N723DA

Unknown
Serious

Lockheed L-1011-385-1 S/N: 193C-1150

Accident Details

Date
Friday, June 27, 1997
NTSB Number
NYC97LA129
Location
COVINGTON, KY
Event ID
20001208X08233
Coordinates
39.080265, -84.499565
Aircraft Damage
Unknown
Highest Injury
Serious
Fatalities
0
Serious Injuries
1
Minor Injuries
0
Uninjured
95
Total Aboard
96

Probable Cause and Findings

the failure of the primary and secondary elevator driveshafts, and the failure of maintenance personnel to detect the failure of the primary shaft during scheduled inspections.

Aircraft Information

Registration
N723DA
Make
LOCKHEED
Serial Number
193C-1150
Year Built
1977
Model / ICAO
L-1011-385-1

Registered Owner (Historical)

Name
TRANS ATLANTIC AIRLINES
Address
225 BROADWAY STE 1201
Status
Deregistered
City
NEW YORK
State / Zip Code
NY 10007-3773
Country
United States

Analysis

On June 26, 1997, at 2350 eastern daylight time, a fight attendant was seriously injured in a galley elevator while the Lockheed L-1011-385-1, N723DA, operated by Delta Air Lines as flight 1885, was being pushed back from the gate at Covington, Kentucky. There were no injuries to the cockpit crew of 3, the remaining 7 flight attendants, or the 85 passengers onboard the airplane, which was not damaged. Visual meteorological conditions prevailed for the flight destined for Atlanta, Georgia. An instrument flight rules flight plan had been filed for the flight that was conducted under 14 CFR Part 121.

According to the Captain's statement:

"...As we began pushback, a Flight Attendant called the cockpit and advised that a Flight Attendant had been injured in the right (First Officer's) galley elevator. I stopped the pushback so that I could get more information...[the flight attendant] advised that she had been bruised and that her ankle was swollen. The lift had fallen from passenger level down to galley level...We called the local emergency medical team for assistance...The EMT's transported her to a local hospital...."

The investigation revealed that the elevator was operated by an electric motor driving two shafts that were co-located. The primary shaft lay inside of the secondary shaft. The primary shaft carried the load until it failed, at which time two dogs on the secondary shaft engaged the lift sprocket, to raise/lower the galley elevator. A failure of the primary shaft could be detected by visual inspection of a washer at the end of the shaft.

According to Engineering Report 7-72422-20, from Delta Air Lines, Inc., dated July 18, 1997:

"...In the flight, DAL flight # 1074 from Los Angeles (LAX to CVG) which was immediately prior to the accident flight, the flight attendants had noticed that the galley lifts were not flush with the service center floor. However, this was not considered unusual by the flight attendants and not reported to maintenance. Consequently no special attention was paid to the galley lift system and it was not inspected at the end of flight 1704...."

"...The failure mechanism of the primary shaft from the macroscopic appearance of the fracture surfaces...appears to be by rotating-bending fatigue...."

The report also stated:

"The failure mechanism of the secondary shaft was by fatigue crack growth at the base of the dog teeth. The cracks started out of the sharp corner at the junction of the teeth and the shaft body. There were three regions on the fracture surfaces: an thumbnail shaped fatigue crack initiation area, followed by indistinct but continuous striations, and a final fast fracture region showing ductile overload failure. Corrosion was evident in some areas of the surface indicating that the fatigue crack had been propagating form some time...."

The report further stated:

"...The free-fall of the lift was caused by failure of the primary shaft and the two dog teeth on the secondary shaft which are parts of the sprocket assembly. The failure of the secondary shaft dog teeth was unexpected as the design of the sprocket assembly included a 'fail-safe' mechanism that would indicate primary shaft failure after which the secondary shaft dog is supposed to carry the torque load for a duration of at least 300 hours, which is the interval between inspections of the fail-safe mechanism...."

According to the Delta Air Lines maintenance program, the area was last inspected on a service check, on June 23, 1997, 33 hours prior to the accident.

Data Source

Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# NYC97LA129