Incident Overview

Date: Friday 6 March 2009
Aircraft Type: National Aerospace Laboratories (NAL) Saras
Owner/operator: National Aerospace Laboratories – NAL
Registration Number: VT-XRM
Location: near Bidadi – ÿ India
Phase of Flight: En route
Status: Destroyed, written off
Casualties: Fatalities: 3 / Occupants: 3
Component Affected: Propeller Blade Pitch, Propeller RPM, Side Slip, Bank Angle, Altitude, and Control Inputs.Propeller Blade Pitch, Propeller RPM, Side Slip, Bank Angle, Altitude, and Control Inputs.
Investigating Agency: DGCA IndiaDGCA India
Category: Accident
A National Aeronautical Laboratories Saras prototype light civilian transport aircraft was lost during a test flight, resulting in the deaths of all three crew members. The flight, scheduled for 49 test points, involved a simulated approach to 10000 feet AMSL, followed by an engine relight procedure. The aircraft experienced a sudden and uncontrolled descent, culminating in a catastrophic impact with the ground. The incident highlights a critical failure in the relighting procedure, exacerbated by inadequate crew coordination and a lack of proper risk assessment.A National Aeronautical Laboratories Saras prototype light civilian transport aircraft was lost during a test flight, resulting in the deaths of all three crew members. The flight, scheduled for 49 test points, involved a simulated approach to 10000 feet AMSL, followed by an engine relight procedure. The aircraft experienced a sudden and uncontrolled descent, culminating in a catastrophic impact with the ground. The incident highlights a critical failure in the relighting procedure, exacerbated by inadequate crew coordination and a lack of proper risk assessment.

Description

A National Aeronautical Laboratories Saras prototype, an Indian designed light civilian transport aircraft, registered VT-XRM, was destroyed in a accident during a test flight. All three crew members were killed. The Saras airplane was scheduled for carrying out test flight no 49, which would include inflight engine shut down and relight procedure at 10000 feet AMSL. The aircraft took-off from Bangalore-Hindustan Airport (BLR) at 14:55. The flight was cleared to flight level 100. After completing general handling checks at 9000’AMSL without any events, a single engine simulated approach was carried out on runway 09. At about 15:11 the crew were cleared to perform an overshoot. The crew contacted the Bangalore Radar controller, who cleared them back to FL100 and proceed to sector Southwest 2 for carrying out the engine relight test procedure. The crew reported reaching 9000’AMSL in sector Southwest at about 15:18. The no. 1 engine was then shut down and secured following the test procedure at about 15:31. After about 47 seconds, the no. 1 engine relight procedure was initiated at around 9200’AMSL. After a successful left engine shut down and its securing procedure, at about 15:31 left engine relight procedure was initiated at about 9200’AMSL. The propeller blade pitch was selected from feathered to fine. This led to an increased in propeller rpm from 5 to 55%. Side slip increased up to 28 degrees and bank angle changed from 8 deg right to 70 degrees left. The pitch attitude was seen reaching -42 degrees. Propeller rpm continued to increase to 91%. Then the aircraft went into a sudden dive from 9200’ to 7300’ for about 13 secs. The aircraft was brought under control at this altitude. The crew continued their attempt to relight the engine but this was not successful. Meanwhile the side slip remained at 22 degrees with a pitch attitude of about -15 deg. The speed remained at 130 kt and altitude reduced from 7000 feet to 5200 feet. A second relight attempt was successful but the airplane was still in a rapid descent passing 4800 feet. Rudder pedal forces increased to as high as 90 kg with aileron forces raising to 40 kg. The crew were not able to fully control the airplane and arrest the descent. It impacted the ground. The aircraft was completely destroyed due impact and fire. PROBABLE CAUSE(S): Incorrect relight procedure devised by the designer and adopted by the crew at insufficient height leading to rapid loss of altitude and abnormal behavior of aircraft resulted into accident. Contributory factors: a) Lack of crew coordination and cockpit procedures b) Handling of the controls c) Non-aborting of flight by the crew in coordination with the flight test Director after failure of first relight attempt. d) Devising engine relight procedures by NAL without consulting the propeller manufacturer.

Primary Cause

Inadequate relight procedure, resulting in rapid loss of altitude and abnormal behavior of the aircraft due to insufficient height and a lack of crew coordination.Inadequate relight procedure, resulting in rapid loss of altitude and abnormal behavior of the aircraft due to insufficient height and a lack of crew coordination.

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