If you wish to contribute or participate in the discussions about articles you are invited to join SKYbrary as a registered user

 Actions

Accident and Serious Incident Reports: RE

From SKYbrary Wiki

Article Information
Category: Runway Excursion Runway Excursion
Content source: SKYbrary About SKYbrary
Content control: EUROCONTROL EUROCONTROL

Definition

Reports relating to accidents which include Runway Excursion as an outcome.

The reports are organised in two sections. In the first section, reports are organised according to the sub-categories Overrun on Take Off, Overrun on Landing, and Veer Off. In the second section, events are organised according to the tagging system currently employed on Runway Excursion events in our database.

Events by Sub-Category

Overrun on Take Off

Overrun on Take Off.jpg

Overrun on Landing

Overrun on Landing.jpg

  • CRJ2, Traverse City MI USA, 2007 (On 12 April 2007, a Bombardier CRJ-600 being operated by Pinnacle Airlines on a scheduled night passenger flight from Minneapolis-St. Paul to Traverse City overran the end of the slippery landing runway by 90 metres in normal visibility. There were no injuries to any of the 52 occupants but the aircraft sustained substantial, but repairable, damage, primarily at the forward lower fuselage.)
  • MD11, New York JFK USA, 2003 (A McDonnell Douglas MD11F failed to complete its touchdown on runway 04R at New York JFK until half way along the 2560 metre-long landing runway and then overran the paved surface by 73 metres having been stopped by the installed EMAS. The Investigation found no evidence that the aircraft was not serviceable and noted that the and that the landing had been attempted made with a tailwind component which meant that the runway was the minimum necessary for the prevailing aircraft landing weight.)
  • CRJ7, Lorient France, 2012 (On 16 October 2012, a Brit Air Bombardier CRJ 700 landed long on a wet runway at Lorient and overran the runway. The aircraft sustained significant damage but none of the occupants were injured. The Investigation attributed the accident to poor decision making by the crew whilst showing signs of complacency and fatigue and failing to maintain a sterile flight deck or go around when the approach became unstable. A context of deficiencies at the airport and at the Operator was also detailed and it was concluded that aquaplaning had occurred.)
  • PC6, Evora Portugal, 2012 (On 29 July 2012, the rudder of a Pilatus PC6 detached in flight and fell onto the stabiliser/elevator preventing its normal movement. Pitch control was gained using the electric stabiliser trim and a successful touchdown was achieved on the second attempt. However, directional control could not be maintained and a lateral runway excursion followed. Investigation attributed the rudder failure to maintenance error which went undetected. Unapproved dispensation by the maintenance organisation involved, which allowed some dual inspections for correct completion of safety critical tasks to be carried out by the same person, was considered to be a significant contributory factor.)
  • B738, Mangalore India, 2010 (On 22 May 2010, an Air India Express Boeing 737-800 overran the landing runway at Mangalore when attempting a go around after thrust reverser deployment following a fast and late touchdown off an unstable approach. Almost all of the 166 occupants were killed when control was lost and the aircraft crashed into a ravine off the end of the runway. It was noted a relevant factor in respect of the approach, landing and failed go around attempt was probably the effect of ‘sleep inertia’ on the Captain’s performance and judgement after a prolonged sleep en-route)

Veer Off

Directional Control.jpg On landing...

  • ATP, Vilhelmina Sweden, 2016 (On 6 April 2016, a BAe ATP partly left the side of the runway soon after touchdown, regaining it after 155 metres before completing its landing roll. It sustained damage rendering it unfit to continue flying but this was not noticed until five further flights had been made. Investigation attributed the excursion to lack of pilot response to unexpected beta range power and the continued flying to the aircraft Captain's failure to ensure proper event recording, accurate operator notification or a post-excursion engineering inspection of the aircraft. Systemic inadequacy in safety management and culture at the operator was identified.)
  • JS32, Torsby Sweden, 2014 (On 31 January 2014, an Estonian-operated BAE Jetstream 32 being used under wet lease to fulfil a government-funded Swedish domestic air service requirement landed long at night and overran the end of the runway. The Investigation concluded that an unstabilised approach had been followed by a late touchdown at excessive speed and that the systemic context for the occurrence had been a complete failure of the aircraft operator to address operational safety at anything like the level appropriate to a commercial operation. Failure of the responsible State Safety Regulator to detect and act on this situation was also noted.)
  • A30B, Bratislava Slovakia, 2012 (On 16 November 2012, an Air Contractors Airbus A300 departed the left the side of the landing runway at Bratislava after an abnormal response to directional control inputs. Investigation found that incorrect and undetected re-assembly of the nose gear torque links had led to the excursion and that absence of clear instructions in maintenance manuals, since rectified, had facilitated this. It was also considered that the absence of any regulation requiring equipment in the vicinity of the runway to be designed to minimise potential damage to aircraft departing the paved surface had contributed to the damage caused by the accident.)
  • A343, Nairobi Kenya, 2008 (On 27 April 2008 an Airbus A340-300 crew lost previously-acquired visual reference in fog on a night auto ILS into Nairobi but continued to a touchdown which occurred with the aircraft heading towards the edge of the runway following an inappropriate rudder input. The left main gear departed the paved surface and a go around was initiated and a diversion made. The event was attributed to a delay in commencing the go around. No measured RVR from any source was passed by ATC although it was subsequently found to have been recorded as I excess of Cat 1 limits throughout.)
  • AT72, Mumbai India, 2009 (On 10 November 2010, a Kingfisher Airlines ATR 72-200 made an excessively steep and unstabilised tailwind approach in light rain to runway 27 at Mumbai in visual daylight conditions. After touching down late, the aircraft was steered off the side of the runway when it became obvious that an overrun would otherwise occur. The Investigation found that ATC had failed to advise of water patches on the runway and aquaplaning had occurred. It also found that without aquaplaning, the available distance from the actual touchdown point would have been sufficient to stop the aircraft in.)

Directional Control.jpg On take off..

  • B738, Nuremburg Germany, 2010 (On 8 January 2010, an Air Berlin Boeing 737-800 attempted to commence a rolling take off at Nuremburg on a runway pre-advised as having only ‘medium’ braking action. Whilst attempting to position the aircraft on the runway centreline, directional control was lost and the aircraft exited the paved surface onto soft ground at low speed before the flight crew were able to stop it. The event was attributed to the inappropriately high taxi speed onto the runway and subsequent attempt to conduct a rolling take off. Relevant Company standard operating procedures were found to be deficient.)
  • JS31, Kärdla Estonia, 2013 (On 28 October 2013 a BAe Jetstream 31 crew failed to release one of the propellers from its starting latch prior to setting take off power and the aircraft immediately veered sharply off the side of the runway without directional control until the power levers were returned to idle. The aircraft was then steered on the grass towards the nearby apron and stopped. The Investigation found that the pilots had habitually used "multiple unofficial procedures" to determine propeller status prior to take off and also noted that no attempt had been made to stop the aircraft using the brakes.)
  • B752, Mumbai India, 2010 (On 9 June 2010, a Boeing B757-200 being operated by Chennai-based Blue Dart Aviation on a scheduled cargo flight from Mumbai to Bangalore lined up and commenced a night take off in normal ground visibility aligned with the right hand runway edge lights of 45 metre wide runway 27. ATC were not advised of the error and corrective action and once airborne, the aircraft completed the intended flight without further event. A ground engineer at Bangalore then discovered damage to the right hand landing gear assembly including one of the brake units. After being alerted, the Mumbai Airport Authorities discovered a number of broken runway edge lights.)
  • A306, Stockholm Sweden, 2010 (On 16 January 2010, an Iran Air Airbus A300-600 veered off the left side of the runway after a left engine failure at low speed whilst taking off at Stockholm. The directional control difficulty was attributed partly to the lack of differential braking but also disclosed wider issues about directional control following sudden asymmetry at low speeds. The Investigation concluded that deficiencies in the type certification process had contributed to the loss of directional control. It was concluded that the engine malfunction was due to the initiation of an engine stall by damage caused by debris from a deficient repair.)
  • A320, Harstad/Narvik Norway 2004 (On 25 November 2004, a MyTravel Airways Airbus A320 departed the side of the runway at Harstad, Norway at a low speed after loss of directional control when thrust was applied for a night take off on a runway with below normal surface friction characteristics. It was found that the crew had failed to follow an SOP designed to ensure that any accumulated fan ice was shed prior to take off and also failed to apply take off thrust as prescribed, thus delaying their appreciation of the uneven thrust produced.)

