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Accident Prevention: Crew Fails To Compute Crosswind Component, Boeing 757 Nosewheel Collapses On Landing

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FLIGHT SAFETY F O U N D AT I O N

Accident Prevention
Vol. 57 No. 3 For Everyone Concerned with the Safety of Flight March 2000

Crew Fails to Compute Crosswind Component,


Boeing 757 Nosewheel Collapses on Landing
A crosswind component of approximately 35 knots existed for the runway in use at
Schiphol Airport in Amsterdam, Netherlands. The report said that the flight crew did not
calculate the crosswind component and had insufficient time, after disengaging the
autopilot at 100 feet, to align the aircraft properly for landing.

FSF Editorial Staff

At 2348 local time on Dec. 24, 1997, a Transavia • “Disconnect of the autopilot in the ‘align’ mode
Airlines Boeing 757-236 (B-757) was landed in under the existing wind conditions resulted in an
strong and gusty wind conditions on Runway 19R out-of-trim condition of the aircraft;
at Schiphol Airport, Amsterdam, Netherlands. The
fuselage was not aligned with the runway when the • “The low altitude of the autopilot disconnect in
aircraft touched down hard, and the nose gear relation to the existing wind conditions allowed
collapsed. The aircraft slid approximately 3,000 the pilot insufficient time to gain complete control
meters (9,843 feet) on the runway and came to a of the aircraft, which resulted in a hard, traversing
stop off the side of the runway. Three of the 213 landing; [and,]
occupants received minor injuries while evacuating
the aircraft, and one passenger complained of heart • “The hard nosewheel touchdown, exceeding the
problems. certified design limits, resulted in a failure of the
nose-gear construction.”
The Dutch Transport Safety Board, in its final report on the
accident, said that the causal factors were the following: The aircraft was operated as a charter flight to Amsterdam
from Las Palmas, Canary Islands, Spain. The aircraft,
• “[The] runway-allocation system at Schiphol Airport manufactured in 1994, had 13,630 service hours and 4,645
resulted in strong crosswind conditions for the landing cycles.
runway in use;
The flight departed from Las Palmas at 2003.
• “By the omission to state clear and definite crosswind
limitations in the Transavia Operations Manual, a “Prior to departure, the crew had discussed the weather at
defense barrier against unsafe operations was lost; Schiphol,” the report said. “The forecast for Schiphol [for the
estimated time of arrival included] a wind of 230 degrees [at]
• “Non-calculation and/or discussion of [the] crosswind 26 knots, gusts [to] 40 knots, a visibility of more than 10
component resulted in continuing the approach in kilometers [6.2 statute miles], no significant weather, clouds
adverse weather conditions; scattered at 1,000 feet and broken [at] 2,500 feet.”
The captain was the pilot flying. The captain, 53, had an airline
transport pilot (ATP) license and 23,197 flight hours, including
2,208 flight hours in type.

The first officer, 34, had an ATP license and 3,744 flight hours,
including 1,074 flight hours in type.

The cabin crew included a purser (lead cabin attendant) and


five cabin attendants.

“All cabin crewmembers had a valid recurrent training


certificate,” said the report.

[The report provided no information on the crew’s duty time,


rest time or activities before the flight.]

Before beginning the descent to Amsterdam, the flight crew


was told that the surface winds at Schiphol Airport were from
220 degrees at 30 knots and that wind velocity varied from 19
knots to 40 knots.

“The cockpit crew expected turbulence in the approach and


requested the purser to have the cabin ready early in the
approach,” the report said. “During the descent, the passengers
were informed about the expected turbulence in the approach.”

At 2333, the flight crew received the following automatic


terminal information system (ATIS) message, which was issued
at 2325:

