What happened
On July 8, 2016, at approximately 19:40 UTC, a Piper PA-36-375, registration PR-TVE, was conducting agricultural spraying operations over an orange plantation near Fazenda Graminha, in Botucatu, São Paulo. The aircraft, operated by Aeroagrícola Chapadube Ltda., was performing its final application of the day when it struck high-voltage power lines. Following the collision with the electrical wires, the aircraft impacted the ground, resulting in substantial damage to the airframe and the fatal injury of the pilot.
The investigation
CENIPA's investigation established that the pilot was fully qualified, holding valid commercial licenses and agricultural ratings, and possessed a valid medical certificate. The aircraft was also in an airworthy condition, with all maintenance logs up to date and weight and balance within manufacturer limits.
Investigators determined that while the pilot had performed a reconnaissance flight prior to the operation and was aware of the presence of the power lines, these obstacles were not recorded in any flight notes or aeronautical charts. The investigation also noted that the accident occurred roughly 23 minutes before sunset. At the time of the impact, the aircraft was flying directly toward the sun, which, combined with the low light levels of dusk, likely hindered the visibility of the wires. Additionally, while the presence of various medications in the pilot's gear was noted, investigators could not definitively determine if medication use contributed to the accident.
Findings
- Inefficient flight planning, as the pilot failed to document known terrain obstacles in flight logs to prevent oversight during operations.
- Reduced visibility due to the sun's position directly in the aircraft's path (glare) and the approaching sunset.
- The presence of the power lines on sloped terrain, which complicated visual identification.
- The high workload inherent to agricultural aviation, which demands intense sensory perception and spatial orientation.
Safety action
Following the publication of the report, a recommendation was issued to the National Civil Aviation Agency (ANAC) to work with the operator to improve flight planning, risk management, and managerial supervision to enhance operational safety levels.