What happened
On April 11, 2007, a Neiva NE-821, registration PT-VCH, was performing a scheduled mail transport flight from Salvador to Barreiras, with an intermediate stop at Lençóis Aerodrome (SBLE), Bahia. During the approach to Lençóis, the crew encountered weather conditions significantly below the established minimums. While the official METAR reported a ceiling of 7,000 feet, the crew reported visibility of only 2,000 meters and a ceiling of 400 feet.
As the aircraft approached runway 32, the co-pilot identified the runway from the left side of the pavement at an altitude of approximately 400 feet. The commander attempted a landing by banking the aircraft to the right, creating a 45-degree angle relative to the runway centerline, while deploying full flaps and landing gear. This diagonal approach caused the aircraft to sink rapidly and strike the ground forcefully. The aircraft touched down 900 meters past the threshold, outside the left edge of the runway, causing the nose gear to collapse. The aircraft then slid across the runway and came to a stop on the opposite grass area after a 120-degree rotation. The two crew members were uninjured, but the aircraft sustained severe damage.
The investigation
CENIPA's investigation focused on the decision-making process and the operational environment. Investigators found that the flight was conducted under Instrument Flight Rules (IFR) in an area without airway's guidance, and the crew had transitioned to Visual Flight Rules (VFR) for the landing. The investigation noted that the commander'1s windshield was fogged on the left side, likely due to a failure to use the defogging system. Furthermore, there was no evidence of a pre-landing briefing regarding approach stabilization or missed approach procedures. The investigation also examined the psychological state of the commander, noting an attitude of invulnerability.
Findings
- Unstable approach: The commander attempted a landing on a diagonal trajectory relative to the runway centerline.
- Poor decision-making: The commander proceeded with the landing despite the co-pilot's refusal to take control and the presence of weather conditions below safety minimums.
- Adverse weather: Low visibility and low ceilings prevented the necessary early identification of the runway.
- Lack of coordination: There was a failure in cockpit resource management, as the commander made critical decisions unilaterally.
- Inadequate flight planning: The pilot lacked precise knowledge regarding the minimum safety altitudes for the route.
- Psychological factors: The commander exhibited an attitude of invulnerability and excessive self-confidence, which hindered a critical analysis of the situation.