“Schiphol Arrival Information Echo: Main landing


Runway 19R; transition level 045 [4,500 feet]; wind
Boeing 757 220 degrees [at] 31 knots, maximum 41 knots,
minimum 21 knots; visibility 10 kilometers; clouds
The Boeing 757-200 series is a medium-range airliner designed few [at 2,200 feet], scattered [at 2,800 feet];
to carry 186 passengers in a typical mixed-class configuration.
The B-757 can accommodate up to 239 passengers in temperature 12 [degrees Celsius]; dew point 9
charter service, putting its capacity between that of the Boeing [degrees Celsius] … .”
737-400 and the Boeing 767. A longer-range version and a
freighter configuration of the B-757 also are available. At 2335, the ATIS message was changed to show that the
The B-757-200 is powered by two turbofan engines mounted surface winds were from 230 degrees at 33 knots, gusting to
in underwing pods. Engine pairs for the B-757 are provided by 45 knots, and that the wind direction varied between 200
Pratt & Whitney (PW 2037 or PW 2040) and Rolls-Royce (535 degrees and 260 degrees. The message, however, was broadcast
series). The engines differ slightly in their static thrust.
as Information Echo.
The aircraft has a maximum takeoff weight of 104,325 kilograms
(230,000 pounds) and engine thrust is rated between 170 “This ATIS message was inadvertently transmitted under the
kilonewtons (kN; 38,200 pounds) and 197.1 kN (43,100 pounds).
At maximum takeoff weight with 186 passengers, the B-757 has
same code as the previous [message],” the report said. “Because
a range of between 5,222 kilometers (km; 2,820 nautical miles of the same letter code, ATC [air traffic control] as well as the
[nm]) and 5,519 km (2,980 nm), depending on the engine cockpit crew were not alerted that the wind conditions had
installed. The B-757 has a top speed of Mach 0.86 and a normal changed.”
cruising speed of Mach 0.80.

The two-pilot cockpit of the B-757 has a computerized, fully The report said that Schiphol Airport had a “noise preferential
integrated flight management system (FMS) that can provide runway allocation system” to enhance aircraft-noise abatement.
automatic guidance and control of the aircraft from immediately
Table 1 (page 3) shows the system’s order of preference of
after takeoff to final approach and landing. The FMS controls
navigation, guidance and engine thrust to ensure that the aircraft runway pairs for takeoff and landing. [The airport has five
flies the most efficient route and flight profile. runways: Runway 01L-19R; Runway 01R-19L; Runway
04-22; Runway 06-24; and Runway 09-27. The report provided
Source: Jane’s All the World’s Aircraft no information on approach aids for runways other than the
approach aids for Runway 19R.]

2 FLIGHT SAFETY FOUNDATION • ACCIDENT PREVENTION • MARCH 2000


The report said that the allocation of Runway 19R for landings
Table 1 was based in part on a 2138 forecast for winds from 230 degrees
Preferred Runway Pairs at Schiphol at 24 knots, gusting to 36 knots.
Airport, Amsterdam, Netherlands, “The preferential runway allocation system, especially by
Dec. 24, 1997 excluding Runway 24 for landing, does not reflect the
prevailing wind direction at Schiphol, thereby creating an
Preference Landing Runway Takeoff Runway
increase in crosswind operations,” the report said. “This,
1 06 01L
together with a crosswind criterion of up to 25 knots and the
2 19R 24 freedom to exceed this value, makes the present preferential
3 06 09 runway allocation system, in potential, an invitation to unsafe
4 27 24 operations.”
5 01R 01L
6 01L 01L The report said, “It must be noted that acceptance of an
assigned runway is the final responsibility of the pilot-in-
Source: Dutch Transport Safety Board
command [PIC].”

After receiving the information in the first broadcast of ATIS


Information Echo, the flight crew conducted the approach
The report said that the International Civil Aviation checklist and decided to use 125 knots for VREF (landing
Organization (ICAO) recommends a crosswind limitation of reference speed).
15 knots for noise-abatement runway allocation at night; the
criteria for runway allocation at Schiphol Airport at night “The crew decided to determine the FAS (final approach speed)
included crosswind limitations of 25 knots on a dry runway, after a later wind check,” said the report.
15 knots on a runway with a surface condition between dry
and wet, and five knots on a wet runway. The estimated aircraft landing weight was 81,946 kilograms
(180,658 pounds), and the center of gravity (CG) was 27.8
“[The dry-runway crosswind limitation] is only marginally percent mean aerodynamic chord (MAC). The maximum
below the maximum allowable crosswind component of most landing weight was 95,254 kilograms/210,000 pounds, and
aircraft,” the report said. “Furthermore, ATC is free to exceed the acceptable CG range for landing was 13.2 percent MAC
the established [noise preferential runway allocation system] to 33.6 percent MAC.
wind criteria to extend the use of a runway combination with
a higher preference … .” Approach control told the crew to conduct the instrument
landing system (ILS) approach to Runway 19R. At 2344, the
At the time of the accident, the following notices to airmen first officer told Schiphol Tower that the flight was established
(Notams) affected runway allocation at the airport: on the ILS approach to Runway 19R.

