations Part 135 and 91 subpart K operations from using a portable electronic device for nonoperational use while at their duty station on the flight deck while the aircraft is being operated. (A-13-007)
  • Require all 14 Code of Federal Regulations Part 121, 135, and 91 subpart K operators to incorporate into their initial and recurrent pilot training programs information on the detrimental effects that distraction due to the nonoperational use of portable electronic devices can have on performance of safety-critical ground and flight operations. (A-13-008)
  • Require all 14 Code of Federal Regulations Part 121, 135, and 91 subpart K operators to review their respective general operations manuals to ensure that procedures are in place that prohibit the nonoperational use of portable electronic devices by operational personnel while in flight and during safety-critical preparatory and planning activities on the ground in advance of flight. (A-13-009)
  • Inform pilots of helicopters with low inertia rotor systems about the circumstances of this accident, particularly emphasizing the findings of the simulator flight evaluations, and advise them of the importance of simultaneously applying aft cyclic and down collective to achieve a successful autorotation entry at cruise airspeeds. (A-13-010)
  • Revise the Helicopter Flying Handbook to include a discussion of the entry phase of autorotations that explains the factors affecting rotor rpm decay and informs pilots that immediate and simultaneous control inputs may be required to enter an autorotation. (A-13-011)
  • Require the installation of a crash-resistant flight recorder system on all newly manufactured turbine-powered, nonexperimental, nonrestricted-category aircraft that are not equipped with a flight data recorder and a cockpit voice recorder and are operating under 14 Code of Federal Regulations Parts 91, 121, or 135. The crash-resistant flight recorder system should record cockpit audio and images with a view of the cockpit environment to include as much of the outside view as possible, and parametric data per aircraft and system installation, all as specified in Technical Standard Order C197, “Information Collection and Monitoring Systems.” (A-13-012)
  • Require all existing turbine-powered, nonexperimental, nonrestricted-category aircraft that are not equipped with a flight data recorder or cockpit voice recorder and are operating under 14 Code of Federal Regulations Parts 91, 121, or 135 to be retrofitted with a crash-resistant flight recorder system. The crash-resistant flight recorder system should record cockpit audio and images with a view of the cockpit environment to include as much of the outside view as possible, and parametric data per aircraft and system installation, all as specified in Technical Standard Order C197, “Information Collection and Monitoring Systems.” (A-13-013)

    To Air Methods Corporation:

  • Expand your policy on portable electronic devices to prohibit their nonoperational use during safety-critical ground activities, such as flight planning and preflight inspection, as well as in flight. (A-13-014)
  • Revise company procedures so that pilots are no longer solely responsible for nonroutine operational decisions but are required to consult with the Air Methods Operational Control Center for approval to accept or continue a mission when confronted with elevated risk situations, such as fuel-related issues and unplanned deviations. (A-13-015)

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The National Transportation Safety Board will lead a team to assist the Afghanistan Ministry of Transportation and Commercial Aviation in the investigation of a cargo plane crash at Bagram Air Base in Afghanistan.

NTSB Senior Air Safety Investigator Tim LeBaron will be the U.S. accredited representative. He will lead a team of three additional investigators from the NTSB as well as representatives from the Federal Aviation Administration and The Boeing Company.

The private cargo plane, a Boeing 747-400 operated by National Air Cargo, crashed just after takeoff from the U.S.-operated air base at 11:20 a.m. local time Monday. All seven crewmembers onboard were killed and the airplane destroyed. The seven crew members were all American citizens. The accident site is within the perimeter of Bagram Air Base.

The international cargo flight was destined for Dubai World Central – Al Maktoum International Airport, Dubai, United Arab Emirates.

The Afghanistan Ministry of Transportation and Commercial Aviation is leading the investigation and will be the sole source of information regarding the investigation. According to the International Civil Aviation Organization, they can be reached at (873) 68 2341450 / 49 or by fax at (873) 68 1280784.

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FAA and Port Authority of New York and New Jersey Reach Agreement on Airport Safety Violations

WASHINGTON – The Federal Aviation Administration (FAA) and the Port Authority of New York and New Jersey (PANYNJ) have reached a settlement agreement about aircraft rescue and firefighting (ARFF) violations from December 2010 to June 2012 at four New York area airports owned and operated by the PANYNJ — John F. Kennedy, Teterboro, LaGuardia, and Newark Liberty International.

“We expect all airports to comply with our safety regulations and to correct any deficiencies immediately,” said U.S. Transportation Secretary Ray LaHood. “These violations were egregious, and they will not be tolerated.”

Under the agreement, the PANYNJ agrees to pay a $3.5 million fine within 30 days. If there is a violation of the settlement agreement, the FAA will impose an additional fine of $1.5 million and will assess an additional $27,500 daily for each violation. In addition to the fine, the PANYNJ has agreed to take the following actions, with FAA approval, to address the underlying problems that led to systemic noncompliance with ARFF requirements at the four airports:

  • The Port Authority will create a dedicated ARFF force to carry out airport-related ARFF functions with no collateral police officer duties.
  • The staff will report directly to the Department of Aviation and be operational no later than March 31, 2014.
  • The Port Authority will hire an ARFF fire chief and facility captains as soon as possible, but no later than March 31, 2014.
  • The Port Authority will submit a curriculum for training to the FAA on or before December 31, 2013, which includes at least 75 hours of initial ARFF training and 40 hours of annual recurrent firefighting training in addition to Part 139 training, pertaining to an airport’s operational and safety standards and providing for such things as firefighting and rescue.
  • The ARFF personnel will work a 12-hour shift.
  • The Port Authority will amend the airport certification manuals for the four airports to include: an organizational chart; a process to maintain ARFF training records; and a description of ARFF operations, including shift assignments, personnel training records management, and Department of Aviation oversight.
  • The Port Authority will conduct monthly internal audits of ARFF training and shift assignments and annual external audits to ensure that all ARFF personnel assigned to a shift are trained.