Events by A&I Tag

Excessive Airspeed

  • MD83, Barcelona Spain, 2006 (On 9 January 2006, a Mc Donnell Douglas MD83 being operated by Spanair on a scheduled passenger flight from Bilbao to Barcelona made an unstablised day VMC approach to a dry runway 07R at destination and landed long with apparently locked brakes before coming to a stop 140 metres from the end of the 2660 metre long runway. Following ATC reports of a fire in the area of the left main landing gear, an evacuation was ordered using the right side doors during which five of the 96 occupants received minor injuries. The RFFS arrived at the scene during the evacuation and extinguished the fire. Significant damage occurred to both main landing gear assembles and to both wings and the tail assembly but there was no damage to the primary structure.)
  • SW4, Sanikiluaq Nunavut Canada, 2012 (On 22 December 2012, the crew of a Swearingen SA227 attempting a landing, following an unstabilised non-precision approach at Sanikiluaq at night with questionable alternate availability in marginal weather conditions, ignored GPWS PULL UP Warnings, then failed in their attempt to transition into a low go around and the aircraft crashed into terrain beyond the runway. One occupant – an unrestrained infant – was killed and the aircraft was destroyed. The Investigation faulted crew performance, the operator and the regulator and reiterated that lap-held infants were vulnerable in crash impacts.)
  • B752, Girona Spain, 1999 (On 14th September 1999, a Britannia Airways Boeing 757 crash landed and departed the runway after a continued unstabilised approach in bad weather to Girona airport, Spain.)
  • C550, Southampton UK, 1993 (On 26 May 1993, a Cessna Citation II being operated by a UK Air Taxi Company on a positioning flight from Oxford to Southampton to collect passengers with just the flight crew on board overran the ‘very wet’ landing runway at the destination in normal daylight visibility and ended up on an adjacent motorway where it collided with traffic, caught fire and was destroyed. The aircraft occupants and three people in cars received minor injuries.)
  • B738, Sochi Russia, 2018 (On 1 September 2018, a Boeing 737-800, making its second night approach to Sochi beneath a large convective storm with low level windshear reported, floated almost halfway along the wet runway before overrunning it by approximately 400 metres and breaching the perimeter fence before stopping. A small fire did not prevent all occupants from safely evacuating. The Investigation attributed the accident to crew disregard of a number of windshear warnings and a subsequent encounter with horizontal windshear resulting in a late touchdown and noted that the first approach had meant that the crew had been poorly prepared for the second.)

RTO decision after V1

  • DH8B, Nuuk Greenland, 2019 (On 30 May 2019, a DHC8-200 departing from Nuuk could not be rotated at the calculated speed even using full aft back pressure and the takeoff was rejected with the aircraft coming to a stop with 50 metres of the 950 metre long dry runway remaining. The initial Investigation focus was on a potential airworthiness cause associated with the flight control system but it was eventually found that the actual weights of both passengers and cabin baggage exceeded standard weight assumptions with the excess also resulting in the aircraft centre of gravity being outside the range certified for safe flight.)
  • B733, Birmingham UK, 2009 (On 6 February 2009, the crew of a Boeing 737-300 departing Birmingham successfully rejected take off from well above V1 when it became clear to the First Officer as handling pilot, that it was impossible to rotate. The Investigation found that cause of the rotation difficulty was that the crew had failed to set the stabiliser trim to the appropriate position for take off after delaying this action beyond the normal point in pre flight preparations because ground de icing was in progress and not subsequently noticing.)
  • B739, Kathmandu Nepal, 2018 (On 19 April 2018, a Boeing 737-900 made a high speed rejected takeoff at Kathmandu in response to a configuration warning and overran the runway without serious consequences. The Investigation found that when a false Takeoff Configuration Warning caused by an out of adjustment switch had been annunciated just after V1, the Captain had decided to reject the takeoff because of concerns about the local terrain and locally adverse weather. It was noted that the aircraft operator did not provide criteria for rejecting takeoff up to or above the 80 knot crosscheck but that the Boeing reference QRH did so.)
  • B732, Pekanbaru Indonesia, 2002 (On 14 January 2002, a Boeing 737-200, operated by Lion Air, attempted to complete a daylight take off from Pekanbaru, Indonesia without flaps set after a failure to complete the before take off checks. The rejected take off was not initiated promptly and the aircraft overran the runway. The take off configuration warning failed to sound because the associated circuit breaker was so worn that it had previously auto-tripped and this had not been noticed.)
  • LJ60, Columbia SC USA, 2008 (On September 19 2008, a Learjet 60 departing Columbia SC USA on a non scheduled passenger overran after attempting a rejected take off from above V1 and then hit obstructions which led to its destruction by fire and the death or serious injury of all six occupants. The subsequent investigation found that the tyre failure which led to the rejected take off decision had been due to under inflation and had damaged a sensor which caused the thrust reversers to return to their stowed position after deployment with the unintended forward thrust contributing to the severity of the overrun.)

High Speed RTO (V above 80 but no above V1)

