N207JB

Substantial
None

CANADAIR LTD CL-600-2B16S/N: 5194

Accident Details

Date
Wednesday, May 23, 2012
NTSB Number
ERA12LA356
Location
Hallandale, FL
Event ID
20120523X04047
Coordinates
25.988611, -80.131111
Aircraft Damage
Substantial
Highest Injury
None
Fatalities
0
Serious Injuries
0
Minor Injuries
0
Uninjured
2
Total Aboard
2

Probable Cause and Findings

The failure of the co-pilot to properly close and latch the passenger door before departure, and the flight crew's failure to ensure that the door was secure by using the door warning system. Contributing to the accident was the flight crew's inadequate use of checklists.

Aircraft Information

Registration
Make
CANADAIR LTD
Serial Number
5194
Engine Type
Turbo-fan
Year Built
1996
Model / ICAO
CL-600-2B16
Aircraft Type
Fixed Wing Multi Engine
No. of Engines
2
Seats
22
FAA Model
CL-600-2B16

Registered Owner (Current)

Name
CYPRESS COVE AIR LLC
Address
22510 N 18TH DR
City
PHOENIX
State / Zip Code
AZ 85027-1363
Country
United States

Analysis

HISTORY OF FLIGHT

On May 23, 2012, about 1547 eastern daylight time, a Canadair Challenger 601-3R (CL-600-2B16), N207JB, was substantially damaged following separation of the main passenger door near Hallendale, Florida. The air transport pilot and commercial-rated co-pilot were not injured. The airplane was registered to a corporation and was operated by Majestic Jet Inc. under the provisions of 14 Code of Federal Regulations Part 91 as a positioning flight. Visual meteorological conditions prevailed and an instrument flight rules flight plan was filed. The flight originated at Opa Locka Airport (OPF), Opa Locka, Florida at 1543 and was destined for Pompano Beach Airpark (PMP), Pompano Beach, Florida.

The pilot reported in a written statement that, about 3 minutes into the flight, a "loud bang" was heard, a rush of air entered the cabin, and it became evident that the main cabin door had separated from the airplane. The flight was about 4 nautical miles (nm) south of Fort Lauderdale-Hollywood International Airport (FLL) at the time, so he elected to land the airplane there. He stated that the noise in the cockpit was so loud that they could not hear on the radio. The pilot landed the airplane on runway 10L without further incident.

The co-pilot reported in a written statement that, during ground operations, he closed the main passenger door and checked for a green light to ensure that it was secure. He performed the takeoff and was at the controls when the door separation occurred. The pilot took over the controls and performed an emergency landing on runway 10L at FLL.

In an interview with a Federal Aviation Administration (FAA) inspector after the accident, the co-pilot reported that he "believed" that the door warning lights were working, but he could not positively recall seeing the green "Door Safe" light illuminated after closing the door. He also did not remember activating the warning system "Recall" switch prior to takeoff.

Ramp security video footage revealed that a crewmember entered the airplane through the main passenger door, the door closed, and then the door momentarily opened partially and closed again prior to departure. When questioned about this, the co-pilot reported that he re-closed the door because it did not secure on the first attempt. PERSONNEL INFORMATION

The pilot held an airline transport pilot certificate with type ratings in the Cessna CE-500, Canadair CL-600, Boeing B747, McDonnell Douglas DC-10, and Gulfstream G-IV. He reported 12,300 hours total flight time, including 3,500 hours in the same make and model as the accident airplane.

The co-pilot held a commercial pilot certificate with ratings for airplane single engine land, airplane multiengine land, and instrument airplane. He also held a flight instructor certificate for airplane single engine land, airplane multiengine land, and instrument airplane. He reported 2,550 hours total flight time, including 65 hours in the same make and model as the accident airplane.

According to the FAA inspector, the co-pilot was hired by the operator on October 21, 2011. He was assigned to the CL-600 in February, 2012. Prior to his employment with the operator, he did not have any experience on pressurized or turbine-powered aircraft. He completed initial in-house training on the airplane on February 25, 2012, and that training was administered by the pilot. The co-pilot stated that he had received no formal training on the CL-600 other than that administered by the pilot. The training records did not specifically indicate any training on the operation of the main cabin door. The inspector's review of flight log information indicated that the co-pilot had logged 14 flights as a required crewmember, with a total flight time of 19.9 hours in the same make and model as the accident airplane. AIRCRAFT INFORMATION

The airplane was a low wing, retractable tricycle landing gear, transport category airplane. It was equipped with two General Electric CF34-3A1 engines.

