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ASN Wikibase Occurrence # 199747
Last updated: 12 June 2019
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Date:17-SEP-2017
Time:08:35
Type:Silhouette image of generic B733 model; specific model in this crash may look slightly different
Boeing 737-33V
Owner/operator:Fly Jordan op. for Royal Wings
Registration: JY-SOA
C/n / msn: 29338/3114
Fatalities:Fatalities: 0 / Occupants: 132
Other fatalities:0
Aircraft damage: Minor
Category:Serious incident
Location:Aqaba-King Hussein International Airport (AQJ) -   Jordan
Phase: Landing
Nature:Passenger
Departure airport:Amman-Queen Alia International Airport (OJAI)
Destination airport:Aqaba-King Hussein International Airport (AQJ/OJAQ)
Investigating agency: AAID Jordan
Narrative:
On 17 September 2017, Royal Wings Flight JO6888 a Boeing 737-300, departed from Amman (OJAI) to Aqaba (OJAQ) at 04: 47 UTC. This was the first leg of a flight to Dubai. The flight departed OJAI with a delay of 47 minutes from the scheduled departure time due to late boarding of passengers.
The copilot was the pilot flying and the captain was the pilot monitoring until the controls were transferred to the captain before touchdown as the copilot was unable to land the aircraft on the runway.
During cruise the crew realized that the delay before departure would negatively affect their duty time and consequently asked for straight approach on runway 19 to save time. The ATC Controller informed the crew that the wind was varying with speeds between 10-12 knots and other traffic was expected to depart runway 01. The captain of the flight accepted the prevailing wind condition at runway 19, however, no agreement was made yet to land runway 19.
At 35 miles from AQB VOR the ATC contacted the crew and asked them if they there are able to maintain their speed to continue landing on runway 19, the crew accepted and continued to a straight in approach.
During final and after selecting the landing gear down, the aircraft was not correctly configured for landing. The flaps were set to configuration one at height of 650 ft AGL, multiple GPWS aural warning were triggered but disregarded by the crew. The high speed approach was not corrected by the crew efficiently and the aircraft continued. The aircraft crossed the threshold at 115 ft radio altitude at flaps 5 and continued along the runway to the point when the flaps were selected to 30 at 90 ft radio altitude.
The aircraft floated over the runway and first officer (pilot flying) was unable to land. The captain took over the controls and managed to put the aircraft on the runway but with relatively higher than normal speed. The aircraft touched down at 7400 ft beyond the runway threshold. The airplane came to a stop 10,600 feet beyond the runway threshold (600 feet inside the soft area), and around 200 feet right of the extended runway centerline.

CAUSES
The cause of this Incident was Flight Crew failure to discontinue the Unstabilized Approach and their persistence in continuing with the landing despite 8 numbers of warning from EGWPS

CONTRIBUTING FACTORS
The following factors are believed to be the main causal factors of the occurrence:
a) The delay on ground OJAI for 47 minutes influenced crew decision to land on RWY19 at OJAQ to save time.
b) The straight in, unstabilized approach was the main result of the Aircraft high energy for the consecutive phases out from 1000 ft down to the touchdown point.
c) The higher than allowed tailwind component that recorded an average of 16 knots during final approach and landing phases.
d) Incorrect landing configuration was a contributing factor for Aircraft high speed and explain pilot flying inability to control the prolonged float of the Aircraft and the ability to roll it out.
e) The pilot monitoring (Captain) was aware of the tailwind, however he accepted the prevailing conditions without discussing the operational limitations of the Aircraft with the pilot flying.
f) Crew inaction to discontinue the unstabilized approach and make a go around helped in the developed situation.
g) Crew poor situational awareness and lack of coordination.
h) Deliberate Disregard of the aural warnings without correcting the Aircraft attitude.
i) Lack of cockpit management (CRM) for task sharing and decision making. Crew resource management (CRM) was not evident during the approach phase of flight
j) Failure of the airline to provide its pilots with clear and consistent guidance and training regarding company policies and procedures related to stabilization criteria and the necessary actions to be followed including the conduct of go around.
k) inability to recognize the two critical elements, namely fixation and complacency that affected pilot decision to land the aircraft while the approach was not meeting the stabilization criteria
l) Negative organizational factors were evidenced in terms of operational pressure that was exerted by the management of Solitaire air.
m) Inadequate risk management by the operator as the repeated reports of duty time exceedances were not known or observed by the operational safety management
n) Noncompliance to state regulations regarding the proper training of crews was found a contributing factor as the PIC CRM conversion training was not completed in a correct way.
o) Non availability of customized flight safety documents (FCOM, FCTM and QRH) which includes the manufacture recommended standard operating procedures.

Sources:

http://royanews.tv/news/136622
https://www.albawaba.com/business/pr/solitaire-air-aircraft-leased-royal-wings-skids-course-aqaba-airport-1022548

Accident investigation:
cover
  
Investigating agency: AAID Jordan
Status: Investigation completed
Duration: 1 year and 3 months
Download report: Final report


Revision history:

Date/timeContributorUpdates
17-Sep-2017 13:30 Captain Adam Added
17-Sep-2017 14:06 Captain Adam Updated [Photo, ]
17-Sep-2017 14:43 harro Updated [Cn, Operator, Location, Departure airport, Destination airport, Embed code, Narrative]
11-Nov-2017 21:04 Captain Adam Updated [Embed code, Photo, ]
20-Dec-2018 13:59 harro Updated [Time, Operator, Total occupants, Departure airport, Destination airport, Narrative, Accident report, ]

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