N354NT

HISTORY OF FLIGHT

On March 8, 2007, at 1502 Hawaii standard time, an Aerospatiale AS350BA helicopter, N354NT, operated by Heli-USA Airways, Inc., was substantially damaged when it collided with terrain following a loss of control while landing at the Princeville Airport (HI01), Princeville, Hawaii. The certificated airline transport pilot and three passengers were killed, and three passengers were seriously injured. Visual meteorological conditions prevailed for the local air tour flight that departed the Princeville Airport about 1415, and was conducted under 14 Code of Federal Regulations (CFR) Part 135.

According to the company dispatcher, the helicopter departed for a 45-minute sightseeing flight. When the pilot contacted the company base by radio about 1455, the dispatcher anticipated a routine radio call announcing his return. Instead, the pilot announced, "I'm having hydraulic problems, and I'm probably going to have to do a run-on landing." The dispatcher took her hand-held radio, ran to the hangar area, and notified the base operator and the maintenance supervisor of the pilot's intentions. She stated that as the conversation with the pilot continued, the language he used to describe his situation changed from "hydraulic problem" to "hydraulic failure." She continued to monitor the frequency as the helicopter neared the airport. As the helicopter approached the ground, she heard the pilot state, "Okay we're done." Then, the sound of the rotor changed pitch and the helicopter impacted the ground.

In interviews, several employees of the company explained how they prepared for the helicopter's arrival and heard it approaching. Some of the employees saw the helicopter "low" over the approach end of the runway, as they stood at base operations near the departure end of the runway. The helicopter then disappeared from their view, and shortly thereafter, they heard the sounds of impact.

Another witness, who worked at the terminal building at the center of the airport and had an unobstructed view of the helicopter through her office window, watched the helicopter approach. She noticed that the helicopter was not approaching the runway faster than usual, but it was flying lower than usual. The helicopter slowed over the runway at less than 10 feet above the ground, then turned slowly towards the grassy area on the left side of the runway. The witness wondered what the helicopter was doing, because the helicopter was moving slowly in a level attitude seeming as though it would land in the grass. Then, "...all of a sudden, the nose went down and [the helicopter] hit the ground." She described the entire series of events as happening "slowly." When asked about the landing gear floats, the witness stated that they were not deployed prior to the accident.

PERSONNEL INFORMATION

The pilot-in-command, age 59, was current and qualified to fly the accident helicopter in accordance with CFR Parts 135 and 91. A review of Federal Aviation Administration (FAA) airman records revealed that the pilot held an airline transport pilot certificate with a rotorcraft-helicopter rating, a commercial pilot certificate with a rotorcraft-helicopter rating, and a rotorcraft-helicopter flight instructor certificate. The pilot had accrued 10,471 total hours of flight experience, with about 3,500 hours in the accident make and model helicopter.

The airline transport pilot certificate was issued on August 20, 1977; the commercial certificate was issued on November 19, 1971 and the flight instructor certificate was issued on August 10, 1975. The original issuance of the FAA commercial pilot certificate was based on the pilot's previous military flight training and experience.

The pilot's most recent FAA second-class medical certificate was issued on January 24, 2007. The certificate carried a limitation that required the pilot to have correcting lenses available for near vision correction.

The pilot completed primary helicopter flight training with the U.S. Army in September of 1968. The primary flight training was conducted in a TH-55A Osage (Hughes Model 292). He later flew combat missions, and was an instructor in the UH-1 Iroquois.

A copy of the pilot's resume was obtained and reviewed. The following synopsis is a chronological summary of the pilot's employment history as a helicopter pilot:

1967 - 1971 Pilot/Instructor US Army

1975 - 1977 Pilot Bell Helicopters - Instructor (Esfahan, Iran)

1977 - 1980 Pilot Rocky Mountain Helicopters - EMS operations

1980 - 1981 Pilot Windward Helicopters - Oil support and external load

1982 - 2000 Pilot Rocky Mountain Helicopters - EMS Ops and Safety Manager

2004 - 2007 Pilot Heli USA Airways, Inc. - Air tour operations

The pilot's most recent Airman Competency/Proficiency Check was successfully completed on February 25, 2007. The pilot was also a company check airman per Special Federal Aviation Regulation 71, "Special Operating Rules for Air Tour Operations in the State of Hawaii."