“We expect the Port Authority to have trained safety personnel to ensure the safety of the travelling public and airport personnel, just like we have at all airports in the United States,” said FAA Administrator Michael P. Huerta.

The FAA became aware of ARFF violations as a result of an annual airport certification safety inspection of JFK in December 2011. The FAA also discovered similar violations at Teterboro, which prompted a full review of training at LaGuardia, Newark Liberty International, and Stewart International Airports. The review of ARFF training revealed violations at LaGuardia and Newark, with no violations at Stewart.

The FAA believes the settlement agreement provides the best long-term solution to ensure ARFF compliance, given the systemic nature of the PANYNJ airport problems.

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FAA Delays Closure of 149 Air Traffic towers until June 15

WASHINGTON – The U.S. Department of Transportation’s Federal Aviation Administration (FAA) announced today that it will delay the closures of all 149 federal contract air traffic control towers until June 15. Last month, the FAA announced it would eliminate funding for these towers as part of the agency’s required $637 million budget cuts under sequestration.

This additional time will allow the agency to attempt to resolve multiple legal challenges to the closure decisions. As part of the tower closure implementation process, the agency continues to consult with airports and operators and review appropriate risk mitigations. Extending the transition deadline will give the FAA and airports more time to execute the changes to the National Airspace System.
“This has been a complex process and we need to get this right,” said U.S. Transportation Secretary Ray LaHood. “Safety is our top priority. We will use this additional time to make sure communities and pilots understand the changes at their local airports.”

As of today, approximately 50 airport authorities and other stakeholders have indicated they may join the FAA’s non-Federal Contract Tower program and fund the tower operations themselves. This additional time will allow the FAA to help facilitate that transition.

“We will continue our outreach to the user community to answer any questions and address their concerns about these tower closures,” said FAA Administrator Michael Huerta.

On March 22, the FAA announced that it would stop federal funding for 149 contract towers across the country. A phased, four-week closure process was scheduled to begin this Sunday, April 7. That phased closure process will no longer occur. Instead, the FAA will stop funding all 149 towers on June 15 and will close the facilities unless the airports decide to continue operations as a nonfederal contract tower.

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February 7, 2013
WASHINGTON – At a news conference today, NTSB Chairman Deborah A.P. Hersman identified the origin of the Jan. 7 battery fire that occurred on a Japan Airlines 787 parked at Boston Logan Airport, and said that a focus of the investigation will be on the design and certification requirements of the battery system.

“U.S. airlines carry about two million people through the skies safely every day, which has been achieved in large part through design redundancy and layers of defense,” said Hersman. “Our task now is to see if enough – and appropriate – layers of defense and adequate checks were built into the design, certification and manufacturing of this battery.”

After an exhaustive examination of the JAL lithium-ion battery, which was comprised of eight individual cells, investigators determined that the majority of evidence from the flight data recorder and both thermal and mechanical damage pointed to an initiating event in a single cell. That cell showed multiple signs of short circuiting, leading to a thermal runaway condition, which then cascaded to other cells. Charred battery components indicated that the temperature inside the battery case exceeded 500 degrees Fahrenheit.

As investigators work to find the cause of the initiating short circuit, they ruled out both mechanical impact damage to the battery and external short circuiting. It was determined that signs of deformation and electrical arcing on the battery case occurred as a result of the battery malfunction and were not related to its cause.

Chairman Hersman said that potential causes of the initiating short circuit currently being evaluated include battery charging, the design and construction of the battery, and the possibility of defects introduced during the manufacturing process.

During the 787 certification process, Boeing studied possible failures that could occur within the battery. Those assessments included the likelihood of particular types of failures occurring, as well as the effects they could have on the battery. In tests to validate these assessments, Boeing found no evidence of cell-to-cell propagation or fire, both of which occurred in the JAL event.

The NTSB learned that as part of the risk assessment Boeing conducted during the certification process, it determined that the likelihood of a smoke emission event from a 787 battery would occur less than once in every 10 million flight hours. Noting that there have been two critical battery events on the 787 fleet with fewer than 100,000 flight hours, Hersman said that “the failure rate was higher than predicted as part of the certification process and the possibility that a short circuit in a single cell could propagate to adjacent cells and result in smoke and fire must be reconsidered.”

As the investigation continues, which will include testing on some of the batteries that had been replaced after being in service in the 787 fleet, the NTSB will continue to share its findings in real time with the FAA, Boeing, the Japan Transport Safety Board, and the French investigative agency, the Bureau d’Enquêtes et d’Analyses.

“The decision to return the fleet to flight will be made by the FAA, which underscores the importance of cooperation and coordination between our agencies,” Hersman said.

She also announced that the NTSB would release an interim report of factual findings within 30 days.

Additional information, including a video of the today’s media briefing, the PowerPoint presentation, the FAA’s Special Conditions for the B-787 battery system, and related documents, can be accessed at http://go.usa.gov/4K4J.

Redwings Airlines Suspension Pending

Red Wings Airlines is grounded. Almost.

Beginning Feb 4, Red Wings will be suspended due to the results of an inspection that turned up pilot training and flight preparation breaches.

