National Transportation Safety Board
Aviation Accident Final Report

 

 

Location:

SHELTON, NE

Accident Number:

CHI93MA143

Date & Time:

04/28/1993, 2350 CDT

Registration:

N115GP

Aircraft:

BEECH C99

Aircraft Damage:

Destroyed

Defining Event:

 

Injuries:

2 Fatal

Flight Conducted Under:

Part 91: General Aviation - Instructional

Analysis

THE FLIGHT WAS A PART 135 SIX-MONTH PROFICIENCY CHECK FOR THE PILOT IN THE LEFT SEAT.  BOTH PILOTS WERE CHECK AIRMEN FOR THE COMMUTER AIR CARRIER.  THE FLIGHT TOOK OFF AT 2343 AFTER CESSATION OF COMPANY REVENUE OPERATIONS.  THE COCKPIT VOICE RECORDER RECORDED CONVERSATION OF BOTH PILOTS DISCUSSING AEROBATICS.  THE PILOT IN THE LEFT SEAT STARTED TO DESCRIBE THE PERFORMANCE OF A PROHIBITED MANEUVER (APPARENTLY A BARREL ROLL).  THE RECORDING ENDED BEFORE DESCRIPTION OF THE MANEUVER WAS COMPLETED.  THE AIRPLANE IMPACTED IN A NOSE LEVEL ATTITUDE WITH THE LEFT WING SLIGHTLY DOWN.  THERE WAS EVIDENCE THE MANEUVER WAS PERFORMED AT AN ALTITUDE INSUFFICIENT TO ASSURE RECOVERY OF THE AIRPLANE.  A FILLED OUT GRADE SHEET FOR THE FLIGHT BEING FLOWN WAS FOUND IN THE CHECK AIRMAN'S MAILBOX.  (FOR FURTHER INFORMATION, SEE NTSB SUMMARY REPORT NTSB/AAR-94/01/SUM)

Probable Cause and Findings

The National Transportation Safety Board determines the probable cause(s) of this accident to be:
THE DELIBERATE DISREGARD FOR THE FEDERAL AVIATION REGULATIONS, GP EXPRESS PROCEDURES, AND PRUDENT CONCERN FOR SAFETY BY THE TWO PILOTS IN THEIR DECISION TO EXECUTE AN AEROBATIC MANEUVER DURING A SCHEDULED CHECK RIDE FLIGHT, AND THE FAILURE OF GP EXPRESS MANAGEMENT TO ESTABLISH AND MAINTAIN A COMMITMENT TO INSTILL PROFESSIONALISM IN THEIR PILOTS CONSISTENT WITH THE HIGHEST LEVELS OF SAFETY NECESSARY FOR AN AIRLINE OPERATING SCHEDULED PASSENGER SERVICE.

Findings

 

Occurrence #1: ABRUPT MANEUVER
Phase of Operation: MANEUVERING

Findings
1. (C) PROCEDURES/DIRECTIVES - DISREGARDED - PILOT IN COMMAND
2. (C) PROCEDURES/DIRECTIVES - DISREGARDED - CHECK PILOT
3. (C) AEROBATICS - ATTEMPTED - PILOT IN COMMAND
4. (C) INADEQUATE SURVEILLANCE OF OPERATION - COMPANY/OPERATOR MGMT
----------

Occurrence #2: IN FLIGHT COLLISION WITH TERRAIN/WATER
Phase of Operation: MANEUVERING

Findings
5. LIGHT CONDITION - NIGHT
6. ALTITUDE - INADEQUATE - PILOT IN COMMAND

 

Factual Information

On April 28, 1993, at 2350 central daylight time (cdt), a Beech C-99, N115GP, operated by GP Express Airlines, Inc., crashed near Shelton, Nebraska.  The airplane was destroyed and the two air transport certificated pilots were fatally injured.  The flight was an air carrier training flight conducted under 14 CFR Part 91, and originated at the Central Nebraska Regional Airport, Grand Island, Nebraska, at 2343.  No flight plan was filed and visual meteorological conditions prevailed at the time.

