What happened
On April 15, 2010, an agricultural aircraft, a Neiva EMB-201A registered as PT-GRY, was performing its final pesticide application flight of the day at Fazenda Panorama in Correntina, Bahia. The aircraft was operating in an agricultural capacity for Aerosafra Aviação Agrícola Ltda.
During the landing roll, approximately 700 meters from the runway threshold, the right main gear struck a rock. The impact caused the aircraft to veer diagonally to the right, traveling approximately 63 meters. During this excursion, the right wing made contact with nearby cotton crops. In an attempt to regain directional control, the pilot applied the brakes, which caused the aircraft's nose to dip, resulting in a nose-over (pilonagem). The pilot sustained serious injuries, and the aircraft suffered substantial damage.
The investigation
CENIPA investigators found that while the pilot was fully qualified and the aircraft was airworthy and within weight limits, several operational irregularities were present. The landing strip, which the operator believed was a registered temporary landing area, was not officially recorded with ANAC. Although recent repairs had been attempted on the strip, the work was incomplete, leaving numerous loose stones across the surface, particularly on the right side of the runway.
The investigation also identified that the pilot was not wearing required personal protective equipment (PPE), such as a flight suit or mask. Furthermore, the investigation noted that the pilot had been working for approximately forty consecutive days, suggesting inadequate rest periods. The investigation also highlighted that the pilot's seat was adjusted to an unusually high position, and the seatbelt was improperly adjusted with excessive slack, both of which contributed to the severity of the cervical spine injury sustained during the impact.
Findings
- Unimproved infrastructure: The presence of loose stones due to incomplete runway maintenance was a primary factor.
- Organizational failures: Inadequate management oversight regarding pilot rest, PPE compliance, and the verification of runway conditions.
- Pilot judgment and actions: The use of heavy braking to correct the deviation contributed to the nose-over.
- Inadequate safety equipment use: Improper seat and seatbelt adjustment increased the risk of injury during the impact.