The Red Wings fleet is made up of Tu-204 jets.

WE WONDER if the airline is under safety suspension why they are waiting until Feb 4 to ground the airline. If it is truly unsafe, why is it not immediately grounded? Why wait?

Rosaviatsia has said it had found various violations, and claims the airline’s financial problems prevent adequate fleet maintenance.

The airline is owned by Alexander Lebedev who is affiliated with the Novaya Gazeta; his son owns Britain’s The Independent and Evening Standard.

Lebedev said the suspension is unfounded, that his airline was unfairly targeted, a political move, and a campaign against Tu-204 planes.

On January 31, Rosaviatsia officials questioned if Tupolev Tu-204 airliners should have been grounded after Tu-204 reverser failure at Moscow Vnukovo International Airport resulted in an accident that killed 5 Red Wings crew and injured 3.

On December 29, 2013, a Red Wings Tu-204 crashed on landing after overrunning runway 19 when engine thrust reverser shells to fail to deploy at Moscow Vnukovo International Airport. 8 crew aboard, 5 fatalities, 3 injuries.

On December 20, 2012, a Red Wings Tupolev Tu-204-100V skidded off the runway during landing at Tolmachevo Airport . No fatalities.

On May 24, 2009, a Red Wings Tupolev Tu-204 developed fuel system problems and diverted to Krasnodar. No fatalities.

On August 2, 2008, a Red Wings Tupolev Tu-204 made an emergency landing in Minsk after an engine failure. No fatalities.

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Fourth Investigative Update on Boeing 787 Battery Fire

NTSB Provides Fourth Investigative Update on Boeing 787 Battery Fire in Boston

January 27, 2013
WASHINGTON – The National Transportation Safety Board today released a fourth update on its investigation into the Jan. 7 fire aboard a Japan Airlines Boeing 787 at Logan International Airport in Boston. The fire occurred after the airplane had landed and no passengers or crew were onboard.

The event airplane, JA829J was delivered to JAL on December 20, 2012. At the time of the battery fire, the aircraft had logged 169 flight hours with 22 cycles. The auxiliary power unit battery was manufactured by GS Yuasa in September 2012.

NTSB investigators have continued disassembling the internal components of the APU battery in its Materials Laboratory in Washington, and disassembly of the last of eight cells has begun. Examinations of the cell elements with a scanning-electron microscope and energy-dispersive spectroscopy are ongoing.

A cursory comparative exam has been conducted on the undamaged main battery. No obvious anomalies were found. More detailed examination will be conducted as the main battery undergoes a thorough tear down and test sequence series of non-destructive examinations.

In addition to the activities at the NTSB lab, members of the investigative team continue working in Seattle and Japan and have completed work in Arizona. Their activities are detailed below.

The airworthiness group completed testing of the APU start power unit at Securaplane in Tucson and the APU controller at UTC Aerospace Systems in Phoenix. Both units operated normally with no significant findings.

Two additional NTSB investigators were sent to Seattle to take part in FAA’s comprehensive review. One of the investigators will focus on testing efforts associated with Boeing’s root cause corrective action efforts, which FAA is helping to lead. The other will take part in the FAA’s ongoing review of the battery and battery system special conditions compliance documentation.

The NTSB-led team completed component examination of the JAL APU battery monitoring unit at Kanto Aircraft Instrument Company, Ltd., in Fujisawa, Kanagawa, Japan. The team cleaned and examined both battery monitoring unit circuit boards, which were housed in the APU battery case. The circuit boards were damaged, which limited the information that could be obtained from tests, however the team found no significant discoveries.

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January 25, 2013
WASHINGTON – The National Transportation Safety Board will hold a Board meeting to determine the probable cause of the crash of an air tour helicopter near Las Vegas.

On December 7, 2011, at about 4:30 pm PST, a Eurocopter AS350-B2 helicopter, operated by Sundance Helicopters, Inc., on a sightseeing trip, crashed in mountainous terrain about 14 miles east of Las Vegas, Nevada. The pilot and four passengers were killed, and the helicopter was destroyed by impact forces and postimpact fire.
Event: Board Meeting
Date/Time: Tuesday, January 29, 2013, 9:30 am EST
Location: NTSB Board Room and Conference Center
429 L’Enfant Plaza, SW
Washington, DC 20594
Participants: NTSB Board Members
Live Webcast: A link to the webcast will be available on the following page shortly before the start of the meeting: http://www.capitolconnection.net/capcon/ntsb/ntsb.htm

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FAA Issues Battery Statement. And Me Too…Attention, Boeing…

My experts are telling me that it looks like Boeing is all alone on these 787 battery fires. The FAA issued 31 ‘Special Conditions’ (you can read that to mean that the FAA gave Boeing a whole lot of slack) but this battery problem is not getting a free ride, or any favors.

SAFETY is the top priority. Make no mistake. The sooner the Dreamliner and its battery is grounded, the sooner the fix will be found and it will be safe to fly again. Well. While you’re at it fixing the battery problem, get that team of pilots who fly this thing to go over all areas of failure thus far, including the engines. Look at ALL of these…

  • Nov 6 2010: Boeing flight Texas: electrical problems in the aft electronics bay which disabled the primary flight displays in the cockpit.
  • Nov 6 2011: ANA Flight Okayama forced to deploy the landing gear using the alternate extension backup system, after an active warning light, which said that the wheels were not properly down.
  • July 28 2012: Boeing Flight Charleston: contained engine failure during a taxi test at Charleston International Airport PRE Delivery Taxi test. Debris fell from engine
  • Dec 4, 2012: United over Mississippi: “multiple messages” regarding flight-system errors, and diverted to New Orleans (KMSY). The problems occurred when one of the plane’s generators failed. Power was supplied to the aircraft with the five functioning generators.
  • Jan 7, 2013: JAL Boston: fire was discovered in a battery and electrical compartment of the aircraft.
  • Jan 8, 2013: JAL Boston: 40 gallons of fuel had spilled from one of its wing tanks at the gate. The plane was contacted before takeoff and it returned to the terminal without incident. Probably a case of overfilling the tank.
  • Jan 9, 2013: ANA Yamaguchi: Brake problems
  • Jan 16, 2013: ANA Takamatsu: instrument indications of smoke in the forward electrical compartment. No fire was found.

