ASN Aircraft accident de Havilland Canada DHC-6 Twin Otter 200 N141PV Perris Valley, CA

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Accident description

Last updated: 19 May 2013

Status:	Final
Date:	22 APR 1992
Time:	11:09
Type:	de Havilland Canada DHC-6 Twin Otter 200
Operator:	Perris Valley Aviation
Registration:	N141PV
C/n / msn:	141
First flight:	1968
Total airframe hrs:	29391
Engines:	2 Pratt & Whitney Canada PT6A-20A
Crew:	Fatalities: 2 / Occupants: 2
Passengers:	Fatalities: 14 / Occupants: 20
Total:	Fatalities: 16 / Occupants: 22
Airplane damage:	Destroyed
Airplane fate:	Written off (damaged beyond repair)
Location:	near Perris Valley, CA (United States of America)
Phase:	Initial climb (ICL)
Nature:	Parachuting
Departure airport:	Perris Valley Airport, CA, United States of America
Destination airport:	Perris Valley Airport, CA, United States of America

Narrative:
The no. 2 engine lost power after take-off. The aircraft crashed from a height of 50-75 feet some 200 feet past runway 17.

PROBABLE CAUSE: "The pilot-in-command's inadvertent feathering of the wrong propeller following an engine power loss, and the failure of the operator to assure that the pilot was provided with adequate training in the airplane. Factors related to the accident were: water contamination of fuel in the airport storage tanks, the operator's lack of fuel quality control procedures, improper fuel servicing, improper pre-flight by the pilot(s), and exceeding the gross weight/forward cg limits of the airplane."

Sources:
» Air Safety Week 5.4.1993 (p. 6)
» ICAO Adrep Summary 5/94 (#42)
» NTSB Safety Recommendations A-94-16 through -19
» NTSB Safety Recommendations A-94-20 through -23
» Scramble 156
Sample newspaper article from Newspaperarchive.com

Follow-up / safety actions

NTSB issued 8 Safety Recommendations

Issued: 17-FEB-1994	To: FAA	A-94-016
IN CONJUCTION WITH INDUSTRY, USPA, AND CAMI, DEVELOP AND TEST UNIVERSAL RESTRAINT SYSTEMS CAPABLE OF PROVIDING ADEQUATE PROTECTION TO PARACHUTISTS SIMILAR TO THAT PROVIDED FOR SEATED PASSENGERS. (Closed - Acceptable Action)
Issued: 17-FEB-1994	To: FAA	A-94-017
IN CONJUCTION WITH INDUSTRY, USPA, AND CAMI, PROVIDE FOR THE SEATING OF PARACHUTISTS TO ASSURE AN ADEQUATE LEVEL OF CRASH ENERGY ABSORPTION IN THE EVENT OF A SURVIVABLE AIRCRAFT ACCIDENT. (Closed - Unacceptable Action)
Issued: 17-FEB-1994	To: FAA	A-94-018
AMEND 14 CFR 91.30 TO REQUIRE EACH PARACHUTIST OR OTHER PASSENGER WHO IS SEATED ON AN AIRCRAFT CABIN FLOOR TO USE RESTRAINT SYSTEMS. THE RESTRAINT SYSTEM MUST BE DESIGNED, TESTED, AND APPROVED TO PROVIDE A LEVEL OF OCCUPANT PROTECTION SIMILAR TO THAT PROVIDED FOR PASSENGERS IN FORWARD AND AFT FACING SEATS THAT HAVE A SAFETY BELT AND SHOULDER HARNESS. (Closed - Acceptable Alternate Action)
Issued: 17-FEB-1994	To: FAA	A-94-019
DIRECT FLIGHT STANDARDS DISTRICT OFFICES TO INCREASE THEIR SURVEILLANCE OF SPORT PARACHUTE OPERATIONS AND COMPLY WITH THEIR ASSOCIATED OPERATIONS BULLETINS REGARDING PARACHUTE OPERATIONS. (Closed - Acceptable Action)
Issued: 17-FEB-1994	To: U.S.Parachute Association	A-94-020
REVISE THE USPA OPERATIONS MANUAL TO REQUIRE RESTRAINT SYSTEM USE DURING TAKEOFF AND LANDINGS. (Closed - Acceptable Action)
Issued: 17-FEB-1994	To: U.S.Parachute Association	A-94-021
PUBLISH AND DISTRIBUTE THE CONTENT OF THIS RECOMMENDATION LETTER ALL USPA MEMBERS. (Closed - Acceptable Action)
Issued: 17-FEB-1994	To: U.S.Parachute Association	A-94-022
PARTICIPATE IN THE DESIGN, DEVELOPMENT, AND TESTING OF A UNIVERSAL RESTRAINT SYSTEM THAT WOULD PROVIDE ADEQUATE PROTECTION FOR PARACHUTISTS SEATED ON AN AIRCRAFT FLOOR. (Closed - Acceptable Action)
Issued: 17-FEB-1994	To: U.S.Parachute Association	A-94-023
PARTICIPATE IN THE DESIGN, DEVELOPMENT, AND TESTING OF SEATING FOR PARACHUTISTS THAT WOULD PROVIDE AN ADEQUATE LEVEL OF CRASH ENERGY ABSORPTION IN THE EVENT OF A SURVIVABLE AIRCRAFT ACCIDENT. (Closed - Unacceptable Action)

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DHC-6 Twin Otter

161^st loss
844 built
17^th worst accident (at the time)
29^th worst accident (currently)

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United States of America

196^th worst accident (at the time)
218^th worst accident (currently)

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