What happened
On January 15, 2022, a Piper PA-25-260, registration PR-SOD, was performing an agricultural flight at the São Domingos Sugar Mill airstrip in Uchô/SP, Brazil. During the landing roll, the aircraft's right wing struck a support vehicle that had been parked within the limits of the landing area. The impact caused the aircraft to veer to the right, leading the propeller to strike an airstrip assistant who was standing near the vehicle preparing for supply replenishment. While the pilot escaped without injury, the ground worker sustained fatal injuries. The aircraft sustained minor damage to its wings and propeller.
The investigation
CENIPA's investigation focused on the environmental conditions and the operational environment of the dirt airstrip. Although meteorological reports showed calm winds and good visibility at the time of the accident, the investigation established that it had rained the previous night, leaving the unpaved surface slippery and muddy. The investigation also examined the physical state of the aircraft, noting that while the flight controls were functional, the connection between the tailwheel and the rudder steering mechanism was missing. Furthermore, investigators analyzed the presence of obstacles on the runway, including parked vehicles and uneven terrain caused by heavy vehicle traffic.
Findings
- The aircraft's right wing collided with a support vehicle parked at the threshold of the landing area.
- The propeller, while still in motion, struck the ground assistant.
- The airstrip surface was slippery due to recent rainfall and contained uneven terrain.
- The practice of parking support vehicles within the landing area and the use of the runway for ground traffic reduced the available space for safe operations.
- The aircraft's tailwheel steering connection was missing, which hindered directional control on the ground.
- There was evidence of an organizational culture that prioritized operational speed over safety, allowing high-risk procedures such as backtracking close to parked vehicles.
Safety action
CENIPA issued a recommendation to Brazil’s National Civil Aviation Agency (ANAC) to work with the operator, Soldeira Aviação Agrícola, to ensure that operations comply with RBAC-137 regulations, specifically regarding the technical condition of the aircraft fleet and the management of risks associated with the use of agricultural landing areas.