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ASN Wikibase Occurrence # 185302
Last updated: 25 May 2017
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Date:11-MAR-2016
Time:13:18 LT
Type:Silhouette image of generic AS65 model; specific model in this crash may look slightly different
Eurocopter AS 365N3 Dauphin 2
Owner/operator:National Airborne Service Corps (NASC)
Registration: NA-107
C/n / msn: 6556
Fatalities:Fatalities: 2 / Occupants: 5
Other fatalities:0
Airplane damage: Written off (damaged beyond repair)
Location:0.3nm off Shimen District, New Taipei -   Taiwan
Phase: Manoeuvring (airshow, firefighting, ag.ops.)
Nature:Non Scheduled Passenger
Departure airport:Song Shan Airport
Destination airport:
Narrative:
The helicopter crashed while supporting a salvage operation. Two crew members died from the injuries sustained. The three other POB were seriously injured.
Video shows the aircraft in the hover at c100ft before yawing rapidly, turning through 360 degrees several times and impacting the sea.
The helicopter was dispatched to take an engineer and two Coast Guard (CGA-SSC) specialists to a Taiwan-registered 13,500-ton freighter, that ran aground 10 March 2016 about 300 meters off the coast, to see how much oil had been leaked by the ship.
All 21 of the freighter's crew members were earlier airlifted to safety after they abandoned ship.

The GPS system indicated that the aircraft began yawing towards the left at 1317:44. Before the aircraft yawed
towards the left, the pilot said, "mission abort, mission abort". Four seconds later (1317:48), the aircraft began to turn drastically. According to the copilot's interview, the aircraft was shaking in all directions as the aircraft drastically spun towards the left. The copilot also heard the pilot saying, "What is happening to the aircraft?" As the spinning speed of the aircraft accelerates, the CGA-SSC member performing the hoisting mission was thrown up by the great centrifugal force generated by the spinning motions and aircraft altitude changed. After the CGA-SSC member impacted the main rotor and crashing into the sea, the aircraft plummeted on the sea surface to the left of the cargo ship at 1317:59 with a right roll in an easterly direction.

Findings related to probable causes:
The available evidence indicated that maintenance performed the tail gear box control rod bearing inspection through the periodic check in accordance with the Alert Service Bulletin AS365-05.00.61R4 and all successive measurements were within the criteria. The maintenance personnel did not detect the bearing was worn, the tactile/sensitive manual axial play check is mainly based on the judgment of the operator and therefore subjective to detect manually.
The bearing wear continued, which spalled off the inner ring shoulder, completely detached the outer ring, and eventually led to the malfunction of pitch control in the tail rotor bearing. Due to the failure of the tail rotor pitch function, the pilot could not control the flight direction. Flying at a low altitude and driven by large horsepower, the main rotor was damaged from impact. The pilot could no longer perform relevant emergency procedures according to the flight manual and eventually lost control and crashed into the sea.

There were 14 safety recommendations issued.

Sources:

http://www.asc.gov.tw/main_en/docDetail.aspx?uid=318&pid=318&docid=794
http://www.taiwannews.com.tw/etn/news_content.php?id=2893639
http://focustaiwan.tw/news/asoc/201603110016.aspx (registration source)
http://www.airliners.net/photo/Taiwan---National/Eurocopter-AS-365N-3-Dauphin/2712018/M/
http://www.asc.gov.tw/main_en/docDetail.aspx?uid=318&pid=318&docid=745
http://www.taipeitimes.com/News/front/archives/2016/03/12/2003641375
https://www.bea.aero/en/investigation-reports/notified-events/detail/event/perte-de-controle-en-lacet-collision-avec-la-surface-de-leau-lors-dune-operation-de-treuillage/
https://www.flightglobal.com/news/articles/taiwan-as365-crash-caused-by-maintenance-oversights-436070/
http://aerossurance.com/helicopters/trpc-loss-hoisting-as365/
https://www.asc.gov.tw/main_en/docaccident.aspx?acd_no=208&uid=343&pid=296

Safety recommendations:

Safety recommendation ASC-ASR-17-04-001 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-002 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-003 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-004 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-005 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-006 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-007 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-008 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-009 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-010 issued 7 April 2017 by ASC to NASC, Ministry of the Interior
Safety recommendation ASC-ASR-17-04-011 issued 7 April 2017 by ASC to Coast Guard Administration
Safety recommendation ASC-ASR-17-04-012 issued 7 April 2017 by ASC to Coast Guard Administration
Safety recommendation ASC-ASR-17-04-013 issued 7 April 2017 by ASC to Coast Guard Administration
Safety recommendation ASC-ASR-17-04-014 issued 7 April 2017 by ASC to Airbus Helicopters South East Asia


Revision history:

Date/timeContributorUpdates
11-Mar-2016 08:39 gerard57 Added
11-Mar-2016 13:14 Aerossurance Updated [Time, Aircraft type, Nature, Source, Narrative]
11-Mar-2016 13:20 Aerossurance Updated [Phase, Embed code, Narrative]
11-Mar-2016 14:14 franka Updated [Registration, Source]
11-Mar-2016 15:08 Iceman 29 Updated [Cn, Source, Embed code]
12-Mar-2016 15:54 TB Updated [Aircraft type, Location, Narrative]
12-Mar-2016 15:57 Black Typhoon Updated [Time, Aircraft type]
12-Mar-2016 16:12 TB Updated [Aircraft type, Location]
12-Mar-2016 17:02 Aerossurance Updated [Operator, Location, Departure airport, Source]
12-Mar-2016 17:11 Aerossurance Updated [Operator]
14-Mar-2016 09:36 Aerossurance Updated [Source]
04-May-2016 12:57 Aerossurance Updated [Source, Narrative]
08-Apr-2017 06:22 harro Updated [Source, Narrative]
10-Apr-2017 17:24 Aerossurance Updated [Source, Narrative]
20-Apr-2017 20:33 Aerossurance Updated [Location, Source]

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