Unable to rotate at VR

  • B773, Lagos Nigeria, 2010 (On 11 Jan 2010, an Air France Boeing 777-300ER successfully rejected a night take off from Lagos from significantly above V1 when control column pressure at rotation was perceived as abnormal. The root and secondary causes of the incident were found to be the failure of the Captain to arm the A/T during flight deck preparation and his inappropriate response to this on the take off roll. It was considered that his performance may have being an indirect consequence of his decision to take a 40 minute period of in-seat rest during the 90 minute transit stop at Lagos.)
  • B763, Manchester UK, 2008 (On 13 December 2008, a Thomsonfly Boeing 767-300 departing from Manchester for Montego Bay Jamaica was considered to be accelerating at an abnormally slow rate during the take off roll on Runway 23L. The aircraft commander, who was the pilot not flying, consequently delayed the V1 call by about 10 - 15 because he thought the aircraft might be heavier than had been calculated. During the rotation the TAILSKID message illuminated momentarily, indicating that the aircraft had suffered a tail strike during the takeoff. The commander applied full power and shortly afterwards the stick shaker activated briefly. The aircraft continued to climb away and accelerate before the flaps were retracted and the after-takeoff check list completed. The appropriate drills in the Quick Reference Handbook (QRH) were subsequently actioned, fuel was dumped and the aircraft returned to Manchester for an overweight landing without further incident.)
  • MD83, Ypsilanti MI USA, 2017 (On 8 March 2017, a Boeing MD83 departing Ypsilanti could not be rotated and the takeoff had to be rejected from above V1. The high speed overrun which followed substantially damaged the aircraft but evacuation was successful. The Investigation found that the right elevator had been locked in a trailing-edge-down position as a result of damage caused to the aircraft by high winds whilst it was parked unoccupied for two days prior to the takeoff. It was noted that on an aircraft with control tab initiated elevator movement, this condition was undetectable during prevailing pre flight system inspection or checks.)
  • CL60, Teterboro USA, 2005 (On 2 February 2005, a Challenger, belonging to Platinum Jet Management, crashed after taking off from Teterboro, New Jersey, USA. The aircraft's center of gravity was well forward of the forward takeoff limit.)
  • DH8A, Ottawa Canada, 2003 (On 04 November 2003, the crew of a de Havilland DHC-8-100 which had been de/anti iced detected a pitch control restriction as rotation was attempted during take off from Ottawa and successfully rejected the take off from above V1. The Investigation concluded that the restriction was likely to have been the result of a remnant of clear ice migrating into the gap between one of the elevators and its shroud when the elevator was moved trailing edge up during control checks and observed that detection of such clear ice remnants on a critical surface wet with de-icing fluid was difficult.)

Collision Avoidance Action

  • B733 / DH8D, Fort McMurray Canada, 2014 (On 4 August 2014, a Boeing 737-300 making a day visual approach at Fort McMurray after receiving an ILS/DME clearance lined up on a recently-constructed parallel taxiway and its crew were only alerted to their error shortly before touchdown by the crew of a DHC8-400 which was taxiing along the same taxiway in the opposite direction. This resulted in a go around being commenced from 46 feet agl. The Investigation noted that both pilots had been looking out during the final stages of the approach and had ignored important SOPs including that for a mandatory go around from an unstable approach.)
  • E135, George South Africa, 2009 (On 7 December 2009, an South African Airlink Embraer 135 overran the recently refurbished wet landing runway at George after braking was ineffective and exited the aerodrome perimeter to end up on a public road. There was no fire and all occupants were able to evacuate the aircraft. The subsequent investigation attributed the overrun principally to inadequate wet runway friction following the surface maintenance activities and noted various significant non-compliances with ICAO Annex 14.)
  • B733, Aqaba Jordan, 2017 (On 17 September 2017, a Boeing 737-300 requested and was approved for a visual approach to Aqaba which involved a significant tailwind component and, after approaching at excessive speed, it touched down late and overran the 3000 metre runway onto sandy ground. The Investigation found that despite EGPWS Alerts relating to both the high rate of descent and late configuration, the Captain had instructed the First Officer to continue what was clearly an unstabilised approach and when touchdown had still not occurred with around 1000 metres of runway left, the Captain took over but was unable to prevent an overrun.)

Parallel Approach Operations

Late Touchdown

  • C550, Southampton UK, 1993 (On 26 May 1993, a Cessna Citation II being operated by a UK Air Taxi Company on a positioning flight from Oxford to Southampton to collect passengers with just the flight crew on board overran the ‘very wet’ landing runway at the destination in normal daylight visibility and ended up on an adjacent motorway where it collided with traffic, caught fire and was destroyed. The aircraft occupants and three people in cars received minor injuries.)
  • A343, Toronto Canada, 2005 (On 2 August 2005, an Air France Airbus A340 attempted a daylight landing at destination on a rain-soaked runway during an active thunderstorm and overran for 300 metres ending up in a ravine from where, despite its destruction by fire, all occupants escaped. The Investigation recommendations focussed mainly on crew decision making in adverse weather conditions and issues related to the consequences of such an overrun on survivability.)
  • SW4, Sanikiluaq Nunavut Canada, 2012 (On 22 December 2012, the crew of a Swearingen SA227 attempting a landing, following an unstabilised non-precision approach at Sanikiluaq at night with questionable alternate availability in marginal weather conditions, ignored GPWS PULL UP Warnings, then failed in their attempt to transition into a low go around and the aircraft crashed into terrain beyond the runway. One occupant – an unrestrained infant – was killed and the aircraft was destroyed. The Investigation faulted crew performance, the operator and the regulator and reiterated that lap-held infants were vulnerable in crash impacts.)
  • B738, vicinity Skavsta Sweden, 2004 (On 2 July 2004, a Boeing 737-800 being operated by Irish operator Ryanair on a scheduled passenger flight from London Stansted to Skavsta Sweden, completed an extremely high speed and unstable approach in day VMC to destination during which relevant Operator SOPs were comprehensively ignored, EGPWS warnings were not actioned and AFM limits for trailing edge flap deployment were breached. Despite this, a landing at excessive speed was accommodated by just within the full length of the 2878 metre long dry runway.)
  • B737, Fort Nelson BC Canada, 2012 (On 9 January 2012, an Enerjet Boeing 737-700 overran the landing runway 03 at Fort Nelson by approximately 70 metres after the newly promoted Captain continued an unstabilised approach to a mis-managed late-touchdown landing. The subsequent Investigation attributed the accident to poor crew performance in the presence of a fatigued aircraft commander.)

Significant Tailwind Component

  • SW4, Sanikiluaq Nunavut Canada, 2012 (On 22 December 2012, the crew of a Swearingen SA227 attempting a landing, following an unstabilised non-precision approach at Sanikiluaq at night with questionable alternate availability in marginal weather conditions, ignored GPWS PULL UP Warnings, then failed in their attempt to transition into a low go around and the aircraft crashed into terrain beyond the runway. One occupant – an unrestrained infant – was killed and the aircraft was destroyed. The Investigation faulted crew performance, the operator and the regulator and reiterated that lap-held infants were vulnerable in crash impacts.)
  • A318/B738, Nantes France, 2010 (On 25 May 2010 an Air France Airbus A318 making an automatic landing off an ILS Cat 2 approach at Nantes experienced interference with the ILS LOC signal caused by a Boeing 737-800 which was departing from the same runway but early disconnection of the AP removed any risk of un-correctable directional control problems during the landing roll. Both aircraft were operating in accordance with their ATC clearances. Investigation attributed the conflict to the decision of TWR not to instruct the A318 to go around and because of diminished situational awareness.)
  • B738, Kingston Jamaica, 2009 (On 22 December 2009, the flight crew of an American Airlines’ Boeing 737-800 made a long landing at Kingston at night in heavy rain and with a significant tailwind component and their aircraft overran the end of the runway at speed and was destroyed beyond repair. There was no post-crash fire and no fatalities, but serious injuries were sustained by 14 of the 154 occupants. The accident was attributed almost entirely to various actions and inactions of the crew. Damage to the aircraft after the overrun was exacerbated by the absence of a RESA.)
  • CRJ7, Kanpur India, 2011 (On 20 July 2011, an Alliance Air CRJ 700 touched down over half way along the 9000 ft long runway at Kanpur after a stable ILS approach but with an unexpected limiting tailwind component and failed to stop before the end of the paved surface. Although an emergency evacuation was not necessary and there were no injuries, the aircraft was slightly damaged by impact with an obstruction. The subsequent investigation attributed the event to the commanders continued attempt at a landing when a late touchdown became increasingly likely.)
  • A343, Toronto Canada, 2005 (On 2 August 2005, an Air France Airbus A340 attempted a daylight landing at destination on a rain-soaked runway during an active thunderstorm and overran for 300 metres ending up in a ravine from where, despite its destruction by fire, all occupants escaped. The Investigation recommendations focussed mainly on crew decision making in adverse weather conditions and issues related to the consequences of such an overrun on survivability.)

