Aviation Accident Summaries

Aviation Accident Summary MIA00LA212

NASHVILLE, TN, USA

Aircraft #1

N868JB

Cessna 560 XL

Analysis

The pilot stated that he applied braking and left rudder control inputs to make the left turn and the aircraft did not respond, but continued to gain speed straight ahead, exiting the taxiway, and striking a building. Components from the aircraft's brake system were tested and they passed acceptance tests, with the exception of those components that had been damaged in the collision. In addition, when the transcripts of recorded CVR information were compared with procedures specified in the aircraft operating checklist, there was no correlation or consistency between the transcripts of the Captain and copilot's recorded conversations, with the procedures specified in the aircraft checklist. Examination of the aircraft also showed that the emergency braking system had not been activated on the accident aircraft, as specified in the taxi procedures, located in section III of the aircraft operating manual. The taxi procedures specify what the pilot should operate the emergency brake system when a hard braking condition, or a no braking condition is encountered. The emergency brake control is located under the left instrument panel.

Factual Information

HISTORY OF FLIGHT On July 10, 2000, about 0745 central daylight time, a Cessna 560XL, N868JB, registered to and operated by HCA Squared LLC., as a title 14 CFR part 91 corporate flight, crashed into a building while taxiing for takeoff at Nashville, Tennessee. Visual meteorological conditions prevailed, and an instrument flight rules flight plan was filed. The airline transport-rated pilot, first officer, and the five passengers sustained no injuries, and the aircraft incurred substantial damage. The flight was originating at the time of the accident. The pilot stated that he advanced the throttle to start the aircraft moving, and then reduced the throttles to idle speed. He further stated that the taxi path required a 90-degree turn between the corporate hangar and a brick building, and the ramp slants down towards the brick building. He said the aircraft had moved about 30 to 40 feet, and when he applied brakes and left rudder control inputs to make the left turn, the aircraft did not respond but continued to gain speed straight ahead and it struck the building. The copilot said that he had his head down in the cockpit looking at the checklist and completing the items, when he heard the captain say that he had no brakes or steering. The copilot further stated that he immediately applied brakes and full left rudder, but the aircraft did not respond to control inputs. According to the copilot, the aircraft jumped the curb, and struck a building. PERSONNEL INFORMATION Records indicate that the captain held airline transport and flight instructor certificates, with airplane single engine land, multiengine land, and instrument airplane ratings. In addition, the captain held type ratings, including one for the CE560XL. Information supplied by the company showed that the captain completed a flight review, to include training on the CE560XL on June 24, 2000. The captain had accumulated 6,693 total flight hours, with 17.0 flight hours in the CE560XL, and held a second-class medical certificate, issued on November 1, 1999, with a limitation requiring the wearing of corrective lenses for near vision. The copilot held airline transport and flight instructor certificates, with airplane single engine land, multiengine land, and instrument airplane ratings. In addition, the copilot held type ratings, including one for the CE560XL, and had completed a flight review, to include training on the CE560XL, on July 23, 1999. The copilot had accumulated 9,422 total flight hours, with 32 flight hours in the CE560XL, and held a second-class medical certificate, issued on September 1, 1999, with a limitation requiring the wearing of corrective lenses for near vision AIRCRAFT INFORMATION N868JB is a 2000 Cessna Citation 560 Excel, serial number 560-5089. At the time of the accident, the aircraft had accumulated 17.8 total flight hours, and had been delivered to the owner with 14.2 hours flight time. According to a company official, the aircraft had only been flown once after it had been acquired. FLIGHT RECORDERS N868JB had been outfitted with a Fairchild model A-200S digital cockpit voice recorder (CVR), serial number 02498. The recorder was sent to the NTSB's vehicle recorder laboratory, where a CVR group was convened on July 25, 2000. The exterior of the CVR showed no evidence of structural damage. The interior of the recorder and the tape sustained no apparent heat or impact damage. The CVR recorder group determined that only the final 06:45 minutes of the recording pertained to the accident, and the recording consisted of four channels of good quality audio information. One channel contained the cockpit area microphone audio information, and the other two channels contained captain and copilot audio information. The recording indicated that the flightcrew experienced a loss of braking capability shortly after commencing taxi operations. Pertinent portions of CVR transcript started at 0740:25 CDT, and continued uninterrupted until 0747:10, when electrical power was removed from the CVR. The recording ended shortly after the aircraft had departed the taxiway and impacted a building. When recorded CVR information was compared with that of the Cessna Citation CE560XL checklist and other documentation for operating the aircraft, there was no correlation or consistency between the recorded conversations of the captain and copilot, with the procedures specified in the aircraft checklist or other operating manuals. As part of the investigation process, the crew of the accident aircraft was invited to review the CVR transcript, and suggest corrections, or additions. To date, neither flightcrew member has accepted the NTSB's invitation to do so. (See NTSB CVR report.) WRECKAGE AND INPACT INFORMATION The aircraft impacted the building and incurred damage to the nose and forward cockpit area. The forward bulkhead was displaced aft, about 6 inches, and the nosewheel was displaced aft, and to the right. TESTS AND RESEARCH Components from the aircraft's brake system were retained, and sent to the various manufacturers for test, under the supervision of FAA personnel. All the components passed acceptance tests, with the only exceptions being those components that had been damaged in the collision. Examination of the aircraft also showed that the emergency braking system had not been activated on the accident aircraft, as specified in the taxi procedures, located in section III of the aircraft operating manual. The taxi procedures specify what the pilot should operate the emergency brake system when a hard braking condition, or a no braking condition is encountered. The emergency brake control is located under the left instrument panel. (See Cessna Aircraft Company brake teardown report.)

Probable Cause and Findings

the flight crew's failure to activate the normal brake system, and failure to follow published aircraft procedures/directives for a hard brake or no braking condition and use the emergency brake system after recognizing a normal brake system failure, which resulted the loss of control during taxi, departure from the taxiway, and collision with a building.

 

Source: NTSB Aviation Accident Database

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