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Safety Recommendation Details

Safety Recommendation A-92-001
Details
Synopsis: ON SEPTEMBER 20, 1990, A BOEING 707-321, N320MJ, OPERATED BY OMEGA AIR, INC., UNDER THE PROVISIONS OF 14 CODE OF FEDERAL REGULATIONS (CFR) 91 AS A FERRY FLIGHT, CRASHED ON TAKEOFF FROM PINAL AIRPARK, MARANA, ARIZONA. EVIDENCE FOUND AT THE SCENE INDICATED THE AIRPLANE WAS AIRBORNE LESS THAN 6 SECONDS BEFORE ITS RIGHT WING STRUCK THE GROUND AND THE AIRPLANE CRASHED. THE CAPTAIN OF THE THREE-MAN CREW SUSTAINED FATAL INJURIES. THE FIRST OFFICER AND FLIGHT ENGINEER RECEIVED INJURIES, AND THE AIRPLANE WAS DESTROYED.
Recommendation: THE NTSB RECOMMENDS THAT THE FEDERAL AVIATION ADMINISTRATION: CONDUCT AN INTERDISCIPLINARY STUDY, WHICH INCLUDES FLIGHT OPERATIONS AND HUMAN PERFORMANCE SPECIALISTS, TO DEVELOP MINIMUM INSTRUMENTATION REQUIREMENTS FOR THE ISSUANCE OF SPECIAL AIRWORTHINESS PERMITS FOR FERRY FLIGHT OF LARGE TURBOJET AIRPLANES. CONSIDERATION SHOULD BE GIVEN TO THE UNIQUE REQUIREMENTS OF AIRPLANES EQUIPPED WITH ELECTRONIC FLIGHT INFORMATION SYSTEMS (EFIS), FLIGHT MANAGEMENT COMPUTERS AND "FLY-BY-WIRE" SYSTEMS.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Action
Mode: Aviation
Location: MARANA, AZ, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA90MA055
Accident Reports:
Report #: None
Accident Date: 9/20/1990
Issue Date: 2/28/1992
Date Closed: 1/23/1996
Addressee(s) and Addressee Status: FAA (Closed - Acceptable Action)
Keyword(s):

Safety Recommendation History
From: NTSB
To: FAA
Date: 1/23/1996
Response: THE BOARD NOTES THAT THE FAA HAS CONDUCTED A MANAGEMENT TEAM STUDY OF THE NATIONAL DESIGNEE MANAGEMENT OVERSIGHT PROGRAM. ALSO, THE FAA ISSUED FLIGHT STANDARDS INFO BULLETINS FOR AIR TRANSPORTATION & AIRWORTHINESS (FSAT 95-03 & FSAW 95-02), "LIST OF MINIMUM INSTRUMENTS TO FERRY LARGE TURBOJET AIRPLANES, " 2/6/95, WHICH PROVIDES PRINCIPAL OPERATIONS & MAINTENANCE INSPECTORS WITH GUIDANCE CONCERNING DARS IN THE ISSUANCE OF FERRY PERMITS FOR LARGE TURBOJET AIRPLANES. BASED ON THESE ACTIONS, THE BOARD CLASSIFIES A-92-1 & -2 CLOSED--ACCEPTABLE ACTION."

From: FAA
To: NTSB
Date: 10/31/1995
Response: THE BOARD NOTES THAT THE FAA HAS CONDUCTED A MANAGEMENT STUDY OF THE NATIONAL DESIGNEE MANAGEMENT OVERSIGHT PROGRAM & HAS ISSUED FLIGHT STANDARDS INFO BULLETIN FOR AIR TRANSPORTATION (FSAT 95-03) & AIRWORTHINESS (FSAW 95-02), LIST OF MINIMUM INSTRUMENTS TO FERRY LARGE TURBOJET AIRPLANES. THIS BULLETIN PROVIDES PRINCIPAL OPERATIONS INSPECTORS & PRINCIPAL MAINTENANCE INSPECTORS WITH GUIDANCE CONCERNING THE DESIGNATED AIRWORTHINESS REPRESENTATIVES IN THE ISSUANCE OF FERRY PERMITS FOR LARGE TURBOJET AIRPLANES.

From: NTSB
To: FAA
Date: 11/15/1994
Response: THE BOARD NOTES THAT THE FAA WILL CONDUCT A STUDY TO IDENTIFY MINIMUM INSTRUMENTATION REQUIREMENTS FOR THE ISSUANCE OF SPECIAL AIRWORTHINESS PERMITS FOR FERRY FLIGHTS OF LARGE TURBOJET AIRPLANES. THIS STUDY WILL INCLUDE AIRPLANES EQUIPPED WITH EFIS, FLIGHT MANAGEMENT COMPUTERS, & "FLY-BY-WIRE" SYSTEMS. PENDING THE RESULTS OF THE MINIMUM INSTRUMENTATION STUDY & THE ISSUANCE OF THE UPDATED GUIDANCE NOTICE, THE BOARD CLASSIFIES A-92-1 "OPEN--ACCEPTABLE ACTION" AND A-92-2 "OPEN--ACCEPTABLE ALTERNATE ACTION."