The airplane arrived for maintenance at the Bombardier Hartford, Connecticut facility on June 20, 2008 and departed on January 5, 2012. Five repairs were documented in the area of the main passenger door, including a pressurization leak when the cabin was pressurized and a failure of the main door closed green light (PASS DR READY light) to operate. The repairs were documented and the airplane was eventually released for service. The maintenance entries and corrective actions are located in the Bombardier Field Notes, contained in the public docket for this investigation. METEOROLOGICAL INFORMATION

The 1550 surface weather observation for FLL included wind from 110 degrees at 10 knots, visibility 10 miles or better, few clouds at 2,000 feet, temperature 28 degrees C, dew point 22 degrees C, and altimeter setting 29.87 inches of mercury. AIRPORT INFORMATION

The airplane was a low wing, retractable tricycle landing gear, transport category airplane. It was equipped with two General Electric CF34-3A1 engines.

The airplane arrived for maintenance at the Bombardier Hartford, Connecticut facility on June 20, 2008 and departed on January 5, 2012. Five repairs were documented in the area of the main passenger door, including a pressurization leak when the cabin was pressurized and a failure of the main door closed green light (PASS DR READY light) to operate. The repairs were documented and the airplane was eventually released for service. The maintenance entries and corrective actions are located in the Bombardier Field Notes, contained in the public docket for this investigation. WRECKAGE AND IMPACT INFORMATION

The main passenger door and associated hardware were found on a golf course at Hallendale, Florida. The impact site coordinates were N 25 59.31, W 080 07.87. Impact marks on the ground were consistent with the top of the door striking the ground first. The door sustained structural damage from ground impact.

An examination of the airframe, including the forward and aft upper latch spigots, forward and aft cams (pull in lever), forward and aft stops, forward and aft rollers, forward and aft upper tension buttons, forward and aft center latch spigots and proximity switches, and forward and aft lower tension buttons showed no evidence of visible anomalies or structural failure. The door's mechanical interface (hinge) was found severed. The door's electrical harness interface was found damaged as a result of the door leaving the airframe in flight. About two feet of electrical wiring were found dangling from connector P2MB. The severed wires contained four power wires that were exposed and were free to contact the airframe in flight. According to the manufacturer, contact with the airframe could create a short circuit and potentially trip circuit breakers CB-D17 and CB-B160, integral to the door warning system. These two circuit breakers were found open during the post-accident examination of the cockpit.

An examination of the external fuselage revealed a puncture in the skin that was similar in size and shape as the door pull out handle. The location was consistent with the pull out handle being in the open position when the puncture occurred. The door pull out handle exhibited a bend of approximately 20 degrees opposite of its contour. The handle was found in its stowed position with the bend standing out and was difficult to extend when manipulated by hand. Its linkage to the internal and external handles was severed from tension loads.

A horizontal impression was found on the fuselage skin that was consistent in location, size and shape with the door's external handle. The horizontal orientation of the impression was consistent with the external handle being in the closed position after the door contact with the fuselage skin occurred. The forward end of the impression had a gouge 0.016" deep and approximately 0.700" high. The aft end of the impression had a gouge 0.005" deep, 1.950" long and 0.350" wide. The paint on the aft end of the impression was smudged consistent with motion towards the closed position.

An examination of the recovered main passenger door revealed that the upper half was crushed from ground impact. Due to the deformity of the door from ground impact, the door latch mechanism rigging was compromised and no attempt was made to establish if the door was rigged properly prior to the accident.

The forward and aft upper latch cams and proximity switches showed no evidence of visible anomalies or structural failure. The green alignment marks were present and visible. When the associated internal linkage was manipulated, the latch cams rotated in a normal manner. The forward and aft pull in levers, forward and aft tension fittings, and the forward and aft center latch cams showed no evidence of visible anomalies or structural failure. The green alignment marks on the center latch cams were present and visible.

The door internal handle showed no evidence of visible anomalies or structural failure. When operated by hand, the forward and aft center latch cams, the external handle, and the associated linkages operated in a normal manner.

Examination of the external handle revealed no evidence of visible anomalies or structural failure. When operated manually, the forward and aft center latch cams, the internal handle, and their associated linkages moved in a normal manner. When the handle was rotated to its closed position (horizontally) relative to the door, the handle stowed normally in its stowed position.

The pushrod, connecting the upper latch cams and lower latch cams, was severed at the lower rod end, with evidence of bending overstress. The rod was housed in the upper portion of the door that was crushed from ground impact. The pushrod parts were removed and forwarded to the NTSB Materials Laboratory for a detailed examination.

The VHF number 1 external antenna, located on the belly of th...

Data Source

Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# ERA12LA356