Significant Crosswind Component

  • B738, Limoges France, 2008 (On 21 March 2008, a Boeing 737-800 being operated by Ryanair on a scheduled passenger flight from Charleroi, Belgium to Limoges carried out a daylight approach at destination followed by a landing in normal ground visibility but during heavy rain and with a strong crosswind which ended with a 50 metre overrun into mud. None of the 181 occupants were injured but both engines were damaged by ingestion of debris.)
  • DHC6, Tiree UK, 2017 (On 7 March 2017, a DHC-6-300 left the side of the runway after touchdown in what the crew believed was a crosswind component within the Operator's crosswind limit. The Investigation concluded that the temporary loss of control of the aircraft was consistent with the occurrence with a sudden gust of wind above the applicable crosswind limits and noted the reliance of the crew on 'spot' winds provided by TWR during the final stages of the approach.)
  • SF34, Izumo Japan, 2007 (On 10 December, 2007 a SAAB 340B being operated by Japan Air Commuter on a scheduled passenger flight left the runway at Izumo Airport during the daylight landing roll in normal visibility and continued further while veering to the right before coming to a stop on the airport apron.)
  • B735, Denver USA, 2008 (Runway Side Excursion During Attempted Take-off in Strong and Gusty Crosswind Conditions.)
  • L410, Isle of Man, 2017 (On 23 February 2017, a Czech-operated Let-410 departed from Isle of Man into deteriorating weather conditions and when unable to land at its destination returned and landed with a crosswind component approximately twice the certified limit. The local Regulatory Agency instructed ATC to order the aircraft to immediately stop rather than attempt to taxi and the carrier’s permit to operate between the Isle of Man and the UK was subsequently withdrawn. The Investigation concluded that the context for the event was a long history of inadequate operational safety standards associated with its remote provision of flights for a Ticket Seller.)

Thrust Reversers not fitted

  • E145, Hannover Germany, 2005 (On 14 August 2005, a British Airways Regional Embraer 145 overran Runway 27L at Hannover by 160 metes after flying a stable approach in daylight but then making a soft and late touchdown on a water covered runway. Dynamic aquaplaning began and this was followed by reverted rubber aquaplaning towards the end of the paved surface when the emergency brake was applied. The aircraft suffered only minor damage and only one of the 49 occupants was slightly injured.)
  • E135, George South Africa, 2009 (On 7 December 2009, an South African Airlink Embraer 135 overran the recently refurbished wet landing runway at George after braking was ineffective and exited the aerodrome perimeter to end up on a public road. There was no fire and all occupants were able to evacuate the aircraft. The subsequent investigation attributed the overrun principally to inadequate wet runway friction following the surface maintenance activities and noted various significant non-compliances with ICAO Annex 14.)
  • B462, Stord Norway, 2006 (On 10 October 2006, a BAE Systems 146-200 being operated by Danish airline Atlantic Airways on a passenger flight from Sola to Stord overran the end of runway 33 at destination at a slow speed in normal visibility at dawn (but just prior to the accepted definition of daylight) before plunging down a steep slope sustaining severe damage and catching fire immediately it had come to rest. The rapid spread of the fire and difficulties in evacuation resulted in the death of four of the 16 occupants and serious injury to six others. The aircraft was completely destroyed.)

Landing Performance Assessment

  • A310, Khartoum Sudan, 2008 (On 10 June 2008, a Sudan Airways Airbus A310 made a late night touchdown at Khartoum and the actions of the experienced crew were subsequently unable to stop the aircraft, which was in service with one thrust reverser inoperative and locked out, on the wet runway. The aircraft stopped essentially intact some 215 metres beyond the runway end after overrunning on smooth ground but a fuel-fed fire then took hold which impeded evacuation and eventually destroyed the aircraft.)
  • B736, Montréal QC Canada, 2015 (On 5 June 2015, a Boeing 737-600 landed long on a wet runway at Montréal and the crew then misjudged their intentionally-delayed deceleration because of an instruction to clear the relatively long runway at its far end and were then unable to avoid an overrun. The Investigation concluded that use of available deceleration devices had been inappropriate and that deceleration as quickly as possible to normal taxi speed before maintaining this to the intended runway exit was a universally preferable strategy. It was concluded that viscous hydroplaning had probably reduced the effectiveness of maximum braking as the runway end approached.)
  • MD83, Port Harcourt Nigeria, 2018 (On 20 February 2018, a Boeing MD-83 attempting a night landing at Port Harcourt during a thunderstorm and heavy rain touched down well beyond the touchdown zone and departed the side of the runway near its end before continuing 300 metres beyond it. The Investigation found that a soft touchdown had occurred with 80% of the runway behind the aircraft and a communications failure on short final meant a wind velocity change just before landing leading to a tailwind component of almost 20 knots was unknown to the crew who had not recognised the need for a go around.)
  • MD88, New York La Guardia USA, 2015 (On 5 March 2015 a Boeing MD88 veered off a snow-contaminated runway 13 at New York La Guardia soon after touchdown after the experienced flight crew applied excessive reverse thrust and thus compromised directional control due to rudder blanking, a known phenomenon affecting the aircraft type. The aircraft stopped partly outside the airport perimeter with the forward fuselage over water. In addition to identifying the main cause of the accident, the Investigation found that exposure to rudder blanking risks was still widespread. It also noted that the delayed evacuation was partly attributable to inadequate crew performance and related Company procedures.)
  • B737, Chicago Midway USA, 2005 (On 8 December 2005, a delay in deploying the thrust reversers after a Boeing 737-700 touchdown at night on the slippery surface of the 1176 metre-long runway at Chicago Midway with a significant tailwind component led to it running off the end, subsequently departing the airport perimeter and hitting a car before coming to a stop. The Investigation concluded that pilots’ lack of familiarity with the autobrake system on the new 737 variant had distracted them from promptly deploying the reversers and that inadequate pilot training provision and the ATC failure to provide adequate braking action information had contributed.)

Off side of Runway

  • A320, Jaipur India, 2014 (On 5 January 2014, an Airbus A320 was unable to land at Delhi due to visibility below crew minima and during subsequent diversion to Jaipur, visibility there began to deteriorate rapidly. A Cat I ILS approach was continued below minima without any visual reference because there were no other alternates within the then-prevailing fuel endurance. The landing which followed was made in almost zero visibility and the aircraft sustained substantial damage after touching down to the left of the runway. The Investigation found that the other possible alternate on departure from Delhi had materially better weather but had been ignored.)
  • A320, Tehran Mehrabad Iran, 2016 (On 13 August 2016, an Airbus A320 departed the side of the runway at low speed during takeoff from Tehran Mehrabad and became immobilised in soft ground. The Investigation found that the Captain had not ensured that both engines were simultaneously stabilised before completing the setting of takeoff thrust and that his subsequent response to the resulting directional control difficulties had been inappropriate and decision to reject the takeoff too late to prevent the excursion. Poor CRM on the flight deck was identified as including but not limited to the First Officer’s early call to reject the takeoff being ignored.)
  • B738, Lyon France, 2009 (On 29 August 2009, an Air Algérie Boeing B737-800 departed the side of the runway during take off but then regained the paved surface after sustaining damage from obstructions, completed the take off without further event and continued to destination. Damage to one of the engines, to tyres and to two lights was discovered at the destination. ATC remained unaware of the excursion until the Operator asked its representative at Lyon to ask the airport to carry out a runway inspection.)
  • B744, Montreal Canada, 2008 (During the landing roll in normal the aircraft veered to the right and stopped with the nose landing gear off the side of the runway.)
  • A320, Brunei, 2014 (On 7 July 2014, an Airbus A320 landing at Brunei departed the side of the runway almost immediately after touchdown and continued to gradually diverge from the runway axis until stopping after a ground run of approximately 1,050 metres. The Investigation concluded that the aircraft commander, having taken over control from the First Officer when the latter lost their previously-acquired prescribed visual reference below Decision Altitude due to a sudden-onset intense rain shower ahead, had then continued the approach without recognising that the only lights still visible to him were those at the right hand edge of the runway.)

