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Last updated: 15 November 2019
Status:Schlussbericht
Datum:Freitag 15 März 1991
Zeit:21:07
Flugzeugtyp:Silhouette image of generic LJ35 model; specific model in this crash may look slightly different
Learjet 35A
Fluggesellschaft:Líder Táxi Aéreo
Kennzeichen: PT-LIH
Werknummer: 35A-433
Baujahr: 1981
Triebwerk: 2 Garrett TFE731-2-2B
Besatzung:Todesopfer: 0 / Insassen: 2
Fluggäste:Todesopfer: 0 / Insassen: 2
Gesamt:Todesopfer: 0 / Insassen: 4
Sachschaden: Zerstört
Konsequenzen: Written off (damaged beyond repair)
Unfallort:Uberlândia-Eduardo Gomes Airport, MG (UDI) (   Brasilien)
Flugphase: Annäherung (APR)
Betriebsart:Ambulanz
Flug von:São Paulo-Congonhas Airport, SP (CGH/SBSP), Brasilien
Flug nach:Uberlândia-Eduardo Gomes Airport, MG (UDI/SBUL), Brasilien
Unfallbericht:
The Learjet 35A took off from São Paulo (CGH) for Uberlândia (UDI), to pick up a patient there. The co-pilot was pilot flying. It was his first flight on a Learjet without an instructor. This was against regulations since the co-pilot was not fully qualified yet and the captain was not qualified to act as an instructor.
When arriving over Uberlândia, the meteorological conditions were below the minimums due to fog: 8/8 clouds at 100 m and a visibility of 200 m. Two approaches were attempted without success. They should have diverted to another airport, but a third attempt was made, probably because the crew felt pressure to accomplish the flight and pick up the patient. A visual approach was attempted at a low height. A sharp turn was flown during the turn to finals. With a large bank angle a left turn was made for runway 04. The airplane stalled and collided with the ground, skidding 300 m before coming to rest.

Probable Cause:

CONCLUSÃO:

Fator Humano - Aspecto Psicológico - Contribuiu
Houve a participação de variáveis psicológicas, a nível individual e organizacional, que interferiram no desempenho da tripulação, com relação à necessidade da realização do pouso em Uberlândia para o transporte de um paciente.

Fator Operacional
(1). Condições Meteorológicas Adversas - Contribuíram
O aeródromo apresentava condições de teto e visibilidade abaixo dos mínimos.

(2). Deficiente Aplicação dos Comandos - Contribuiu
O piloto não usou os comandos da aeronave adequadamente, permitindo que a mesma estolasse e se chocasse com o solo.

(3). Deficiente Coordenação de Cabine - Indeterminado
Houve uma utilização inadequada dos recursos na cabine destinados à correta operação da aeronave, bem como não observância de normas operacionais.

(4). Deficiente Julgamento - Contribuiu
Houve uma avaliação inadequada, por parte da tripulação, das condições meteorológicas.

(5). Deficiente Planejamento - Contribuiu
A preparação do vôo, com relação ao aspecto meteorológico, foi inadequada.

(6). Deficiente Supervisão - Contribuiu
Houve deficiência na supervisão da atividade aérea, pois um piloto com restrições operacionais foi escalado para voar com um comandante que não era instrutor.

Informationsquelle:
» CENIPA - Centro de Investigação e Prevenção de Acidentes Aeronáuticos


Fotos

photo of Learjet-35A-PT-LIH
accident date: 15-03-1991
type: Learjet 35A
registration: PT-LIH
 

Map
This map shows the airport of departure and the intended destination of the flight. The line between the airports does not display the exact flight path.
Distance from São Paulo-Congonhas Airport, SP to Uberlândia-Eduardo Gomes Airport, MG as the crow flies is 550 km (344 miles).

This information is not presented as the Flight Safety Foundation or the Aviation Safety Network’s opinion as to the cause of the accident. It is preliminary and is based on the facts as they are known at this time.
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