Accident & incident report analysis
These pages contain brief descriptions of, and comments relating to, "Crew-caused" approach & landing accident and incidents since 1990.
- All occurred during the final stages of the flight
- All involved basically serviceable aircraft.
- All indicated that actions, failures or decisions by the crew were leading causes of the event.
It should be noted that in many cases, the main reports also contain detailed commentary on deficiencies in other aspects of the total aviation environment in which the flight took place. Typically they include inadequacies in
- communication with ATC or other external agencies
- weather forecasting or reporting
- crew training
- operator organisation
- aircraft maintenance
- operational supervision by the relevant authorities
- systemic protections against for example crew fatigue.
All these elements are often characterised as "holes in the Swiss Cheese" or vulnerabilities that crews need to guard against, or links in a chain that led to the event.
Comments in these pages are deliberately limited to aspects where a change of crew procedure to PicMA might have broken one or more of the crew-related links. This would not in any way diminish the obligation on other parties to rectify the other deficiencies.
The high percentage of reports from relatively few countries does NOT suggest there are poor safety levels in these countries. It is indicative of commendably HIGH standards of reporting, investigation, and transparency. This is especially true in relation to incidents in which no damage or injuries resulted, and which might otherwise not have allowed more general flight safety lessons to be learned.
This list is not yet complete, more pages will be added as and when time permits.