Boeing? Are you listening? I fly everywhere, all over the world but at the moment, I’m not comfortable getting on this great plane that I really want to love for future travel. I’m am confident you can do it, even if all of these wrinkles are going to mean you need to bring in the really big iron. We need all the finders and fixers on this! The world has places to go and things to do, and you’re holding their safety in the palm of your hand.

The Emergency Airworthiness Directive has been issued. Issued Jan 16, 2013
and here is their announcement:

As a result of an in-flight, Boeing 787 battery incident earlier today in Japan, the FAA will issue an emergency airworthiness directive (AD) to address a potential battery fire risk in the 787 and require operators to temporarily cease operations. Before further flight, operators of U.S.-registered, Boeing 787 aircraft must demonstrate to the Federal Aviation Administration (FAA) that the batteries are safe.
The FAA will work with the manufacturer and carriers to develop a corrective action plan to allow the U.S. 787 fleet to resume operations as quickly and safely as possible.
The in-flight Japanese battery incident followed an earlier 787 battery incident that occurred on the ground in Boston on January 7, 2013. The AD is prompted by this second incident involving a lithium ion battery. The battery failures resulted in release of flammable electrolytes, heat damage, and smoke on two Model 787 airplanes. The root cause of these failures is currently under investigation. These conditions, if not corrected, could result in damage to critical systems and structures, and the potential for fire in the electrical compartment.

Last Friday, the FAA announced a comprehensive review of the 787’s critical systems with the possibility of further action pending new data and information. In addition to the continuing review of the aircraft’s design, manufacture and assembly, the agency also will validate that 787 batteries and the battery system on the aircraft are in compliance with the special condition the agency issued as part of the aircraft’s certification.

United Airlines is currently the only U.S. airline operating the 787, with six airplanes in service. When the FAA issues an airworthiness directive, it also alerts the international aviation community to the action so other civil aviation authorities can take parallel action to cover the fleets operating in their own countries.

See Directive:

FCC moving on Wireless Connectivity

The FCC’s “Notice of Proposed Rulemaking and Report and Order” establishes procedures for broadband aboard commercial and private aircraft. According to the paperwork, the authorizations allow broadband services to passengers on a non-harmful interference basis, and several airlines are operating under the terms of those authorizations.

I truly endorse this.

The item below was adopted by the FFC on Dec 20, 2012, released Dec 28, 2012.


NTSB Still Investigating

We should remember this auxiliary battery failed after the passengers had disembarked. As the experts explain it, the battery is an auxiliary. This particular failure wouldn’t be likely to happen in the air, which technically makes it non-life threatening, although a tech or firefighter who was injured when the fire was extinguished might feel differently. I’m not trying to minimize the problem, but passengers’ lives were not threatened.

Nevertheless, I’m looking forward to Boeing’s solution to this. All the experts tell me this is what happens with new planes. Just a matter of getting the kinks out. While it’s not unexpected that new approaches (replacing the hydraulics with high powered electrics) need some ironing out, we’ll all sleep a lot better, and fly a lot easier when the situation is addressed.

NTSB Provides Second Investigative Update on Boeing 787 Battery Fire in Boston

January 14, 2013
WASHINGTON – The National Transportation Safety Board today released a second update on its investigation into the Jan. 7 fire aboard a Japan Airlines Boeing 787 at Logan International Airport in Boston.

The lithium-ion battery that powered the auxiliary power unit on the airplane was removed and transported back to the NTSB Materials Laboratory in Washington on Jan. 10. The battery is currently being examined by NTSB investigators, who plan to disassemble it this week.

In advance of that work, under the direction of the NTSB, radiographic examinations of the incident battery and an exemplar battery were conducted this past weekend at an independent test facility. The digital radiographs and computed tomography scans generated from this examination allowed the team to document the internal condition of the battery prior to disassembling it.

In addition, investigators took possession of burned wire bundles, the APU battery charger, and several memory modules. The maintenance and APU controller memory modules will be downloaded to obtain any available data. Investigators also documented the entire aft electronics bay including the APU battery and the nearby affected structure where components and wire bundles were located.

The airplane’s two combined flight data recorder and cockpit voice recorder units were transported to NTSB headquarters and have been successfully downloaded. The information is currently being analyzed by the investigative team.

The airport emergency response group documented the airport rescue and firefighting efforts to extinguish the fire, which included interviews with first responders. Fire and rescue personnel were able to contain the fire using a clean agent (Halotron), however, they reported experiencing difficulty accessing the battery for removal during extinguishing efforts. All fire and rescue personnel responding to the incident had previously received aircraft familiarization training on the Boeing 787.

NTSB photo of the burned auxiliary power unit battery from a JAL Boeing 787 that caught fire on Jan. 7 at Boston’s Logan International Airport. The dimensions are 19×13.2×10.2 inches and it weighs approximately 63 pounds (new).