From: FAA
To: NTSB
Date: 8/17/1994
Response: THE FAA HAS RECONSIDERED ITS POSITION ON A-92-1 & -2. THE FAA WILL CONDUCT A STUDY WHICH WILL RESULT IN THE IDENTIFICATION OF MINIMUM INSTRUMENTATION REQUIREMENTS FOR THE ISSUANCE OF SPECIAL AIRWORTHINESS PERMITS FOR FERRY FLIGHTS OF LARGE TURBOJET AIRPLANES. AIRPLANES EQUIPPED WITH ELECTRONIC FLIGHT INFO SYSTEMS, FLIGHT MANAGEMENT COMPUTERS, & FLY-BY-WIRE SYSTEMS WILL BE INCLUDED IN THE STUDY. THE INFORMATION DEVELOPED THROUGH THIS STUDY WILL PROVIDE GUIDANCE TO PRINCIPAL OPERATIONS & MAINTENANCE INSPECTORS FOR USE IN THE ISSUANCE OF SPECIAL AIRWORTHINESS PERMITS. IN ADDITION TO THIS INITIATIVE, THE FAA HAS NAMED A NATIONAL DESIGNEE PROGRAM POLICY TEAM WHICH WILL ADDRESS THE ISSUES OF DESIGNEE QUALIFICATIONS & FUNCTIONS. THE TEAM WILL REVIEW & UPDATE ALL GUIDANCE USED BY THE FAA & DESIGNEES & COMBINE THE GUIDANCE INTO A SINGLE NOTICE. I ANTICIPATE THAT THIS PROJECT WILL BY COMPLETED BY DECEMBER 1994.

From: NTSB
To: FAA
Date: 6/10/1993
Response: THE BOARD NOTES THAT THE FAA DISAGREES WITH THESE RECOMMENDATIONS, BUT BELIEVES THAT THE MINIMUM INSTRUMENTATION REQUIRED FOR FLIGHT IS ESTABLISHED IN THE CERTIFICATION & OPERATING RULES APPROPRIATE TO THE AIRCRAFT IN QUESTION & THE TYPE OF FLIGHT ANTICIPATED. THE BOARD'S CONCERN IS THAT THE ISSUANCE OF A SPECIAL AIRWORTHINESS PERMIT CONSTITUTES AN APPROVED DEVIATION FROM THE CERTIFICATION RULES. SIMILARLY, THE OPERATING RULE PERTAINING TO A FERRY FLIGHT (14 CFR 91.20) REQUIRES ONLY AIRSPEED, ALTITUDE, & DIRECTION INSTRUMENTS, BUT NO ATTITUDE INSTRUMENT. AS EVIDENT FROM THE MARANA ACCIDENT, THESE BASIC INSTRUMENTS MAY BE INSUFFICIENT FOR LARGE TURBOJET AIRCRAFT. THE BOARD BELIEVES THAT THE FAA MUST PROVIDE A LIST OF THE MINIMUM FLIGHT INSTRUMENTS OR EQUIPMENT THAT IS CONSIDERED ESSENTIAL FOR FERRYING AIRPLANES OF THIS TYPE. THE BOARD ACKNOWLEDGES THAT THE DAR WAS NOT QUALIFIED & SHOULD NOT HAVE BEEN AUTHORIZED BY THE FAA TO ISSUE SPECIAL AIRWORTHINESS PERMITS FOR LARGE AIRCRAFT. NEVERTHELESS, THE DAR HAD INADEQUATE REGULATORY GUIDANCE FOR MINIMUM INSTRUMENTATION REQUIRED FOR THE FLIGHT. THEREFORE, THE BOARD CONTINUES TO BELIEVE THAT THE FAA SHOULD PROVIDE FURTHER GUIDANCE CONCERNING THE ISSUANCE OF SPECIAL AIRWORTHINESS PERMITS FOR LARGE MULTIENGINE TURBOJET AIRPLANES & REQUIRE THAT ATTITUDE REFERENCE INSTRUMENTS BE CONSIDERED CRITICAL & ESSENTIAL IN LARGE TURBOJET AIRPLANES, EVEN IF VFR WEATHER CONDITIONS ARE ANTICIPATED DURING THE FLIGHT. THE BOARD ASKS THE FAA TO RECONSIDER ITS POSITION & CLASSIFIES THE A-92-1 & 2 AS "OPEN--UNACCEPTABLE RESPONSE."