• Notam A0622/97 said, “Due to noise-abatement The Schiphol Tower controller acknowledged the first officer’s
procedures, use of a nonpreferential runway for takeoff report and said, “The wind is two four zero, maximum four
or landing [is] not permitted; no restrictions for three knots, cleared to land on one nine right.”
emergency operations”;
The report said, “The crew discussed the wind and apparently
• Notam A0764/97 said, “Turbulence forecasted on final had understood the gusts as ‘forty’ instead of ‘four three.’ The
approach area at wind direction [between] 180 [degrees] FAS was determined to be 140 knots.”
and 250 [degrees] and wind speed more than 20 knots”;
and, The report said that the captain used a 15-knot wind-correction
factor to calculate the FAS because he expected wind shear at
• Notam A0810/97 said, “Until Dec. 31 [at] 2359, due to lower altitude. The crew did not discuss the crosswind.
noise-abatement procedures, landing [on] Runway 22 and
Runway 24 with approach over the city is not permitted.” “The CVR [cockpit voice recorder] transcript did not show
any discussion about the crosswind,” the report said. “The
When the accident occurred, Runway 24 was being used for crosswind component was not calculated.”
takeoffs and Runway 19R was being used for landings. Runway
19R is 3,300 meters (10,827 feet) long and 45 meters (148 The Transavia Operations Manual said that the maximum
feet) wide. The runway had a high-intensity approach-light demonstrated crosswind component for the B-757 is 30 knots.
system, runway-centerline lights and runway-edge lights. The The manual did not, however, specify 30 knots as a limit for
asphalt runway surface was damp at the time. crosswind landings, said the report.

FLIGHT SAFETY FOUNDATION • ACCIDENT PREVENTION • MARCH 2000 3


The manual said, “This value is formally not limiting; however, The aircraft was approximately 100 feet above the ground at
actual crosswind components approaching (or even exceeding) 2347 when the captain disconnected the autopilot.
these values should be treated as a strong incentive to divert
to a runway with less crosswind.” “When the autopilot is disconnected at a height of 100 feet,
the pilot has only eight [seconds] to 10 seconds to touchdown,
Turbulence began to increase as the aircraft descended to 2,000 which gives him, especially in turbulent air, not enough time
feet. Nearing 1,500 feet, the flight crew extended the landing to observe, evaluate and control a highly dynamic situation,”
gear, set flaps 20 and programmed the autopilot to maintain said the report.
165 knots.
The B-757’s engines are mounted beneath the wings [the thrust
After flying over the ILS outer marker, the crew set flaps 25, line is below the CG]; thus, thrust changes result in pitch
then flaps 30 and programmed the autopilot to maintain 140 changes. The report said that this increases pilot workload in
knots. gusty wind conditions.

“The landing checklist was completed,” the report said. “The The report said that two flight-simulator studies showed that
indicated airspeed varied considerably due to the gusty control problems were encountered in “adverse weather
wind.” conditions” during the transition from automatic flight to
manual flight.
At 600 feet, the captain told Schiphol Tower that the aircraft’s
flight management system (FMS) showed winds from 240 “From both experiments, it could … be concluded that, at
degrees at 50 knots. The report said that this high crosswind speeds, it is essential to
might not have been accurate. disconnect the autopilot at an altitude which
allows for ample time to adapt to the
“FMS wind calculation uses strong filtering, The captain said that, demanding control tasks,” said the report.
resulting in lagged data for the crew,” the before touchdown,
report said. “In addition, the calculation The captain inadvertently failed to
assumes zero sideslip. Therefore, the shown the aircraft encountered disconnect the autothrottle system when he
FMS wind may not be as accurate as is disconnected the autopilot. The report said
generally believed.” a “head-on” gust that that flight-simulator tests showed that the
caused an increase autothrottle system produced no significant
Nevertheless, the report said that the FMS adverse effects, because the system could
wind calculation and the wind report by in indicated airspeed be overridden manually when necessary.
Schiphol Tower should have prompted the
flight crew to calculate the crosswind and an increase When the captain disconnected the
component and to consider a go-around. in pitch attitude. autopilot, the aircraft yawed five degrees
to the right and began to drift to the left.
“As it [was], the crosswind was not discussed,
and the crosswind component was not calculated by the “The [captain] reacted with control inputs to bring the aircraft
cockpit crew,” said the report. back on the required flight path,” said the report.

