Trust IL76 enroute on Jun 21st 2012, inflight activation of park brake
Last Update: July 17, 2013 / 20:03:09 GMT/Zulu time
The United Arab Emirates General Civil Aviation Authority (GCAA) released their final report into the occurrence, which rated a serious incident, concluding:
The Air Accident Investigation Sector determines that the causes of the RTR 1016 Serious Incident were:
- Tires lock prior to touchdown;
- Switching the parking brakes to ON in-flight and continuing to land with parking brakes engagement; and
- The CRM was not sufficient to detect and prevent the parking brake switch commission error.
Contributing factors to the Serious Incident were:
- Although the parking brake system could have detected the inflight parking brake engagement through the green brake lights, the system was not designed to prevent the in-flight engagement of the parking brake.
- The communication network among the flight deck crew was not sufficient.
The GCAA reported that although all crew members held certification of ICAO Level 4 English skills, the majority did not possess according language skills in post flight interviews. Most of the crew communication during the flight was in Russian.
The investigation was unable to determine who had when and why set the parking brake in flight, however, the park brake system did not malfunction and reacted according to the switch position. The GCAA analysed, that the system was actually aware that the park brakes should not be set in flight and showed an according indication to the crew, which was not detected or observed by the crew, however the system was not designed to prevent setting the park brake in flight.
The GCAA analyed that the cockpit voice recorder did not reveal the crew working the relevant landing checklist item, which required: "Landing gear Down, green announciators glow, parking brake off" - there was no reference made to the park brake. The checklist was to be read by the radio operator, the flight engineer should check the relevant item and the first officer confirm the action.
The GCAA concluded the analysis by stating: "The Investigation believes, it is most probably, that the intra-flight deck communication was not adequate to assure that a checklist item is clearly read, accomplished and confirmed."
This article is published under license from Avherald.com. © of text by Avherald.com.
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