Narrative:Optical illusion on a night time approach caused the plane to crash some 3km short of runway 14.
|Date:||Friday 9 December 1977|
|Time:||ca 22:55 UTC|
de Havilland DH-125-400A
|Operator:||Churchill Falls Co.|
|C/n / msn:|| 25213/NA741|
|First flight:|| |
|Crew:||Fatalities: 2 / Occupants: 2|
|Passengers:||Fatalities: 6 / Occupants: 6|
|Total:||Fatalities: 8 / Occupants: 8 |
|Airplane damage:|| Written off|
|Airplane fate:|| Written off (damaged beyond repair)|
|Location:||Churchill Falls, NF (Canada)
|Phase:|| Approach (APR)|
|Departure airport:||Montreal (unknown airport), QC, Canada|
|Destination airport:||Churchill Falls Airport, NF (ZUM), Canada|
1) Cockpit discipline was inadequate as the approach entered the final phase.
2) Distractions in the cockpit degraded crew performance.
3) The pilots deprived themselves of essential altitude information by not effectively monitoring the flight instruments during the final approach.
4) The Captain, by relying on visual cues from the runway environment lighting in conditions where those cues were degraded, became exposed to visual illusions.
5) The pilots permitted the aircraft to deviate below the safe approach profile until it struck the terrain.
6) On the assumptions that there had been at least one serviceable ELT on board, that it had been activated as a result of the impact or by other means, and that there was the capability at Churchill Falls of homing to the point of origin of the ELT signal, the rescue activity may have been expedited.
» ICAO Circular 153-AN/56 (Accident Digest 23, p.181-193)