At 500 feet, the autopilot began to transition the aircraft from At the time, weather conditions at Schiphol Airport included
a crab attitude to a forward slip. This resulted from the autopilot surface winds from 230 degrees at 33 knots, gusting to 46 knots,
going into “align” mode. moderate-to-severe turbulence, few stratocumulus clouds with
bases at 2,200 feet and scattered stratocumulus clouds with
“In the Boeing 757, the selection of an automatic approach bases at 2,800 feet.
will also include arming of the autoland function,” the report
said. “This results in aircraft alignment starting at “Wind shears were not reported,” the report said. “However,
approximately 500 feet. The corresponding aileron [control the existing wind conditions may have included small-scale
forces] and rudder control forces are not trimmed. Therefore, up[drafts] and downdrafts, and local vortices close to the
an autopilot disconnect below 500 feet may initiate ground.”
destabilization [of the approach].”
The captain said that, before touchdown, the aircraft
The Transavia Operations Manual said that the maximum encountered a “head-on” gust that caused an increase in
crosswind component for autoland operations was 15 knots. indicated airspeed and an increase in pitch attitude.
The manual said that the autopilot and the autothrottle system
should be disconnected “not later than 100 feet RA [radio- “The [captain] pushed the nose down, and the DFDR [digital
altimeter altitude].” flight data recorder] showed an engine-power reduction, after

4 FLIGHT SAFETY FOUNDATION • ACCIDENT PREVENTION • MARCH 2000


which the crew recalled experiencing a violent wing dip to the caused a small fire that was extinguished quickly by aircraft
left, followed by one to the right just prior to touchdown,” rescue and fire fighting (ARFF) personnel.
said the report.
The report said that the cockpit was completely dark and that
The aircraft’s sink rate was approximately 400 feet per minute smoke had entered the cockpit.
when the aircraft touched down on the right-main landing gear.
The aircraft became airborne again, and the nose pitched up. “In the dark, the pilots performed the shutdown procedures by
feel,” the report said. “To prevent smoke entering the cabin,
“The [captain] pushed the nose down, causing a pitch-down they decided to keep the cockpit door closed. The captain was
rate of at least nine degrees per second,” said the report. unable to find the PA [public-address system] handset, and
when he heard someone at the cockpit door, he shouted the
The aircraft had a crab angle of eight degrees when the left- order to evacuate.”
main landing gear and the nose gear contacted the runway.
The Transavia Operations Manual said that the flight crew
“[A] computer simulation showed that the nose gear used all should take the following actions during an aircraft evacuation:
15 inches [38 centimeters] of its available stroke and bottomed
on its endstop,” said the report. • “After shutdown procedures, conditions permitting, the
copilot will leave the aircraft via the forward door on
The report said that the load on the nose gear exceeded by the right-hand side as soon as possible. He/she will take
approximately 20 percent the maximum load the nose gear was control of evacuation outside the aircraft;
designed to withstand. The nose gear collapsed, causing damage
to electrical systems and electronic systems. The cockpit- • “The PIC, conditions permitting, will visually check the
instrument lights extinguished, the cabin-emergency-lighting aircraft for persons left behind and will leave the aircraft
system activated, and the CVR and the DFDR stopped recording. via the aft door on the left-hand side. The PIC will then
take control of the evacuation; [and,]
“Engine controls and flight controls were affected, the
autobrake system disconnected, and the [leading-edge flaps • “If conditions are unfavorable, flight crewmembers will
and trailing-edge] flaps retracted,” said the report. leave the aircraft via the nearest exit (e.g., cockpit side
windows).”
The report said that failure analyses conducted by the National
Aerospace Laboratory (NLR)–Netherlands showed the The report said, “The pilots opened the cockpit side windows,
following results: which improved the visibility. They eventually, after they
assumed that the cabin evacuation was completed because the
• “Fracture surfaces of broken parts of the [nose-landing- noise that could be heard behind the closed cockpit door had
gear] structure showed no indications of preexisting stopped, evacuated the cockpit [through the cockpit side
cracks; [and,] windows].”