In accordance with international investigative treaties, the Japan Transport Safety Board and French Bureau d’Enquêtes et d’Analyses pour la sécurité de l’aviation civile have appointed accredited representatives to the investigation. The NTSB-led investigative team is comprised of subject matter groups in the areas of airplane systems, fire, airport emergency response, and data recorders and includes experts from the Federal Aviation Administration, The Boeing Company, US Naval Surface Warfare Center’s Carderock Division, Japan Airlines (aircraft operator), GS Yuasa (battery manufacturer), and Thales Avionics Electrical Systems (APU battery/charger system).

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WASHINGTON — Thanks to improved data analysis techniques and a new operating mode, the Gamma-ray Burst Monitor (GBM) aboard NASA’s Fermi Gamma-ray Space Telescope is now 10 times better at catching the brief outbursts of high-energy light mysteriously produced above thunderstorms.

The outbursts, known as terrestrial gamma-ray flashes (TGFs), last only a few thousandths of a second, but their gamma rays rank among the highest-energy light that naturally occurs on Earth. The enhanced GBM discovery rate helped scientists show most TGFs also generate a strong burst of radio waves, a finding that will change how
scientists study this poorly understood phenomenon.

Before being upgraded, the GBM could capture only TGFs that were bright enough to trigger the instrument’s on-board system, which meant many weaker events were missed.

“In mid-2010, we began testing a mode where the GBM directly downloads full-resolution gamma-ray data even when there is no on-board trigger, and this allowed us to locate many faint TGFs we had been missing,” said lead researcher Valerie Connaughton, a member of the GBM team at the University of Alabama in Huntsville (UAH). She presented the findings Wednesday in an invited talk at the American Geophysical Union meeting in San Francisco. A paper detailing the results is accepted for publication in the Journal of Geophysical Research: Space Physics.

The results were so spectacular that on Nov. 26 the team uploaded new flight software to operate the GBM in this mode continuously, rather than in selected parts of Fermi’s orbit.

Connaughton’s team gathered GBM data for 601 TGFs from August 2008 to August 2011, with most of the events, 409 in all, discovered through the new techniques. The scientists then compared the gamma-ray data to radio emissions over the same period.

Lightning emits a broad range of very low frequency (VLF) radio waves, often heard as pop-and-crackle static when listening to AM radio. The World Wide Lightning Location Network (WWLLN), a research collaboration operated by the University of Washington in Seattle, routinely detects these radio signals and uses them to pinpoint the
location of lightning discharges anywhere on the globe to within about 12 miles (20 km).

Scientists have known for a long time TGFs were linked to strong VLF bursts, but they interpreted these signals as originating from lightning strokes somehow associated with the gamma-ray emission.

“Instead, we’ve found when a strong radio burst occurs almost simultaneously with a TGF, the radio emission is coming from the TGF itself,” said co-author Michael Briggs, a member of the GBM team.

The researchers identified much weaker radio bursts that occur up to several thousandths of a second before or after a TGF. They interpret these signals as intracloud lightning strokes related to, but not created by, the gamma-ray flash.

Scientists suspect TGFs arise from the strong electric fields near the tops of thunderstorms. Under certain conditions, the field becomes strong enough that it drives a high-speed upward avalanche of electrons, which give off gamma rays when they are deflected by air molecules.

“What’s new here is that the same electron avalanche likely responsible for the gamma-ray emission also produces the VLF radio bursts, and this gives us a new window into understanding this phenomenon,” said Joseph Dwyer, a physics professor at the Florida Institute of Technology in Melbourne, Fla., and a member of the study team.

Because the WWLLN radio positions are far more precise than those based on Fermi’s orbit, scientists will develop a much clearer picture of where TGFs occur and perhaps which types of thunderstorms tend to produce them.

The GBM scientists predict the new operating mode and analysis techniques will allow them to catch about 850 TGFs each year. While this is a great improvement, it remains a small fraction of the roughly 1,100 TGFs that fire up each day somewhere on Earth, according to the team’s latest estimates.

Likewise, TGFs detectable by the GBM represent just a small fraction of intracloud lightning, with about 2,000 cloud-to-cloud lightning strokes for every TGF.

The Fermi Gamma-ray Space Telescope is an astrophysics and particle physics partnership and is managed by NASA’s Goddard Space Flight Center in Greenbelt, Md. Fermi was developed in collaboration with
the U.S. Department of Energy, with important contributions from academic institutions and partners in France, Germany, Italy, Japan, Sweden and the United States.

The GBM Instrument Operations Center is located at the National Space Science Technology Center in Huntsville, Ala. The GBM team includes a collaboration of scientists from UAH, NASA’s Marshall Space Flight Center in Huntsville, the Max Planck Institute for Extraterrestrial Physics in Germany and other institutions.

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NTSB Says Aggressive Test Flight Schedule, Overlooked Errors Led to Stall and Crash

Oct. 10, 2012
The National Transportation Safety Board determined today that the probable cause of the crash of an experimental Gulfstream G650 on April 2, 2011, in Roswell, N.M., was the result of an aerodynamic stall and uncommanded roll during a planned takeoff test flight conducted with only one of the airplane’s two engines operating.
The Board found that the crash was the result of Gulfstream’s failure to properly develop and validate takeoff speeds and recognize and correct errors in the takeoff safety speed that manifested during previous G650 flight tests; the flight test team’s persistent and aggressive attempts to achieve a takeoff speed that was erroneously low; and Gulfstream’s inadequate investigation of uncommanded roll events that occurred during previous flight tests, which should have revealed incorrect assumptions about the airplane’s stall angle of attack in ground effect.