Taxiway Take Off/Landing

  • B733, Amsterdam Netherlands, 2010 (On 10 February 2010 a KLM Boeing 737-300 unintentionally made a night take off from Amsterdam in good visibility from the taxiway parallel to the runway for which take off clearance had been given. Because of the available distance and the absence of obstructions, the take off was otherwise uneventful. The Investigation noted the familiarity of the crew with the airport and identified apparent complacency.)
  • B734, Sharjah UAE, 2015 (On 24 September 2015, a Boeing 737-400 cleared for a night take-off from Sharjah took off from the parallel taxiway. The controller decided that since the taxiway was sterile and the aircraft speed was unknown, the safest option was to allow the take-off to continue. The Investigation noted that the taxiway used had until a year previously been the runway, becoming a parallel taxiway only when a new runway had been opened alongside it. It was noted that the controller had "lost visual watch" on the aircraft and regained it only once the aircraft was already at speed.)
  • A343, Hong Kong China, 2010 (On 27 November 2010, a Finnair Airbus A340-300 unintentionally attempted a night take off from Hong Kong in good visibility from the taxiway parallel to the runway for which take off clearance had been given. ATC observed the error and instructed the crew to abandon the take off, which they then did. The Investigation attributed the crew error partly to distraction. It was considered that the crew had become distracted and that supporting procedures and process at the Operator were inadequate.)
  • B763, Singapore, 2015 (On 12 July 2015, a Japanese-operated Boeing 767-300 deviated from its acknowledged clearance and lit-centreline taxi routing and began take-off from a parallel taxiway in good night visibility, crossing a lit red stop bar in the process. When ATC observed this, the aircraft was instructed to stop which was achieved without further event. A subsequent take-off was uneventful. The crew did not report the event to their airline or their State authorities because the Captain "determined that this case did not need to be reported" and these organisations only became aware when subsequently contacted by the Investigating Agency.)
  • B734, Palembang Indonesia, 2008 (On 2 October 2008, a Boeing 737-400 being used for flight crew command upgrade line training unintentionally landed off a non precision approach at Palembang in daylight on a taxiway parallel to the landing runway. Neither pilot realised their error until the aircraft was already on the ground when they saw a barrier ahead and were able to brake hard to stop only 700 metres from touchdown. It was found that the taxiway involved had served as a temporary runway five years earlier and that previously obliterated markings from that use had become visible.)

Runway Length Temporarily Reduced

  • A343, London Heathrow, UK 2012 (On 5 February 2012, an Airbus A340-300 started its takeoff from an intermediate point on the runway for which no regulated takeoff weight information was available and had only become airborne very close to the end of the runway and then climbed only very slowly. The Investigation found that as the full length of the planned departure runway was not temporarily unavailable, ATC had offered either the intersection subsequently used or the full length of the available parallel runway and that despite the absence of valid performance data for the intersection, the intersection had been used.)
  • A306, Yerevan Armenia, 2015 (On 17 May 2015, an Airbus A300-600 crew descended their aircraft below the correct vertical profile on a visual daytime approach at Yerevan and then landed on a closed section of the runway near the displaced runway threshold. The Investigation found that the crew had failed to review relevant AIS information prior to departing from Tehran and had not been expecting anything but a normal approach and landing. The performance of the Dispatcher in respect of briefing and the First Officer in respect of failure to adequately monitor the Captain's flawed conduct of the approach was highlighted.)
  • A343, Rio de Janeiro Galeão Brazil, 2011 (On 8 December 2011, an Airbus A340-300 did not become airborne until it had passed the end of the takeoff runway at Rio de Janeiro Galeão, which was reduced in length due to maintenance. The crew were unaware of this fact nor the consequent approach lighting, ILS antennae and aircraft damage, and completed their intercontinental flight. The Investigation found that the crew had failed to use the full available runway length despite relevant ATIS and NOTAM information and that even using rated thrust from where they began their takeoff, they would not have become airborne before the end of the runway.)
  • B738, Manchester UK, 2003 (On 16 July 2003, a Boeing 737-800, being operated by Excel Airlines on a passenger flight from Manchester to Kos began take off on Runway 06L without the flight crew being aware of work in progress at far end of the runway. The take off calculations, based on the full runway length resulted in the aircraft passing within 56 ft of a 14 ft high vehicle just after take off.)
  • B738, Paris CDG France, 2008 (On 16 August 2008, an AMC Airlines’ Boeing 737-800 inadvertently began a night take off from an intersection on runway 27L at Paris CDG which left insufficient take off distance available before the end of the temporarily restricted runway length. It collided with and damaged obstructions related to construction works in progress on the closed section of the runway but sustained only minor damage and completed the intended flight to Luxor. The context for the flight crew error was identified as inadequate support from the Operator and inadequate airport risk assessment for operations with a reduced runway length.)

Intentional Premature Rotation

  • B763, Manchester UK, 2008 (On 13 December 2008, a Thomsonfly Boeing 767-300 departing from Manchester for Montego Bay Jamaica was considered to be accelerating at an abnormally slow rate during the take off roll on Runway 23L. The aircraft commander, who was the pilot not flying, consequently delayed the V1 call by about 10 - 15 because he thought the aircraft might be heavier than had been calculated. During the rotation the TAILSKID message illuminated momentarily, indicating that the aircraft had suffered a tail strike during the takeoff. The commander applied full power and shortly afterwards the stick shaker activated briefly. The aircraft continued to climb away and accelerate before the flaps were retracted and the after-takeoff check list completed. The appropriate drills in the Quick Reference Handbook (QRH) were subsequently actioned, fuel was dumped and the aircraft returned to Manchester for an overweight landing without further incident.)
  • B773, London Heathrow UK, 2016 (On 30 August 2016, a Boeing 777-300 crew began takeoff from London Heathrow at an intersection one third of the way along the runway using the reduced thrust calculated for a full-length take off instead of the rated thrust calculated for the intersection takeoff. As a result, the aircraft was only just airborne as it crossed the airport boundary and an adjacent public road. The Investigation attributed the data input error to crew failure to respond appropriately on finding that they had provisionally computed performance data based on different assumptions and concluded that the relevant Operator procedures were insufficiently robust.)
  • MD88, Groningen Netherlands, 2003 (On 17 June 2003, a crew of a Boeing MD-88, belonging to Onur Air, executed a high speed rejected take-off at a late stage which resulted in overrun of the runway and serious damage to the aircraft.)

