Serious incident Embraer EMB-120FC Brasilia EC-JBD,
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ASN Wikibase Occurrence # 187265
 
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Date:Monday 18 January 2016
Time:18:25 LT
Type:Silhouette image of generic E120 model; specific model in this crash may look slightly different    
Embraer EMB-120FC Brasilia
Owner/operator:Swiftair
Registration: EC-JBD
MSN: 120012
Year of manufacture:1986
Fatalities:Fatalities: 0 / Occupants: 2
Aircraft damage: Minor
Category:Serious incident
Location:Amsterdam-Schiphol International Airport (AMS/EHAM) -   Netherlands
Phase: Take off
Nature:Cargo
Departure airport:Amsterdam-Schiphol International Airport (AMS/EHAM)
Destination airport:London-Stansted Airport (STN)
Investigating agency: Dutch Safety Board
Confidence Rating: Information verified through data from accident investigation authorities
Narrative:
The EMB-120 cargo plane was prepared for a flight from Amsterdam to London. The first officer was Pilot Flying and the captain was Pilot Monitoring. As there is only one steering tiller in this type of aircraft, located on the left hand side of the cockpit, the captain performed taxiing until the aircraft was lined up on the runway, ready for take-off. At that time, the controls were handed over to the first officer. During taxiing, the first officer was responsible for radio communication.
At 18:20 hours local time taxi clearance was obtained and the flight crew was instructed to taxi via taxiway A to taxiway B, using intersection A2 and S7 for take-off from runway 24.
During taxiing on taxiway B the ground controller asked if the flight crew would like an intersection take-off. The flight crew accepted this and the ground controller asked if S4 or S5 would be acceptable. The flight crew preferred S5 and the ground controller subsequently cleared the flight to hold short at S5.
As the aircraft approached S5, the ground controller instructed the flight crew to change radio frequency to the Tower frequency. The Pilot Monitoring contacted the Tower frequency and the runway controller gave take-off clearance for runway 24 with the instruction to stay on the Tower frequency.
The flight crew completed the before take-off checklist and the captain positioned the aircraft on runway 24. Subsequently, the runway controller gave the instruction to make a right-hand turn and steer heading 270 after take-off. The captain handed over the controls to the first officer, who became Pilot Flying. The captain, now the Pilot Monitoring, acknowledged the radio call and read back the tower instructions.
Take-off power was selected by the Pilot Flying and, in effect, the aircraft’s speed increased. During the take-off roll some bumps were felt by the flight crew. According to the flight crew it is not unusual to feel bumps as the nose wheel runs over the runway’s centre line lights. The crew heard a "thump" noise as well during the take-off roll. After a brief discussion it was concluded that it might have been a cargo box or the captain’s flight bag that fell to the floor. The take-off roll was continued with all aircraft indications, vibrations and noise being normal.
When the aircraft reached a velocity of 90 knots, the captain made a speed call out which was crosschecked by the first officer. The decision speed (V1 = 112 knots) was called out and, three seconds later, V-rotate (VR = 113 knots) was reached. During rotation, the stall warning light appeared on the Main Annunciator Panel (MAP) and an aural warning sound was activated in the cockpit. The aircraft was pitched down by the Pilot Flying and the take-off was continued.
The aircraft became airborne and a few seconds later the stall warning light disappeared. The flight crew interpreted the warning as false. During the climb the captain took over the flight controls to confirm the aircraft’s controllability after which the controls were handed back to the first officer for the rest of the flight. According to the flight crew all indications, including pressurization and vibrations, were normal during the entire flight.
The aircraft landed at London Stansted Airport on runway 22 after which it taxied to stand 205. The aircraft was parked and the engines were shut down. At the same time, a ground employee alerted the flight crew, by means of hand signals, that the aircraft was damaged. During the walk around, damage to the right-hand fuselage was observed. Also, three propeller blades of the right-hand engine were damaged. A metal wire was found embedded in one of the three damaged propeller blades.
The aircraft was ferried to Madrid on January 22 and was back in service on February 22.

Conclusion by the Dutch Safety Board:
Given the factual information it is concluded that the EMB-120 aeroplane made a misaligned take-off from Runway 24 at Amsterdam Airport Schiphol, at night. During take-off, the crew interpreted the right-hand side runway edge lights as the runway centre line lights. Evidently, visual cues provided in the form of taxiway markings and lighting turned out to be insufficient for a correct guidance of the aeroplane from the taxiway to the runway centre line. The large turning angle, required to align the aeroplane with the runway centre line, in combination with the discontinuity of the taxiway S5 centre
line and absence of the taxiway centre line lighting have contributed to the misaligned take-off. In addition, the ATC clearance during the turn from taxiway B onto S5 and Runway 24 might have distracted the flight crew.
During the take-off roll several runway edge lights were struck by the nose landing gear of which the pilots were unaware. It is suspected that, on several occasions, the edge lights were catapulted leading to damage to the aeroplane. Despite the sustained damage, the aeroplane was able to take off and reach its destination airport. No other damage occurred.
The absence of centre line lighting on taxiway S5 is not in correspondence with the specifications set in CS ADR-DSN.M.710.
The absence of a continuous centre line marking on taxiway S5 leading to the centre line of Runway 06/24 is not in correspondence with the specifications set in CS-ADR-DSN.L.555.
This was corrected after the occurrence had taken place.
LVNL was aware of the risks of intersection take-offs before the incident occurred. However, this did not lead to operational measures by LVNL.
Intersection S5 was also a recommended intersection outside the uniform daylight period despite the fact that the intersection did not have centre line lighting.
The LVNL report does not consider the question of whether intersection S5 is justifiably designated as a ‘recommended intersection’ in the Operations Manual and if offering the intersection concerned is a wise choice.
After the decision was taken not to install centre line lights on intersection S5, LVNL retained the qualification of intersection S5 as a ‘recommended intersection’ in the Operations Manual. There was no reconsideration.

Accident investigation:
cover
  
Investigating agency: Dutch Safety Board
Report number: 
Status: Investigation completed
Duration:
Download report: Final report

Sources:

http://onderzoeksraad.nl/uploads/phase-docs/1243/2e1ca594f79covv-kwartaalrapportage-luchtvaart-kw-i-2016-nl.pdf
https://www.flightradar24.com/data/aircraft/ec-jbd#8922a81

History of this aircraft

Other occurrences involving this aircraft
23 January 1987 N120AM Air Midwest 0 Springfield, MO min

Images:


Damage to fuselage, propeller and nose gear tire (photo: AAIB)


Taxi route (Google Earth / Dutch Safety Board)

Revision history:

Date/timeContributorUpdates
13-May-2016 19:16 harro Added
07-Nov-2018 14:39 harro Updated [Time, Aircraft type, Total occupants, Narrative, Accident report, ]
07-Nov-2018 14:56 harro Updated [Photo]
07-Nov-2018 14:57 harro Updated [Photo]
14-Jun-2022 03:05 Ron Averes Updated [Location]

Corrections or additions? ... Edit this accident description

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