Incident Overview

Date: Wednesday 2 October 1996
Aircraft Type: Boeing 757-23A
Owner/operator: AeroPeru
Registration Number: N52AW
Location: 89 km NW off Lima, Peru – ÿ Pacific Ocean
Phase of Flight: En route
Status: Destroyed, written off
Casualties: Fatalities: 70 / Occupants: 70
Component Affected: Static Ports on the Left Side of the AircraftStatic Ports on the Left Side of the Aircraft
Investigating Agency: DGAT PeruDGAT Peru
Category: Accident
AeroPeru Flight 603, a Boeing 757-200, crashed into the sea off Lima, Peru, resulting in the loss of all 70 occupants. The flight departed from Lima Airport at 00:42 UTC, climbing to approximately 200-300 feet and experiencing a sudden and confusing descent due to airspeed and altitude indications, windshear warnings, and a cascade of alarms. The crew initially attempted to turn back, but the aircraft rapidly descended, impacting the water with the left wing and sustaining significant damage. The stick shaker, overspeed alarms, and terrain alarms became increasingly prominent, leading to a stalling maneuver and subsequent impact. Investigation revealed obstructions on the left static ports, which were subsequently removed by maintenance staff. The pilot-in-command’s actions ? failing to follow GPWS procedures and disregarding radio altimeter readings ? are considered a contributing factor. The co-pilot’s lack of assertive communication regarding ground proximity alarms exacerbated the situation.AeroPeru Flight 603, a Boeing 757-200, crashed into the sea off Lima, Peru, resulting in the loss of all 70 occupants. The flight departed from Lima Airport at 00:42 UTC, climbing to approximately 200-300 feet and experiencing a sudden and confusing descent due to airspeed and altitude indications, windshear warnings, and a cascade of alarms. The crew initially attempted to turn back, but the aircraft rapidly descended, impacting the water with the left wing and sustaining significant damage. The stick shaker, overspeed alarms, and terrain alarms became increasingly prominent, leading to a stalling maneuver and subsequent impact. Investigation revealed obstructions on the left static ports, which were subsequently removed by maintenance staff. The pilot-in-command’s actions ? failing to follow GPWS procedures and disregarding radio altimeter readings ? are considered a contributing factor. The co-pilot’s lack of assertive communication regarding ground proximity alarms exacerbated the situation.

Description

AeroPeru Flight 603, a Boeing 757-200, crashed into the sea off Lima, Peru, killing all 70 occupants. The aircraft performed a regular passenger service from Lima, Peru to Santiago, Chile. The flight took off from runway 15 at Lima Airport at 00:42 hours local time (05:42 UTC). While climbing through an altitude of approximately 200-300 ft, the pilots noted that the airspeed and altitude indications were too low. In calm winds, the windshear warning suddenly sounded three times. The flight crew then declared an emergency. The crew also started to receive rudder ratio and mach speed trim warnings, which were repeated throughout the flight, distracting their attention and adding to the problem of multiple alarms and warnings which saturated and bewildered them, creating confusion and chaos. At 00:53 the flight contacted the Departure controller again, eight minutes after the initial call, reporting they “request vectors from now on”. By then the aircraft had climbed over sea and the flight crew were attempting to turn back, while trying to manage all conflicting warnings. At 00:55:07, the crew radioed: “You’re going to have to help us with altitudes and speed if that’s possible.” And from that moment until the end, the stick shaker, overspeed and “too low – terrain” alarms began to sound. This caused confusion and the copilot said to the captain: “…right now we’re stalling.” The captain disagreed: “we’re not stalling. it’s fictitious, it’s fictitious”. Referring to the stick shaker, the copilot replies “… how can we not be stalling?”. At 01:04 the flight crew was attempting to maintain 4000 feet, however one minute later they start a measured and continuous descent. The aircraft kept descending and impacted the water with the left wing and no. 1 engine at a 10 degrees angle, at a speed of 260 knots. The aircraft pulled up to about 300 feet and flew for another 17 seconds. It then rolled inverted and crashed. The captain’s airspeed indicated 450 knots and altitude 9500 feet. Investigation results showed that the aircraft’s three static ports on the left side were obstructed by masking tape. The tape had been applied before washing and polishing of the aircraft prior to the accident flight. PROBABLE PRINCIPAL CAUSE : ERROR OF THE MAINTENANCE STAFF INCLUDING THE CREW It can be deduced from the investigation carried out that the maintenance staff did not remove the protective adhesive tape from the static ports. This tape was not detected during the various phases of the aircraft’s release to the line mechanic, its transfer to the passenger boarding apron and, lastly, the inspection by the crew responsible for the flight (the walk-around or pre-flight check), which was carried out by the pilot-in-command, [name], according to the mechanic responsible for the aircraft on the day of the accident. CONTRIBUTING CAUSES b.1) PERSONAL ERROR OF THE CREW The pilot-in-command, Mr [name], made a personal error by not complying with the procedure for GPWS alarms and not noticing the readings of the radio altimeters in order to discard everything which he believed to be fictitious. b.2) PERSONAL ERROR INCLUDING THE CREW The co-pilot, Mr [name], made a personal error by not being more insistent, assertive and convincing in alerting the pilot-in-command much more emphatically to the ground proximity alarms.

Source of Information

http://www.skybrary.aero/index.php/B752,_en-route,_vicinity_Chancay_Peru,_1996_(LOC_AW_HF)http://www.skybrary.aero/index.php/B752,_en-route,_vicinity_Chancay_Peru,_1996_(LOC_AW_HF)

Primary Cause

ERROR OF THE MAINTENANCE STAFF INCLUDING THE CREWERROR OF THE MAINTENANCE STAFF INCLUDING THE CREW

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