Contributing to the accident, the NTSB found, was Gulfstream’s pursuit of an aggressive flight test schedule without ensuring that the roles and responsibilities of team members were appropriately defined, sufficient technical planning and oversight was performed, and that hazards had been fully identified and addressed with appropriate, effective risk controls.

“In this investigation we saw an aggressive test flight schedule and pressure to get the aircraft certified,” said NTSB Chairman Deborah A.P. Hersman. “Deadlines are essential motivators, but safety must always trump schedule.”

At approximately 9:34 a.m. Mountain Time, during takeoff on the accident flight, the G-650 experienced a right wing stall, causing the airplane to roll to the right with the right wingtip contacting the runway. The airplane then departed the runway, impacting a concrete structure and an airport weather station, resulting in extensive structural damage and a post-crash fire. The two pilots and two flight engineers on board were fatally injured and the airplane was substantially damaged.

The NTSB made recommendations to the Flight Test Safety Committee and the Federal Aviation Administration to improve flight test operating policies and encourage manufacturers to follow best practices and to coordinate high-risk flight tests. And the Board recommended that Gulfstream Aerospace Corporation commission an independent safety audit to review the company’s progress in implementing a flight test safety management system and provide information about the lessons learned from its implementation to interested manufacturers, flight test safety groups and other appropriate parties.

“In all areas of aircraft manufacturing, and particularly in flight testing, where the risks are greater, leadership must require processes that are complete, clear and include well-defined criteria,” said Chairman Deborah A.P. Hersman. “This crash was as much an absence of leadership as it was of lift.”

The preliminary synopsis of the report is below:

Public Meeting of October 10, 2012
(Information subject to editing)
Aircraft Accident Report:
Crash During Experimental Test Flight
Gulfstream Aerospace Corporation GVI (G650), N652GD
Roswell, New Mexico
April 2, 2011


This is a synopsis from the National Transportation Safety Board’s report and does not include the NTSB’s rationale for the conclusions, probable cause, and safety recommendations. Safety Board staff is currently making final revisions to the report from which the attached conclusions and safety recommendations have been extracted. The final report and pertinent safety recommendation letters will be distributed to recommendation recipients as soon as possible. The attached information is subject to further review and editing.

Executive Summary

On April 2, 2011, about 0934 mountain daylight time, an experimental Gulfstream Aerospace Corporation GVI (G650), N652GD, crashed during takeoff from runway 21 at Roswell International Air Center Airport, Roswell, New Mexico. The two pilots and the two flight test engineers were fatally injured, and the airplane was substantially damaged by impact forces and a postcrash fire. The airplane was registered to and operated by Gulfstream as part of its G650 flight test program. The flight was conducted under the provisions of 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed at the time of the accident.

The accident occurred during a planned one-engine-inoperative (OEI) takeoff when a stall on the right outboard wing produced a rolling moment that the flight crew was not able to control, which led to the right wingtip contacting the runway and the airplane departing the runway from the right side. After departing the runway, the airplane impacted a concrete structure and an airport weather station, resulting in extensive structural damage and a postcrash fire that completely consumed the fuselage and cabin interior.

The National Transportation Safety Board’s (NTSB) investigation of this accident found that the airplane stalled while lifting off the ground. As a result, the NTSB examined the role of “ground effect” on the airplane’s performance. Ground effect refers to changes in the airflow over the airplane resulting from the proximity of the airplane to the ground. Ground effect results in increased lift and reduced drag at a given angle of attack (AOA) as well as a reduction in the stall AOA. In preparing for the G650 field performance flight tests, Gulfstream considered ground effect when predicting the airplane’s takeoff performance capability but overestimated the in ground effect stall AOA. Consequently, the airplane’s AOA threshold for stick shaker (stall warning) activation and the corresponding pitch limit indicator (on the primary flight display) were set too high, and the flight crew received no tactile or visual warning before the actual stall occurred.

The accident flight was the third time that a right outboard wing stall occurred during G650 flight testing. Gulfstream did not determine (until after the accident) that the cause of two previous uncommanded roll events was a stall of the right outboard wing at a lower-than-expected AOA. (Similar to the accident circumstances, the two previous events occurred during liftoff; however, the right wingtip did not contact the runway during either of these events.) If Gulfstream had performed an in-depth aerodynamic analysis of these events shortly after they occurred, the company could have recognized before the accident that the actual in-ground-effect stall AOA was lower than predicted.

During field performance testing before the accident, the G650 consistently exceeded target takeoff safety speeds (V2). V2 is the speed that an airplane attains at or before a height above the ground of 35 feet with one engine inoperative. Gulfstream needed to resolve these V2 exceedances because achieving the planned V2 speeds was necessary to maintain the airplane’s 6,000-foot takeoff performance guarantee (at standard sea level conditions). If the G650 did not meet this takeoff performance guarantee, then the airplane could only operate on longer runways. However, a key assumption that Gulfstream used to develop takeoff speeds was flawed and resulted in V2 speeds that were too low and takeoff distances that were longer than anticipated.

Rather than determining the root cause for the V2 exceedance problem, Gulfstream attempted to reduce the V2 speeds and the takeoff distances by modifying the piloting technique used to rotate the airplane for takeoff. Further, Gulfstream did not validate the speeds using a simulation or physics-based dynamic analysis before or during field performance testing. If the company had done so, then it could have recognized that the target V2 speeds could not be achieved even with the modified piloting technique. In addition, the difficulties in achieving the target V2 speeds were exacerbated in late March 2011 when the company reduced the target pitch angle for some takeoff tests without an accompanying increase in the takeoff speeds.