Incorrect Aircraft Configuration

  • JS41, Rhodes Greece, 2015 (On 2 February 2015, a Jetstream 41 made a hard and extremely fast touchdown at Rhodes and the left main gear leg collapsed almost immediately. The crew were able to prevent the consequent veer left from leading to a lateral runway excursion. The Investigation found that the approach had been significantly unstable throughout with touchdown at around 50 knots above what it should have been and that a whole range of relevant procedures had been violated by the management pilot who had flown the approach in wind shear conditions in which approaches to Rhodes were explicitly not recommended.)
  • GLF4, Le Castellet France, 2012 (On 13 July 2012, a Gulfstream G-IV left the side of the runway at high speed during the landing roll at Le Castellet following a positioning flight after ineffective deceleration after the flight crew had forgotten to arm the ground spoilers. The Investigation found that pilot response to this situation had been followed by a loss of directional control, collision with obstructions and rapid onset of an intense fire. Contributory factors identified included poor procedural compliance by the pilots, their lack of training on a relevant new QRH procedure which Gulfstream had ineffectively communicated and ineffective FAA oversight of the operation.)
  • E145, Bristol UK, 2017 (On 22 December 2017, an Embraer 145 departed the side of the runway shortly after touching down at Bristol and finally stopped 120 metres from the runway edge. The Investigation found that the aircraft had landed after the emergency/parking brake had been inadvertently selected on during the approach when the intention had been to deploy the speed brakes. It was noted that the Captain designated as Pilot Flying had been new to both the aircraft type and the Operator and had been flying under supervision as part of the associated type conversion requirement for line training.)
  • B738, Georgetown Guyana, 2011 (On 30 July 2011, a Boeing 737-800 overran the wet landing runway at Georgetown after a night non-precision approach, exited the airport perimeter and descended down an earth embankment. There were no fatalities but the aircraft sustained substantial damage and was subsequently declared a hull loss. The Investigation attributed the overrun to a touchdown almost two thirds of the way down the runway and failure to utilise the aircraft’s full deceleration capability. Loss of situational awareness and indecision as to the advisability of a go-around after a late touchdown became inevitable was also cited as contributory to the outcome.)
  • E190, Kupang Indonesia, 2015 (On 21 December 2015, an Embraer 195 crew continued a significantly unstable approach which included prolonged repetition of 'High Speed' and a series of EGPWS Alerts which were both ignored and which culminated in a high speed late touchdown which ended in a 200 metre overrun. The Investigation attributed the event to poor flight management and noted the systemic lack of any effective oversight of pilot operating standards compounded in the investigated event by the effects of a steep flight deck authority gradient and the failure to detect anomalies in the normal operating behaviour of both the pilots involved.)

Reduced Thrust Take Off

  • A332, Montego Bay Jamaica, 2008 (On 28 October 2008, an Airbus A330-200 could not be rotated for liftoff whist making a night takeoff from Montego Bay until the Captain had increased the reduced thrust set to TOGA, after which the aircraft became airborne prior to the end of the runway and climbed away normally. The Investigation found that the takeoff performance data used had been calculated for the flight by Company Despatch and the fact that it had been based on a takeoff weight which was 90 tonnes below the actual take off weight had not been noticed by any of the flight crew.)
  • A319, Nice France, 2019 (On 29 August 2019, an Airbus A319 crew used more runway than expected during a reduced thrust takeoff from Nice, although not enough to justify increasing thrust. It was subsequently found that an identical error made by both pilots when independently calculating takeoff performance data for the most limiting runway intersection had resulted in use of data for a less limiting intersection than the one eventually used. The Investigation concluded that the only guaranteed way to avoid such an error would be an automatic cross check, a system upgrade which was not possible on the particular aircraft involved.)
  • B748, Tokyo Narita Japan, 2017 (On 15 July 2017, a Boeing 747-8F close to its maximum takeoff weight only became airborne just before the end of the 2,500 metre-long north runway at Narita after the reduced thrust applicable to the much longer south runway was used for the takeoff and the aircraft cleared the upwind runway threshold by only 16 feet. The Investigation found that the very experienced Captain and the very inexperienced First Officer had both failed to follow elements of the applicable takeoff performance change procedures after the departure runway anticipated during pre-start flight preparations prior to ATC clearance delivery had changed.)
  • A345, Melbourne Australia, 2009 (On 20 March 2009 an Airbus A340-500, operated by Emirates, commenced a take-off roll for a normal reduced-thrust take-off on runway 16 at Melbourne Airport. The attempt to get the aircraft airborne resulted in a tail strike and an overrun because insufficient thrust had been set based upon an incorrect flight crew data entry.)
  • B773, Auckland Airport New Zealand, 2007 (On 22 March 2007, an Emirates Boeing 777-300ER, started its take-off on runway 05 Right at Auckland International Airport bound for Sydney. The pilots misunderstood that the runway length had been reduced during a period of runway works and started their take-off with less engine thrust and flap than were required. During the take-off they saw work vehicles in the distance on the runway and, realising something was amiss, immediately applied full engine thrust and got airborne within the available runway length and cleared the work vehicles by about 28 metres.)

Fixed Obstructions in Runway Strip

  • A30B, Bratislava Slovakia, 2012 (On 16 November 2012, an Air Contractors Airbus A300 departed the left the side of the landing runway at Bratislava after an abnormal response to directional control inputs. Investigation found that incorrect and undetected re-assembly of the nose gear torque links had led to the excursion and that absence of clear instructions in maintenance manuals, since rectified, had facilitated this. It was also considered that the absence of any regulation requiring equipment in the vicinity of the runway to be designed to minimise potential damage to aircraft departing the paved surface had contributed to the damage caused by the accident.)
  • E55P, Blackbushe UK, 2015 (On 31 July 2015 a Saudi-operated Embraer Phenom on a private flight continued an unstabilised day visual approach to Blackbushe in benign weather conditions. The aircraft touched down with excess speed with almost 70% of the available landing distance behind the aircraft. It overran and was destroyed by impact damage and fire and all occupants died. The Investigation concluded that the combination of factors which created a very high workload for the pilot "may have saturated his mental capacity, impeding his ability to handle new information and adapt his mental model" leading to his continuation of a highly unstable approach.)
  • B738, Manila Philippines, 2018 (On 16 August 2018, a Boeing 737-800 made a stabilised approach to Manila during a thunderstorm with intermittent heavy rain but the crew lost adequate visual reference as they arrived over the runway. After a drift sideways across the 60 metre-wide landing runway, a veer off occurred and was immediately followed by a damaging collision with obstructions not compliant with prevailing airport safety standards. The Investigation found that the Captain had ignored go around calls from the First Officer and determined that the corresponding aircraft operator procedures were inadequate as well as faulting significant omissions in the Captain’s approach brief.)
  • DH8D, Hubli India, 2015 (On 8 March 2015, directional control of a Bombardier DHC 8-400 which had just completed a normal approach and landing was lost and the aircraft departed the side of the runway following the collapse of both the left main and nose landing gear assemblies. The Investigation found that after being allowed to drift to the side of the runway without corrective action, the previously airworthy aircraft had hit a non-frangible edge light and the left main gear and then the nose landing gear had collapsed with a complete loss of directional control. The aircraft had then exited the side of the runway sustaining further damage.)

