Détails:
On final approach approximately 10 miles from the airport, the flight crew received an aft cargo bay fire warning. The flight crew followed checklist procedures, activated the cargo bay fire extinguishers and declared an emergency. The fire indication went out some 20 to 30 seconds after activation of the fire
extinguishers, but a slight smell of smoke was noticed by the cabin crew and flight crew. Flight 116 landed and stopped on the runway to allow airport
firefighters to inspect the aircraft for fire. Firefighters, using infrared sensing equipment, did not detect any sign of fire. The flight crew taxied the aircraft to the terminal but stopped approximately 40 feet back from the gate to allow firefighters to open the aft cargo compartment for a detailed inspection. When the cargo door was opened, a significant amount of smoke was observed. Firefighters entered the cargo compartment and confirmed that the fire had been extinguished. TSB investigators discovered that an intense but relatively small fire had occurred, causing significant structural damage in the floor area of the aft
cargo compartment. Before it was extinguished, the fire had progressed approximately 18 inches up the right side wall of the aircraft, outside the aft cargo compartment. The cargo bay fire-extinguishing system, a Halon-based system, effectively suppressed the fire before it could spread further. The fire appears to have been a direct result of an electrical failure of a heater tape used to prevent water lines from freezing. The electrical failure of the heater tape ignited the covering of the insulation blankets installed below the open cargo floor and some debris found in the area.
FAITS ÉTABLIS QUANT AUX CAUSES ET AUX FACTEURS CONTRIBUTIFS:
1. Le ruban chauffant B110 fixé à la conduite d'alimentation en eau a connu une défaillance dans la zone d'une récente réparation de la conduite d'eau, ce qui a permis aux éléments chauffants du ruban de produire un arc électrique, présentant une source d'inflammation aux matériaux à proximité.
2. Le revêtement en poly(éthylène téréphtalate) (PET) des matelas d'isolation thermique et acoustique était contaminé. Le matériau contaminé présentait une source inflammable capable d'alimenter un incendie qui se propage de lui-même.
3. Le plancher ouvert de la soute permettait aux contaminants et aux débris de s'accumuler dans la soute; les débris et les contaminants étaient du combustible capable d'alimenter un incendie.
4. Les dispositifs de protection de circuit sont conçus pour protéger le câblage de l'aéronef et non les éléments de l'aéronef. Le manque de protection des rubans chauffants a permis au ruban chauffant défectueux de produire un amorçage d'arc.
| Statuts: | Accident investigation report completed and information captured |
| Date: | lundi 13 mai 2002 |
| Heure: | 17:37 EDT |
| Type/Sous-type: |  Boeing 767-3Y0ER |
| Compagnie: | Air Canada |
| Immatriculation: | C-GHML |
| Numéro de série: | 24948/380 |
| Année de Fabrication: | 1991-07-02 (10 years 11 months) |
| Heures de vol: | 46830 |
| Moteurs: | 2 Pratt & Whitney PW4060 |
| Equipage: | victimes: 0 / à bord: 8 |
| Passagers: | victimes: 0 / à bord: 177 |
| Total: | victimes: 0 / à bord: 185 |
| Dégats de l'appareil: | Substantiels |
| Conséquences: | Repaired |
| Lieu de l'accident: | Toronto-Pearson International Airport, ON (YYZ) ( Canada)
|
| Phase de vol: | En approche (APR) |
| Nature: | Transport de Passagers Nat. |
| Aéroport de départ: | Vancouver International Airport, BC (YVR/CYVR), Canada |
| Toronto-Pearson International Airport, ON (YYZ/CYYZ), Canada | |
| Numéro de vol: | 116 |
On final approach approximately 10 miles from the airport, the flight crew received an aft cargo bay fire warning. The flight crew followed checklist procedures, activated the cargo bay fire extinguishers and declared an emergency. The fire indication went out some 20 to 30 seconds after activation of the fire
extinguishers, but a slight smell of smoke was noticed by the cabin crew and flight crew. Flight 116 landed and stopped on the runway to allow airport
firefighters to inspect the aircraft for fire. Firefighters, using infrared sensing equipment, did not detect any sign of fire. The flight crew taxied the aircraft to the terminal but stopped approximately 40 feet back from the gate to allow firefighters to open the aft cargo compartment for a detailed inspection. When the cargo door was opened, a significant amount of smoke was observed. Firefighters entered the cargo compartment and confirmed that the fire had been extinguished. TSB investigators discovered that an intense but relatively small fire had occurred, causing significant structural damage in the floor area of the aft
cargo compartment. Before it was extinguished, the fire had progressed approximately 18 inches up the right side wall of the aircraft, outside the aft cargo compartment. The cargo bay fire-extinguishing system, a Halon-based system, effectively suppressed the fire before it could spread further. The fire appears to have been a direct result of an electrical failure of a heater tape used to prevent water lines from freezing. The electrical failure of the heater tape ignited the covering of the insulation blankets installed below the open cargo floor and some debris found in the area.
