Casualties unknown

2006-09-23: AVIONS PIERRE ROBIN S.A. ROBIN DR 400/500 (HB-KFE) — Celerina, GR, CH

Celerina, GR, CH

On September 23, 2006, an AVIONS PIERRE ROBIN S.A. ROBIN DR 400/500 (registration HB-KFE) was involved in an aviation accident near Celerina, GR, CH. Investigators recorded the probable cause as: The accident was caused by an improper departure maneuver in complex terrain, exacerbated by the pilot's lack of familiarity with the Samedan aerodrome and an overestimation of the aircraft's performance capabilities in mountainous conditions. This summary draws on records from the Swiss Transportation Safety Investigation Board (STSB / SUST).

Sourcesthe Swiss Transportation Safety Investigation Board (STSB / SUST)Primary reportUpdated 1785639345Data APIEditorial standards

A flight from Samedan to Sion ended in a fatal terrain collision after the pilot executed an inappropriate departure maneuver in mountainous terrain.

What happened

On September 23, 2006, a Robin DR-400/500, registration HB-KFE, departed from Samedan aerodrome on runway 21. The flight, which included the pilot and three passengers, was intended to return to Sion. During the flight, the aircraft flew toward the Lake St. Moritz area. In the Charnadüra region, characterized by a narrow valley, the pilot initiated a right-hand turn at a low altitude. During this maneuver, the aircraft began to wobble and tipped onto its right wing, resulting in a collision with the ground near Suot Crasta, Celerina. The impact caused the aircraft to catch fire and be destroyed. All four fatalities occurred among the occupants of the aircraft.

The investigation

The investigation examined the aircraft's technical condition, the pilot's experience, and the local meteorological and topographical environment. Investigators found that the aircraft's takeoff weight was approximately 1124 kg, which was near its maximum capacity of 1150 kg. Technical analysis of the engine and propeller showed no prior mechanical failures, though the high density altitude and heavy weight likely reduced engine performance. The investigation also noted that the pilot had never previously landed at or departed from Samedan aerodrome. Furthermore, the visual approach charts for Samedan did not explicitly detail a specific departure route or warn of the risks associated with deviating from the standard path.

Findings

  • The primary cause of the accident was an inappropriate flight tactic that led to a loss of control.
  • The pilot lacked experience operating at this specific mountain aerodrome.
  • The pilot overestimated the aircraft's flight performance under the prevailing conditions.
  • There was a lack of clear guidance regarding an appropriate departure route on the aeronautical charts.
  • Strong southwesterly winds (the Maloja wind) created significant turbulence and downdrafts in the area.
  • The visual approach charts failed to clearly indicate the necessary changes in direction or the dangers of expanding the departure path into areas prone to downdrafts.

Probable cause

The accident was caused by an improper departure maneuver in complex terrain, exacerbated by the pilot's lack of familiarity with the Samedan aerodrome and an overestimation of the aircraft's performance capabilities in mountainous conditions.

Investigation report by the Swiss Transportation Safety Investigation Board (STSB / SUST). Original record: https://www.sust.admin.ch/inhalte/AV-berichte/2000_f.pdf. This page is a structured re-presentation; facts and quotes are in the Swiss Transportation Safety Investigation Board (STSB), Switzerland.