Gulfstream maintained an aggressive schedule for the G650 flight test program so that the company could obtain Federal Aviation Administration (FAA) type certification by the third quarter of 2011. The schedule pressure, combined with inadequately developed organizational processes for technical oversight and safety management, led to a strong focus on keeping the program moving and a reluctance to challenge key assumptions and highlight anomalous airplane behavior during tests that could slow the pace of the program. These factors likely contributed to key errors, including the development of unachievable takeoff speeds, as well as the superficial review of the two previous uncommanded roll events, which allowed the company’s overestimation of the in-ground-effect stall AOA to remain undetected.

After the accident, Gulfstream suspended field performance testing through December 2011 while the company examined the circumstances of the accident. In March 2012, Gulfstream reported that company field performance testing had been repeated and completed successfully. In June 2012, the company reported that FAA certification field performance testing had been successfully completed. Gulfstream obtained FAA type certification for the G650 on September 7, 2012.


1. The test team’s focus on achieving the takeoff safety speeds for the flight tests and the lack of guidance specifying precisely when the pitch angle target and pitch limit applied during the test maneuver contributed to the team’s decision to exceed the initial pitch target and the pitch angle at which a takeoff test was to be discontinued.

2. A stall on the right outboard wing produced a right rolling moment that the flight crew was not able to control, which led to the right wingtip contacting the runway and the airplane departing the runway from the right side.

3. Given the airplane’s low altitude, the time-critical nature of the situation, and the ambiguous stall cues presented in the cockpit, the flight crew’s response to the stall event was understandable.

4. The impact forces from the accident were survivable, but the cabin environment deteriorated quickly and became unsurvivable because of the large amount of fuel, fuel vapor, smoke, and fire entering the cabin through the breaches in the fuselage.

5. The airplane stalled at an angle of attack (AOA) that was below the in ground effect stall AOA predicted by Gulfstream and the AOA threshold for the activation of the stick shaker stall warning.

6. If Gulfstream had performed an in-depth aerodynamic analysis of the cause of two previous G650 uncommanded roll events, similar to the analyses performed for roll events during previous company airplane programs, the company could have recognized that the actual in-ground-effect stall angle of attack for the accident flight test was significantly lower than the company predicted.

7. Gulfstream’s decision to use a takeoff speed development method from a previous airplane program was inappropriate and resulted in target takeoff safety speed values that were too low to be achieved.

8. By not performing a rigorous analysis of the root cause for the ongoing difficulties in achieving the G650 takeoff safety speeds (V2), Gulfstream missed an opportunity to recognize and correct the low target V2 speeds.

9. Before the accident flight, Gulfstream had sufficient information from previous flight tests to determine that the target takeoff safety speeds (V2) could not be achieved with a certifiable takeoff rotation technique and that the V2 speeds needed to be increased.

10. Deficiencies in Gulfstream’s technical planning and oversight contributed to the incorrect speeds used on the day of the accident.

11. Because Gulfstream did not clearly define the roles and responsibilities for on site test team members, critical safety-related parameters were not being adequately monitored and test results were not being sufficiently examined during flight testing on the day of the accident.

12. Gulfstream’s focus on meeting the G650’s planned certification date caused schedule related pressure that was not adequately counterbalanced by robust organizational processes to prevent, identify, and correct the company’s key engineering and oversight errors.

13. Gulfstream’s flight test safety program at the time of the accident was deficient because risk controls were insufficient and safety assurance activities were lacking.

14. The inherent risks associated with field performance flight testing, and minimum unstick speed testing in particular, could be reduced if airplane manufacturers considered the potential for a lower maximum lift coefficient in ground effect when estimating the stall angle of attack in ground effect.

15. Effective flight test standard operating policies and procedures that are fully implemented by manufacturers would help reduce the inherent risks associated with flight testing.

16. Flight test safety management system guidance specifically tailored to the needs of manufacturers would help promote the development of effective flight test safety programs.

17. External safety audits would help Gulfstream monitor the implementation of safety management principles and practices into its flight test operations and sustain long-term cultural change.

18. Flight test safety would be enhanced if manufacturers and flight test industry groups had knowledge of the lessons learned from Gulfstream’s implementation of its flight test safety management system.

19. Advance coordination between flight test operators and airport operations and aircraft rescue and firefighting personnel for high-risk flight tests could reduce the response time to an accident site in the event of an emergency.

Probable Cause

The National Transportation Safety Board determines that the cause of this accident was an aerodynamic stall and subsequent uncommanded roll during a one engine-inoperative takeoff flight test, which were the result of (1) Gulfstream’s failure to properly develop and validate takeoff speeds for the flight tests and recognize and correct the takeoff safety speed (V2) error during previous G650 flight tests, (2) the G650 flight test team’s persistent and increasingly aggressive attempts to achieve V2 speeds that were erroneously low, and (3) Gulfstream’s inadequate investigation of previous G650 uncommanded roll events, which indicated that the company’s estimated stall angle of attack while the airplane was in ground effect was too high. Contributing to the accident was Gulfstream’s failure to effectively manage the G650 flight test program by pursuing an aggressive program schedule without ensuring that the roles and responsibilities of team members had been appropriately defined and implemented, engineering processes had received sufficient technical planning and oversight, potential hazards had been fully identified, and appropriate risk controls had been implemented and were functioning as intended.