AIRCRAFT INFORMATION

The Aerospatiale AS350BA helicopter was powered by a single Turbomeca Arriel 1B turboshaft engine, with a three bladed main rotor system, and a conventional two bladed tail rotor for anti-torque and heading control. The helicopter had a seating capacity of 6 passengers plus a pilot and had 2 doors on each side of the helicopter.

The helicopter was manufactured in France in 1979. The AS350 series helicopters were made by Aerospatiale, Inc., a French company that later changed its name to Eurocopter, Inc., with a merger of Aerospatiale and Messerschmitt-Boelkow-Blohm (MBB), a German helicopter company.

The helicopter had accrued 21,706 total hours of operation and its most recent 100-hour inspection was completed on February 22, 2007, at 21,642 hours. An engine change was performed on February 28, 2007, at 21,665 aircraft hours.

A postaccident weight and balance estimate conducted by Eurocopter using the published weights of the pilot (145 pounds), a fuel load of 183 pounds, and a combined passenger weight of 1,085 pounds indicated that, at the time of the accident, the helicopter's approximate weight was 4,397 pounds, which was less than the certificated maximum allowable gross weight limit of 4,630 pounds.

Company Maintenance Program

The company was authorized by the FAA to conduct CFR Part 135 flight operations and maintenance in accordance with its FAA issued operations specifications (ops specs). The ops specs allowed the company to conduct maintenance on its helicopters as prescribed by the original equipment manufacturer (OEM) maintenance programs and were tracked by a computer database.

The company maintained its helicopters in accordance with a maintenance program that consisted of regularly scheduled inspections, component changes, parts replacements, heavy checks (such as 100 or 500 hour inspections), unscheduled maintenance, maintenance check flights after specific types of maintenance, such as flight controls, hydraulic servos, main/tail rotor blade replacement and engine changes. The accident helicopter was maintained using compact disks (CDs) provided by Eurocopter and Turbomeca.

The company General Operating Manual (GOM) was an FAA accepted, company written manual of standard operating procedures. Chapter 13 of the GOM outlined maintenance requirements, mechanics responsibilities, instructions for training of company mechanics, as well as a list of Required Inspection Items (RII). The RIIs called for separate inspections and signed logbook entries by mechanics that did not perform the actual work on the helicopter. The initial mechanic signed the logbook to indicate that the work was completed and a different mechanic stamped and signed the logbook to indicate that the work was inspected and approved for return to service.

Maintenance Record Review for the Accident Helicopter

A review of the maintenance logbook for the 30 days prior to the accident revealed that on February 9, 2007, (total time of 21,573.8 hours), the left lateral servo was removed and replaced; but no mechanic's RII stamp was present and neither was a maintenance check flight (ops checks) performed, as required by the GOM. On February 23, 2007, an ops check was entered in the helicopter logbook after completion of the most recent 100-hour heavy check inspection prior to the accident; however, no test flight time was logged as required. Instead the next flight time entry was for a revenue flight. The aircraft had accumulated 21,642.7 flight hours at the last heavy check.

On February 28, 2007, the engine was removed and replaced with a serviceable overhauled engine. An ops check was performed on March 1, 2007 after the engine change and 0.2 hours was recorded for the flight time. According to the Eurocopter flight manual, a four-page procedure was required that included logbook entries. According to Eurocopter, this ops check typically takes between 1 to 2 hours to complete.

Maintenance Procedures

During the investigation, maintenance activities were observed at the Princeville base. Even though the Eurocopter Maintenance procedures mandated work cards, none were in use throughout the investigation period. In fact, the computer based CD programs were used only occasionally. The mechanics stated that they only viewed the computer CD programs when they were unsure of a particular procedure. The maintenance section of the Heli-USA GOM required the use of the latest edition of the Eurocopter Maintenance CD; however, the most current CD found at the Princeville base was 3 revisions out of date.

METEOROLOGICAL INFORMATION

At 1453, the weather reported at the Lihue International Airport (PHLI), Lihue, Hawaii, 15 miles southeast, included scattered clouds at 5,500 feet, and winds from 050 degrees at 13 knots. The temperature was 23 degrees Celsius, and the dew point was 12 degrees Celsius.

AIRPORT INFORMATION

The Princeville Airport (HI01) had one hard-surfaced asphalt runway, 5/23. Runway 5/2...