• “Examination of the fracture surfaces indicated overload The report said, “In retrospect, it could be argued that the smoke
as the cause of the collapse.” in the cockpit was not a condition preventing the copilot to
immediately leave the aircraft via the side window. Also, the
The aircraft veered right and struck several runway-edge lights. captain, after he assumed the evacuation was completed, could
The captain brought the aircraft toward the runway centerline. at least have checked if the conditions restricted him to visually
At the captain’s command, the first officer declared “mayday” check the cabin for persons left behind.”
to Schiphol Tower.
The captain said that, after he evacuated the aircraft, he was
The aircraft slid approximately 3,000 meters and veered off told by ARFF personnel that all of the passengers had evacuated
the right side of the runway. The aircraft then traveled the aircraft.
approximately 100 meters (328 feet) over soft terrain.
The purser and the cabin attendants had not heard the captain’s
“When off the runway, the main-gear [assemblies] sank into shouted evacuation order.
the soft terrain and collided with the top covers of the runway-
light transformer units,” the report said. “Both main-landing “A number of passengers, alarmed by the sparks and flames
gears incurred serious damage. Both engines were damaged during the rollout, expected a speedy evacuation, and a large
by ingested concrete debris.” number of them got up from their seats and started to move
towards the exits,” the report said. “Since no evacuation order
The aircraft came to a stop 50 meters (164 feet) beyond the had been received, the cabin attendants shouted the order to
runway edge. Overheated brakes on the left-main landing gear remain seated.”

FLIGHT SAFETY FOUNDATION • ACCIDENT PREVENTION • MARCH 2000 5


The purser then initiated the evacuation of the aircraft. The “Aircraft manufacturers give limits for the
purser was in the forward section of the cabin and tried to maximum crosswind for each type of aircraft. They
use the PA system to tell cabin attendants in the aft section include a limit based on tests, the demonstrated
of the cabin to evacuate the aircraft. The PA system was crosswind and a limit based on simulations — the
not functioning, however; the aft-cabin attendants did not manufacturer’s limit. [For] the Boeing 757, the
receive the order to evacuate and did not open the four aft- manufacturer’s limit is a crosswind of 40 knots (at
cabin exits. an angle 90 degrees to the flight direction), and
the demonstrated crosswind limit is, without gusts,
“Passengers in the aft cabin, seeing forward-cabin passengers 30 knots (also at 90 degrees). The latter limit is
evacuate, either demanded that their exits should be opened generally adopted by aircraft users. In the case of
as well or moved forward to evacuate through the forward Transavia, [the following] note was included in the
exits,” the report said. “Eventually, all exits were opened.” pilots’ manual, though a great deal was left to the
judgment of the pilots, themselves:
Two aft-cabin slides did not deploy automatically and had to
be deployed manually by the cabin attendants. The wind “‘[Crosswind] means that the given component
moved the right-aft-cabin slide to an unusable position. The is the maximum demonstrated crosswind
other aft-cabin slides deployed at steep angles because of during aeroplane type certification; this value
the aircraft’s tail-high attitude. Because of the wind, is formally not limiting; however, actual
assistance from ARFF personnel was required to control the crosswind components approaching (or even
usable slides. Most passengers evacuated using slides at the exceeding) these values should be treated as a
forward exits. strong incentive to divert to a runway with less
crosswind.’
“Three passengers were slightly injured by abrasion, and
one passenger complained of heart problems,” “After the accident, the Transavia
said the report. [The report provided no manual was amended [to include] a
further information about the passenger “Although the risk of crosswind limit of 30 knots … .
who complained of heart problems.]
accidents is very low, “A complicating factor is the increasing
The report provided the following analysis use of runway-allocation systems.
as an introduction to recommendations made
it increases sharply Certain runways may be closed for
as a result of the accident investigation: with a crosswind of environmental reasons, especially in
connection with noise nuisance, which
“The consequences of the accident 20 knots or more.” increases the chance of having to land
could have been far worse. The with a crosswind. For this reason,
[investigation] identified the fact that ICAO, of which nearly all countries are
the plane landed in a strong crosswind as one of the members, has advised its members to regulate runway
main causes of the accident. On the basis of the wind usage so as to ensure that the crosswind component
data available to the control tower, a crosswind does not exceed 15 knots.
component of 35 knots was calculated at the start of
the investigation. Later, however, the [NLR] “Since wind-speed-measuring systems are not
determined that, in reality, [the crosswind component] always accurate — (because the measurements are
may have been 10 knots higher. made at locations other than the relevant landing
zone, the measured wind speed may differ from the
“Most aircraft accidents occur during takeoff and actual speed at the runway in question) — and the
landing, with landing entailing the most risks. wind speed (and direction) may be constantly
‘Statistics over the last 10 years show that the major changing, the limit of 15 knots represents an in-built
risk is during approach and landing. This is when safety margin and can prevent the demonstrated
50 percent of all aircraft accidents occur.’1 As far as crosswind limit [from] being exceeded. … If the
other causal factors are concerned, wind is a airport has only one runway, then obviously no
circumstantial factor in one out of three accidents.2 allocation can take place, and the demonstrated
The combination of landing and weather conditions crosswind limit specified by the [aircraft]
(a strong crosswind), therefore, warrants closer manufacturer should be used. If it is impossible to
attention. Various studies have pointed to the risks land within the stipulated limits, the aircraft will
associated with this combination. For instance, an have to be diverted to another airfield.
NLR study states that, although the risk of accidents
is very low, it increases sharply with a crosswind of “In practice, there seems to be a tendency to allow
20 knots or more. aircraft to land in a strong crosswind despite the