To the Federal Aviation Administration:

1. Inform domestic and foreign manufacturers of airplanes that are certified under 14 Code of Federal Regulations Parts 23 and 25 about the circumstances of this accident and advise them to consider, when estimating an airplane’s stall angle of attack in ground effect, the possibility that the airplane’s maximum lift coefficient in ground effect could be lower than its maximum lift coefficient in free air.

2. Work with the Flight Test Safety Committee to develop and issue detailed flight test operating guidance for manufacturers that addresses the deficiencies documented in this report regarding flight test operating policies and procedures and their implementation.

3. Work with the Flight Test Safety Committee to develop and issue flight test safety program guidelines based on best practices in aviation safety management.

4. After the Flight Test Safety Committee has issued flight test safety program guidelines, include these guidelines in the next revision of Federal Aviation Administration Order 4040.26, Aircraft Certification Service Flight Test Risk Management Program.

5. Inform 14 Code of Federal Regulations Part 139 airports that currently have (or may have in the future) flight test activity of the importance of advance coordination of high risk flight tests with flight test operators to ensure adequate aircraft rescue and firefighting resources are available to provide increased readiness during known high risk flight tests.

To the Flight Test Safety Committee:

6. In collaboration with the Federal Aviation Administration, develop and issue flight test operating guidance for manufacturers that addresses the deficiencies documented in this report regarding flight test operating policies and procedures and their implementation, and encourage manufacturers to conduct flight test operations in accordance with the guidance.

7. In collaboration with the Federal Aviation Administration, develop and issue flight test safety program guidelines based on best practices in aviation safety management, and encourage manufacturers to incorporate these guidelines into their flight test safety programs.

8. Encourage members to provide notice of and coordinate high-risk flight tests with airport operations and aircraft rescue and firefighting personnel.

To Gulfstream Aerospace Corporation:

9. Commission an audit by qualified independent safety experts, before the start of the next major certification flight test program, to evaluate the company’s flight test safety management system, with special attention given to the areas of weakness identified in this report, and address all areas of concern identified by the audit.

10. Provide information about the lessons learned from the implementation of its flight test safety management system to interested manufacturers, flight test industry groups, and other appropriate parties.


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NTSB investigative update on SC GEnx-1B engine failure

September 27, 2012
WASHINGTON – This is an update on the NTSB’s investigation into a July 28, 2012 incident involving a Boeing 787-8 airplane that experienced a loss of thrust in the right engine—a General Electric (GE) GEnx-1B turbofan – during a pre-first flight, low-speed taxi test at Charleston International Airport in Charleston, South Carolina. As reported in an earlier update, the investigation found that the forward end of the fan midshaft (FMS) fractured and separated. Examination of other pre-delivery engines revealed a second GEnx-1B engine with a cracked FMS that was installed on a 787-8 airplane that had not yet flown.

The investigation is ongoing, and an initial inspection of all in-service GEnx engines has been completed. Most recently, on September 11, 2012, a Boeing 747-8F with GE GEnx-2B turbofan engines experienced a loss of power in the No. 1 engine during the takeoff roll at Shanghai Pudong International Airport, Shanghai, China. The Civil Aviation Administration of China (CAAC) is investigating this incident, and the NTSB is participating as the state of design and manufacture of the engine and aircraft. Any investigative updates regarding this incident will be provided by the CAAC.

As part the CAAC’s investigation and in relation to the NTSB’s ongoing investigation of the July 28th engine failure, preliminary findings from the examination of the Shanghai incident engine revealed that the FMS was intact and showed no indications of cracking. The examination and teardown of that engine is continuing under the direction of the CAAC.

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WASHINGTON – Today the NTSB recommended that the Federal Aviation Administration require that large airplanes be equipped with an anti-ground collision aid, such as an on-board external-mounted camera system, to provide pilots a clear view of the plane’s wingtips while taxing to ensure clearance from other aircraft, vehicles and obstacles.

On large airplanes (such as the Boeing 747, 757, 767, and 777; the Airbus A380; and the McDonnell Douglas MD-10 and MD-11), the pilot cannot see the airplane’s wingtips from the cockpit unless the pilot opens the cockpit window and extends his or her head out of the window, which is often impractical.

The NTSB said that the anti-collision aids should be installed on newly manufactured and certificated airplanes and that existing large airplanes should be retrofitted with the equipment.

“A system that can provide real-time information on wingtip clearance in relation to other obstacles will give pilots of large airplanes an essential tool when taxiing,” said NTSB Chairman Deborah A.P. Hersman. “While collision warning systems are now common in highway vehicles, it is important for the aviation industry to consider their application in large aircraft.”

The recommendations follow three recent ground collision accidents (all currently under investigation) in which large airplanes collided with another aircraft while taxing:

• May 30, 2012: The right wingtip of an EVA Air Boeing 747-400 struck the rudder and vertical stabilizer of an American Eagle Embraer 135 while taxing at Chicago’s O’Hare International Airport (Preliminary Report: http://go.usa.gov/rPFh).

• July 14, 2011: A Delta Air Lines Boeing 767 was taxing for departure when its left winglet struck the horizontal stabilizer of an Atlantic Southeast Airlines Bombardier CRJ900 (Preliminary Report: http://go.usa.gov/rnzC).

• April 11, 2011: During a taxi for departure, the left wingtip of an Air France A380 struck the horizontal stabilizer and rudder of a Comair Bombardier CRJ701 (Preliminary Report: http://go.usa.gov/rnzW).

The NTSB made the same recommendation to the European Aviation Safety Agency, which sets standards for aircraft manufacturers in Europe.

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