For detailed narrative see Summary Report of this accident.

 

 

 

Pilot Information

Certificate:

Airline Transport; Flight Instructor

Age:

29, Male

Airplane Rating(s):

Multi-engine Land; Single-engine Land

Seat Occupied:

Left

Other Aircraft Rating(s):

None

Restraint Used:

Seatbelt, Shoulder harness

Instrument Rating(s):

Airplane

Second Pilot Present:

Yes

Instructor Rating(s):

Airplane Multi-engine

Toxicology Performed:

Yes

Medical Certification:

Class 1 Valid Medical--no waivers/lim.

Last FAA Medical Exam:

03/17/1993

Occupational Pilot:

 

Last Flight Review or Equivalent:

 

Flight Time:

5611 hours (Total, all aircraft), 2200 hours (Total, this make and model), 275 hours (Last 90 days, all aircraft), 82 hours (Last 30 days, all aircraft), 4 hours (Last 24 hours, all aircraft)

 

 

Aircraft and Owner/Operator Information

Aircraft Make:

BEECH

Registration:

N115GP

Model/Series:

C99 C99

Aircraft Category:

Airplane

Year of Manufacture:

 

Amateur Built:

No

Airworthiness Certificate:

Normal

Serial Number:

U228

Landing Gear Type:

Retractable - Tricycle

Seats:

16

Date/Type of Last Inspection:

04/26/1993, Continuous Airworthiness

Certified Max Gross Wt.:

11300 lbs

Time Since Last Inspection:

15 Hours

Engines:

2 Turbo Prop

Airframe Total Time:

6962 Hours

Engine Manufacturer:

P&W

ELT:

Installed, not activated

Engine Model/Series:

PT6A-36

Registered Owner:

GP EXPRESS AIRLINES

Rated Power:

750 hp

Operator:

GP EXPRESS AIRLINES

Operating Certificate(s) Held:

Commuter Air Carrier (135)

Operator Does Business As:

GP EXPRESS

Operator Designator Code:

GPPA

 

Meteorological Information and Flight Plan

Conditions at Accident Site:

Visual Conditions

Condition of Light:

Night/Bright

Observation Facility, Elevation:

GRI, 1846 ft msl

Distance from Accident Site:

19 Nautical Miles

Observation Time:

2350 CST

Direction from Accident Site:

40°

Lowest Cloud Condition:

Clear / 0 ft agl

Visibility

10 Miles

Lowest Ceiling:

None / 0 ft agl

Visibility (RVR):

0 ft

Wind Speed/Gusts:

6 knots /

Turbulence Type Forecast/Actual:

/

Wind Direction:

270°

Turbulence Severity Forecast/Actual:

/

Altimeter Setting:

30 inches Hg

Temperature/Dew Point:

4°C / -2°C

Precipitation and Obscuration:

 

Departure Point:

GRAND ISLAND, NE (GRI)

Type of Flight Plan Filed:

None

Destination:

 (GRI)

Type of Clearance:

None

Departure Time:

2343 CST

Type of Airspace:

Class G

 

 

Wreckage and Impact Information

Crew Injuries:

2 Fatal

Aircraft Damage:

Destroyed

Passenger Injuries:

N/A

Aircraft Fire:

On-Ground

Ground Injuries:

N/A

Aircraft Explosion:

None

Total Injuries:

2 Fatal

Latitude, Longitude:

 

 


 


Administrative Information

Investigator In Charge (IIC):

MARK         DOUB

Report Date:

05/10/1994

Additional Participating Persons:

PAUL H SCHEERER; LINCOLN, NE

Publish Date:

 

Investigation Docket:

NTSB accident and incident dockets serve as permanent archival information for the NTSB’s investigations. Dockets released prior to June 1, 2009 are publicly available from the NTSB’s Record Management Division at pubinq@ntsb.gov, or at 800-877-6799. Dockets released after this date are available at http://dms.ntsb.gov/pubdms/.