ASN Wikibase Occurrence # 253768
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| Date: | 18-APR-2019 |
| Time: | 21:09 UTC |
| Type: |  Canadair CL-600-1A11 Challenger 600 |
| Owner/operator: | private |
| Registration: | N100QR |
| MSN: | 1043 |
| Fatalities: | Fatalities: 0 / Occupants: 10 |
| Other fatalities: | 0 |
| Aircraft damage: | None |
| Category: | Serious incident |
| Location: | Cabo Frio, RJ (SBCB) -
 Brazil
|
| Phase: | Approach |
| Nature: | Unknown |
| Departure airport: | San Fernando Airport, BA (FDO/SADF) |
| Cabo Frio Airport, RJ (CFB/SBCB) | |
| Investigating agency: | CENIPA |
| Confidence Rating: |  Accident investigation report completed and information captured |
The Sikorsky S-76C, registered PR-CHE, took off from Jacarepaguá, Brazil, around 20:45 UTC, in order to perform a repositioning flight, with two pilots on board. Destination was Cabo Frio.
A Canadair Challenger 600 jet, registered N100QR, was also flying towards Cabo Frio, carrying two pilots and eight passengers.
After starting from an instrument approach procedure, the crew of N100QR changed to a visual approach and, on final approach, overtook PR-CHE, passing under the helicopter, which was also on final approach, with approximately 100 feet of vertical separation.
After the crossing, both aircraft landed without further problems.
Contributing factors.
- Attitude - contributed.
The actions of the N100QR pilots, from the moment they commanded the take-off, indicated a complacent attitude towards the compliance with the air traffic regulations applicable to that flight, fact that favored the air traffic conflict between the aircraft involved in the occurrence and led to inappropriate postures such as overconfidence, improvisation and inobservance of procedures that contributed to this incident.
- Communication - contributed.
The deficiencies observed in the communication process, especially from the moment the N100QR commander decided to abandon the IFR procedure and perform the landing under visual flight rules, contributed to the conflict that occurred in this incident.
From this point on, there were difficulties to organize and express ideas and facts in a coherent way, confusion or absence of information pertinent to the procedure performed, limitation of the receiver's ability to understand the information and misinterpretation of both parties (controller and N100QR crew).
- Flight Discipline - contributed.
The deviations from the applicable standards by the N100QR crew, by not accomplishing the missed approach profile foreseen in the chart, without prior notification or authorization, changed the air traffic control expectations for the flight evolution, influencing the controller's decisions.
- Traffic Planning (ATS) - undetermined.
The non-compliance with the requirements established in paragraph 6.2.4.2 of the Operational Model of the APP-ES implied in the issuance of authorizations without having previously established the separation and proper ordering of approaching aircraft, compromising the quality of traffic planning, which may have contributed to the conflict object of this report.
Sources:
CENIPA
Accident investigation:
 |
|
Other occurrences involving this aircraft
| 27 Sep 2020 | N100QR | private | 0 | Sur del Lago region, Zulia |  |
dst |
Revision history:
| Date/time | Contributor | Updates |
|---|---|---|
| 21-Apr-2021 18:46 | harro | Updated [Aircraft type, Registration, Cn, Operator, Total occupants, Nature, Departure airport] |
| 21-Apr-2021 18:49 | harro | Updated [Narrative] |
Corrections or additions? ... Edit this accident description
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