Ineffective Use of Retardation Methods

  • B744, Maastricht-Aachen Netherlands, 2017 (On 11 November 2017, a type-experienced Boeing 747-400ERF crew making a night rolling takeoff at Maastricht-Aachen lost aircraft directional control after an outer engine suddenly failed at low speed and a veer-off onto soft ground adjacent to the runway followed. The Investigation found that rather than immediately reject the takeoff when the engine failed, the crew had attempted to maintain directional control without thrust reduction to the point where an excursion became unavoidable. The effect of ‘startle’, the Captain’s use of a noise cancelling headset and poor alerting to the engine failure by the First Officer were considered contributory.)
  • DH8D, Hubli India, 2015 (On 8 March 2015, directional control of a Bombardier DHC 8-400 which had just completed a normal approach and landing was lost and the aircraft departed the side of the runway following the collapse of both the left main and nose landing gear assemblies. The Investigation found that after being allowed to drift to the side of the runway without corrective action, the previously airworthy aircraft had hit a non-frangible edge light and the left main gear and then the nose landing gear had collapsed with a complete loss of directional control. The aircraft had then exited the side of the runway sustaining further damage.)
  • B736, Montréal QC Canada, 2015 (On 5 June 2015, a Boeing 737-600 landed long on a wet runway at Montréal and the crew then misjudged their intentionally-delayed deceleration because of an instruction to clear the relatively long runway at its far end and were then unable to avoid an overrun. The Investigation concluded that use of available deceleration devices had been inappropriate and that deceleration as quickly as possible to normal taxi speed before maintaining this to the intended runway exit was a universally preferable strategy. It was concluded that viscous hydroplaning had probably reduced the effectiveness of maximum braking as the runway end approached.)
  • B463, Khark Island Iran, 2016 (On 19 June 2016, a BAe 146-300 landed long at Khark Island and overran the end of the runway at speed with the aircraft only stopping because the nose landing gear collapsed on encountering uneven ground. The Investigation attributed the accident - which caused enough structural damage for the aircraft to be declared a hull loss - entirely to the decisions and actions of the aircraft commander who failed to go around from an unstabilised approach, landed long and then did not ensure maximum deceleration was achieved. The monitoring role of the low experience First Officer was ineffective.)
  • GLF4, Le Castellet France, 2012 (On 13 July 2012, a Gulfstream G-IV left the side of the runway at high speed during the landing roll at Le Castellet following a positioning flight after ineffective deceleration after the flight crew had forgotten to arm the ground spoilers. The Investigation found that pilot response to this situation had been followed by a loss of directional control, collision with obstructions and rapid onset of an intense fire. Contributory factors identified included poor procedural compliance by the pilots, their lack of training on a relevant new QRH procedure which Gulfstream had ineffectively communicated and ineffective FAA oversight of the operation.)

Continued Take Off

  • B738, Belfast International UK, 2017 (On 21 July 2017, a Boeing 737-800 taking off from Belfast was only airborne near the runway end of the runway and then only climbed at a very shallow angle until additional thrust was eventually added. The Investigation found that the thrust set had been based on an incorrectly input surface temperature of -52°C, the expected top of climb temperature, instead of the actual surface temperature. Although inadequate acceleration had been detected before V1, the crew did not intervene. It was noted that neither the installed FMC software nor the EFBs in use were conducive to detection of the data input error.)
  • A320, Basel-Mulhouse-Freiburg France, 2014 (On 6 October 2014, an A320 crew requested, accepted and commenced an intersection takeoff at Basel using reduced thrust performance data based on the originally anticipated full length takeoff which would have given 65% more TODA. Recognition of the error and application of TOGA allowed the aircraft to get airborne just before the runway end but the Investigation found that a rejected take off from high speed would have resulted in an overrun and noted that despite changes to crew procedures after a similar event involving the same operator a year earlier, the relevant procedures were still conducive to error.)
  • CRJX, Madrid Spain, 2015 (On 1 February 2015, a Bombardier CRJ 1000 departed from Pamplona with slush likely to have been in excess of the regulatory maximum depth on the runway. On landing at Madrid, the normal operation of the brake units was compromised by ice and one tyre burst damaging surrounding components and leaving debris on the runway, and the other tyre was slow to spin up and sustained a serious flat spot. The Investigation concluded that the Pamplona apron, taxiway and runway had not been properly cleared of frozen deposits and that the flight crew had not followed procedures appropriate for the prevailing conditions.)
  • A319, Las Vegas NV USA, 2006 (On 30 January 2006 the Captain of an Airbus A319 inadvertently lined up and commenced a night rolling take off from Las Vegas on the runway shoulder instead of the runway centreline despite the existence of an illuminated lead on line to the centre of the runway from the taxiway access used. The aircraft was realigned at speed and the take off was completed. ATC were not advised and broken edge light debris presented a potential hazard to other aircraft until eventually found. The Investigation found that other similar events on the same runway had not been reported at all.)
  • FA50 / Vehicle, Moscow Vnukovo Russia, 2014 (On 20 October 2014 a Dassault Falcon 50 taking off at night from Moscow Vnukovo collided with a snow plough which had entered the same runway without clearance shortly after rotation. Control was lost and all occupants died when it was destroyed by impact forces and post crash fire. The uninjured snow plough driver was subsequently discovered to be under the influence of alcohol. The Investigation found that the A-SMGCS effective for over a year prior to the collision had not been properly configured nor had controllers been adequately trained on its use, especially its conflict alerting functions.)

Continued Landing Roll

  • B739, Yogyakarta Indonesia, 2015 (On 6 November 2015, a Boeing 737-900 overran the 2,200 metre-long landing runway at Yogyakarta after a tailwind approach with airspeed significantly above the applicable Vref followed by a long landing on a wet runway without optimum use of deceleration devices. The flight crew management of the situation once the aircraft had come to a stop was contrary to procedures in a number of important respects. The aircraft operator took extensive action to improve crew performance following the event. The Investigation found significant fault with the airport operator's awareness of runway surface condition and an absence of related significant risk management.)
  • B733, Aqaba Jordan, 2017 (On 17 September 2017, a Boeing 737-300 requested and was approved for a visual approach to Aqaba which involved a significant tailwind component and, after approaching at excessive speed, it touched down late and overran the 3000 metre runway onto sandy ground. The Investigation found that despite EGPWS Alerts relating to both the high rate of descent and late configuration, the Captain had instructed the First Officer to continue what was clearly an unstabilised approach and when touchdown had still not occurred with around 1000 metres of runway left, the Captain took over but was unable to prevent an overrun.)
  • B738, Mangalore India, 2012 (On 14 August 2012, a Boeing 737-800 crew continued a previously stable ILS Cat 1 approach below the prescribed MDA without having acquired the prescribed visual reference. The aircraft was then damaged by a high rate of descent at the initial touchdown in the undershoot in fog. The occurrence was not reported by either the crew or the attending licensed engineer who discovered consequent damage to the aircraft. Dense fog had prevented ATC visual awareness. The Investigation attributed the undershoot to violation of minima and to both pilots looking out for visual reference leaving the flight instruments unmonitored.)
  • A320, Toronto ON Canada, 2017 (On 25 February 2017, an Airbus A320 left the side of the landing runway at Toronto when, for undetermined reasons, the Captain, as Pilot Flying, set up a drift to the right just before touchdown. This was then followed by a lateral runway excursion into wet grass in rain-reduced visibility which continued for 1,650 metres before the aircraft regained the runway and stopped. The Investigation noted that both the absence of runway centreline lighting and the aircraft operator’s policy of not activating the aircraft rain repellent system or applying the alternative hydrophobic windshield coating may have increased the excursion risk.)
  • B738, Georgetown Guyana, 2011 (On 30 July 2011, a Boeing 737-800 overran the wet landing runway at Georgetown after a night non-precision approach, exited the airport perimeter and descended down an earth embankment. There were no fatalities but the aircraft sustained substantial damage and was subsequently declared a hull loss. The Investigation attributed the overrun to a touchdown almost two thirds of the way down the runway and failure to utilise the aircraft’s full deceleration capability. Loss of situational awareness and indecision as to the advisability of a go-around after a late touchdown became inevitable was also cited as contributory to the outcome.)