From: FAA
To: NTSB
Date: 8/20/1992
Response: THE FAA DOES NOT AGREE WITH THESE RECOMMENDATIONS. THE INTENT OF RECOMMENDATIONS A-92-1 AND -2 IS TO ESTABLISH COCKPIT INSTRUMENTATION REQUIREMENTS FOR USE WITH THE ISSUANCE OF SPECIAL AIRWORTHINESS PERMITS FOR FERRY OF LARGE TURBOJET AIRCRAFT. THE MINIMUM INSTRUMENTATION REQUIRED FOR FLIGHT IS ESTABLISHED IN THE CERTIFICATION AND OPERATING RULES APPROPRIATE TO THE AIRCRAFT IN QUESTION AND THE TYPE OF FLIGHT THAT IS ANTICIPATED. ANY DEVIATION FROM THESE REQUIREMENTS UNDER A SPECIAL AIRWORTHINESS CERTIFICATE MUST BE ADDRESSED WITH APPROPRIATE OPERATING LIMITATIONS. CONSEQUENTLY, THE RESPONSIBILITY TO DETERMINE THE APPROPRIATE OPRERATING LIMITS AND REQUIREMENTS FOR ANY GIVEN FERRY FLIGHT RESTS WITH THE INDIVIDUAL WHO ISSUES THE SPECIAL AIRWORTHINESS CERTIFICATE. IN THE ACCIDENT IN QUESTION, THE DESIGNATED AIRWORTHINESS REPRESENTATIVE (DAR) DID NOT PERFORM IN A COMPETENT MANNER. THE FAA HAS REMOVED THE DAR'S DESIGNATION AS A RESULT OF THE INFORMATION WHICH CAME TO LIGHT IN THIS ACCIDENT INVESTIGATION. IN ADDITION TO THE DAR'S UNSATISFACTORY PERFORMANCE, IT APPEARS THAT THERE WERE OPERATIONAL ISSUES WITH THE FLIGHTCREW AND THE AIRCRAFT LOADING AND CONFIGURATION WERE INCORRECT. THE FAA BELIEVES THAT THE INTENT OF RECOMMENDATION A-92-1 AND -2 WILL BE ACCOMPLISHED THROUGH THE ACTIONS INITIATED IN RESPONSE TO RECOMMENDATIONS A-92-3 AND -4. THESE ACTIONS INCLUDE THE REVISION OF FAA ORDER 8000.62, DESIGNATED AIRWORTHINESS REPRESENTATIVES QUALIFICATION CRITERIA, SELECTION, AND APPOINTMENT PROCEDURES; FAA ORDER 8000.63, DESIGNATED AIRWORTHINESS REPRESENTATIVES MONITORING PROGRAM; AND ADVISORY CIRCULAR 183-33A, DESIGNATED AIRWORTHINESS REPRESENTATIVES. BY ADDRESSING THE REQUIREMENTS AND QUALIFICATIONS OF THOSE INDIVIDUALS WHO ISSUE SPECIAL AIRWORTHINESS PERMITS, THE FAA BELIEVES THAT THERE WILL BE A PROPER REVIEW OF ALL THE REQUIREMENTS ATTENDANT TO EACH REQUEST FOR A PERMIT TO INCLUDE THE IDENTIFICATION OF MINIMUM INSTRUMENTATION REQUIREMENTS.

From: NTSB
To: FAA
Date: 4/29/1992
Response: Safety Recommendations A-92-1 and -2 state that the FAA should conduct an interdisciplinary study, which includes flight operations and human performance specialists, to develop minimum instrumentation requirements for the issuance of Special Airworthiness Permits for ferry flight of large turbojet airplanes. Consideration should be given to the unique requirements of airplanes equipped with electronic flight information systems, flight management computers, and "fly-by- wire" systems. Once the study has been analyzed, promulgate a standard of minimum acceptable cockpit instrumentation for large turbojet airplane ferry permits and disseminate this guidance to Principal Operations and Maintenance Inspectors for use in their issuance of Special Airworthiness Permits and in their oversight of activities of Designated Airworthiness Representatives. The Safety Board notes that the FAA is in the process of reviewing these safety recommendations to determine a course of action to address these issues. Pending further information, Safety Recommendations A-92-1 and -2 are classified as "Open--Await Response."

From: FAA
To: NTSB
Date: 4/8/1992
Response: THE FAA IS IN THE PROCESS OF REVIEWING THESE SAFETY RECOMMENDATIONS. THEY WILL APPRISE THE BOARD OF THEIR COURSE OF ACTION TO ADDRESS THESE ISSUES AS SOON AS THE REVIEW IS COMPLETED.