Probable Cause:
FAITS ÉTABLIS QUANT AUX CAUSES ET AUX FACTEURS CONTRIBUTIFS:
1. Le ruban chauffant B110 fixé à la conduite d'alimentation en eau a connu une défaillance dans la zone d'une récente réparation de la conduite d'eau, ce qui a permis aux éléments chauffants du ruban de produire un arc électrique, présentant une source d'inflammation aux matériaux à proximité.
2. Le revêtement en poly(éthylène téréphtalate) (PET) des matelas d'isolation thermique et acoustique était contaminé. Le matériau contaminé présentait une source inflammable capable d'alimenter un incendie qui se propage de lui-même.
3. Le plancher ouvert de la soute permettait aux contaminants et aux débris de s'accumuler dans la soute; les débris et les contaminants étaient du combustible capable d'alimenter un incendie.
4. Les dispositifs de protection de circuit sont conçus pour protéger le câblage de l'aéronef et non les éléments de l'aéronef. Le manque de protection des rubans chauffants a permis au ruban chauffant défectueux de produire un amorçage d'arc.
Accident investigation:
 |
|
Sources:
» TSBOpérations de secours
During the inspection of this and other aircraft, additional examples of overheated and burned heater tapes were discovered. Affected systems were deactivated.
On June 7, 2002 the FAA issued Airworthiness Directive AD 2002-11-11 applicable to certain Boeing Model 767-200, -300, and -300F series airplanes. This action requires an inspection of visually accessible areas for indications of overheating of the heater tape attached to the potable water fill and drain lines in the forward and aft cargo compartments, exposed foam insulation or missing or damaged protective tape around the potable water fill and drain lines, and debris or contaminants on or near the potable water fill and drain lines. It also requires corrective action, as necessary. This action is necessary to prevent overheating of the heater tape on potable water fill and drain lines, which may ignite accumulated debris or contaminants on or near the potable water fill and drain lines, resulting in a fire in the airplane. This action is intended to address the identified unsafe condition. TSB issued 2 Safety Recommendations
Show all...
On June 7, 2002 the FAA issued Airworthiness Directive AD 2002-11-11 applicable to certain Boeing Model 767-200, -300, and -300F series airplanes. This action requires an inspection of visually accessible areas for indications of overheating of the heater tape attached to the potable water fill and drain lines in the forward and aft cargo compartments, exposed foam insulation or missing or damaged protective tape around the potable water fill and drain lines, and debris or contaminants on or near the potable water fill and drain lines. It also requires corrective action, as necessary. This action is necessary to prevent overheating of the heater tape on potable water fill and drain lines, which may ignite accumulated debris or contaminants on or near the potable water fill and drain lines, resulting in a fire in the airplane. This action is intended to address the identified unsafe condition. TSB issued 2 Safety Recommendations
Show all...
Photos
Plan
Ce plan montre l'aéroport de départ ainsi que la supposée destination du vol. La ligne fixe reliant les deux aéroports n'est pas le plan de vol exact.
La distance entre Vancouver International Airport, BC et Toronto-Pearson International Airport, ON est de 3321 km (2076 miles).
Accident location: Approximate; accuracy within a few kilometers.
La distance entre Vancouver International Airport, BC et Toronto-Pearson International Airport, ON est de 3321 km (2076 miles).
Accident location: Approximate; accuracy within a few kilometers.
Les informations ci-dessus ne représentent pas l'opinion de la 'Flight Safety Foundation' ou de 'Aviation Safety Network' sur les causes de l'accident. Ces informations prélimimaires sont basées sur les faits tel qu'ils sont connus à ce jour.
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