Excessive Exit to Taxiway Speed

  • JS32, Torsby Sweden, 2014 (On 31 January 2014, an Estonian-operated BAE Jetstream 32 being used under wet lease to fulfil a government-funded Swedish domestic air service requirement landed long at night and overran the end of the runway. The Investigation concluded that an unstabilised approach had been followed by a late touchdown at excessive speed and that the systemic context for the occurrence had been a complete failure of the aircraft operator to address operational safety at anything like the level appropriate to a commercial operation. Failure of the responsible State Safety Regulator to detect and act on this situation was also noted.)

Frozen Deposits on Runway

  • B763, Halifax NS Canada, 2019 (On 4 March 2019, a Boeing 767-300 crew lost directional control of their aircraft as speed reduced following their touchdown at Halifax and were unable to prevent it being rotated 180° on the icy surface before coming to a stop facing the runway landing threshold. The Investigation found that the management of the runway safety risk by the airport authority had been systemically inadequate and that the communication of what was known by ATC about the runway surface condition had been incomplete. A number of subsequent corrective actions taken by the airport authority were noted.)
  • CRJX, Madrid Spain, 2015 (On 1 February 2015, a Bombardier CRJ 1000 departed from Pamplona with slush likely to have been in excess of the regulatory maximum depth on the runway. On landing at Madrid, the normal operation of the brake units was compromised by ice and one tyre burst damaging surrounding components and leaving debris on the runway, and the other tyre was slow to spin up and sustained a serious flat spot. The Investigation concluded that the Pamplona apron, taxiway and runway had not been properly cleared of frozen deposits and that the flight crew had not followed procedures appropriate for the prevailing conditions.)

Excessive Water Depth

  • B738, Mumbai India, 2018 (On 10 July 2018, a Boeing 737-800 marginally overran the wet landing runway at Mumbai after the no 1 engine thrust reverser failed to deploy when full reverse was selected after a late touchdown following a stabilised ILS approach. The Investigation found that the overrun was the result of touchdown with almost 40% of the runway behind the aircraft followed by the failure of normal thrust reverser deployment when attempted due to a failed actuator in one of the reversers. The prevailing moderate rain and the likelihood that dynamic aquaplaning had occurred were identified as contributory.)

Intentional Veer Off Runway

  • C402, Virgin Gorda British Virgin Islands, 2017 (On 11 February 2017, a Cessna 402 failed to stop on the runway when landing at Virgin Gorda and was extensively damaged. The Investigation noted that the landing distance required was very close to that available with no safety margin so that although touchdown was normal, when the brakes failed to function properly, there was no possibility of safely rejecting the landing or stopping normally on the runway. Debris in the brake fluid was identified as causing brake system failure. The context was considered as the Operator’s inadequate maintenance practices and a likely similar deficiency in operational procedures and processes.)
  • AN72, Sao Tome, Sao Tome & Principe, 2017 (On 29 July 2017, an Antonov AN-74 crew sighted several previously unseen large “eagles” rising from the long grass next to the runway as they accelerated for takeoff at Sao Tome and, concerned about the risk of ingestion, made a high speed rejected takeoff but were unable to stop on the runway and entered a deep ravine just beyond it which destroyed the aircraft. The Investigation found that the reject had been unnecessarily delayed until above V1, that the crew forgot to deploy the spoilers which would have significantly increased the stopping distance and that relevant crew training was inadequate.)

Misaligned take off

  • E120, Amsterdam Netherlands, 2016 (On 18 January 2016, an Embraer 120 crew made a night takeoff from Amsterdam Runway 24 unaware that the aircraft was aligned with the right side runway edge lights. After completion of an uneventful flight, holes in the right side fuselage and damage to the right side propeller blades, the latter including wire embedded in a blade leading edge, were found. The Investigation concluded that poor visual cues guiding aircraft onto the runway at the intersection concerned were conducive to pilot error and noted that despite ATS awareness of intersection takeoff risks, no corresponding risk mitigation had been undertaken.)
  • AT72, Karup Denmark, 2016 (On 25 January 2016, an ATR 72-200 crew departing from and very familiar with Karup aligned their aircraft with the runway edge lights instead of the lit runway centreline and began take-off, only realising their error when they collided with part of the arrester wire installation at the side of the runway after which the take-off was rejected. The Investigation attributed the error primarily to the failure of the pilots to give sufficient priority to ensuring adequate positional awareness and given the familiarity of both pilots with the aerodrome noted that complacency had probably been a contributor factor.)
  • DH8A, Rouyn-Noranda QC Canada, 2019 (On 23 January 2019, a Bombardier DHC8-100 failed to complete its intended night takeoff from Rouyn-Noranda after it had not been commenced on or correctly aligned parallel to the (obscured) centreline and the steadily increasing deviation had not been recognised until a runway excursion was imminent. The Investigation attributed this to the failure of the crew to pay sufficient attention to the external perspective provided by the clearly-visible runway edge lighting whilst also noting the Captain’s likely underestimation of the consequences of a significant flight deck authority gradient and a failure to fully follow relevant applicable operating procedures.)

Runway Condition not as reported

  • B763, Halifax NS Canada, 2019 (On 4 March 2019, a Boeing 767-300 crew lost directional control of their aircraft as speed reduced following their touchdown at Halifax and were unable to prevent it being rotated 180° on the icy surface before coming to a stop facing the runway landing threshold. The Investigation found that the management of the runway safety risk by the airport authority had been systemically inadequate and that the communication of what was known by ATC about the runway surface condition had been incomplete. A number of subsequent corrective actions taken by the airport authority were noted.)
  • B738, Sochi Russia, 2018 (On 1 September 2018, a Boeing 737-800, making its second night approach to Sochi beneath a large convective storm with low level windshear reported, floated almost halfway along the wet runway before overrunning it by approximately 400 metres and breaching the perimeter fence before stopping. A small fire did not prevent all occupants from safely evacuating. The Investigation attributed the accident to crew disregard of a number of windshear warnings and a subsequent encounter with horizontal windshear resulting in a late touchdown and noted that the first approach had meant that the crew had been poorly prepared for the second.)
  • CRJ9, Turku Finland, 2017 (On 25 October 2017, a Bombardier CRJ-900 crew lost directional control after touchdown at Turku in the presence of a tailwind component on a contaminated runway at night whilst heavy snow was falling. After entering a skid the aircraft completed a 180° turn before finally stopping 160 metres from the end of the 2500 metre-long runway. The Investigation found that skidding began immediately after touchdown with the aircraft significantly above the aquaplaning threshold and that the crew did not follow the thrust reverser reset procedure after premature deployment or use brake applications and aileron inputs appropriate to the challenging conditions.)

Related Articles

For all accident reports held on SKYbrary, see the main section on Accident Reports.