6 FLIGHT SAFETY FOUNDATION • ACCIDENT PREVENTION • MARCH 2000


attendant risks. Diverting aircraft to another airfield • “The preferential runway allocation system in use at
which has a runway with a less-strong wind or with a [Schiphol Airport] should be reviewed with respect to:
more favorable orientation in relation to the wind —
e.g., head-on — is generally felt to be very – “Recommended ICAO limitations;
inconvenient by all concerned, including passengers,
– “Uncertainty of present wind information;
crew and airlines; passengers are not at their
destination and miss their connections, no – “Potential risks of operating in (strong) crosswind
replacement crew is available, technical inspection conditions; [and,]
of the aircraft cannot be carried out, etc.
– “Freedom by ATC to exceed the established [runway-
“The Transavia aircraft was allocated Runway 19R allocation] criteria.”
by [air] traffic control. The available wind data
initially fell within the demonstrated limits, but the The report made the following recommendations to aircraft
situation changed just before the landing [and] operators:
Runway 24 would have been the most suitable in
terms of flight safety. Under the runway-allocation • “During training, pilots should be made aware of the
system, this runway is not used for landing purposes uncertainty with regard to wind speed in the reported
at night because the approach route passes over wind information;
Amsterdam and causes noise nuisance. Exceptions
are only made in an emergency. … • “Operations manuals should contain a ‘caution’ with
regard to the minimum height for autopilot disconnect
“Since landings with a strong and/or increasing in adverse wind conditions, especially in relation to the
crosswind entail risks, the question arises as to ‘align’ mode; [and,]
whether in such weather conditions (which are not
unusual in the Netherlands) … it should be possible • “Operators should review passenger-evacuation
to use Runway 24. The case is strengthened by the procedures with respect to:
fact that wind measurements are not always reliable
and the wind direction and strength can suddenly – “(Partial) failure of interphone and/or [PA] systems;
change at the last moment. It is also possible for
– “Use of [evacuation] slides under high wind speeds;
[demonstrated crosswind limits and manufacturer’s
[and,]
crosswind] limits to be suddenly exceeded, as
happened in the [accident]. … The runway-allocation – “Further elaboration of the cockpit-crew evacuation
system should adhere to the ICAO’s recommended duties during actual flight safety training.”♦
crosswind limit of 15 knots. …
[Editorial note: This article, except where specifically noted,
“The fact that the pilot switched from automatic pilot was based on the Dutch Transport Safety Board Final Report:
to manual [aircraft control] — and, above all, the 97-75A/A-26, PH-TKC, Boeing 757, 24 December 1997,
altitude at which this took place — played a role in Amsterdam Airport Schiphol. The 144-page report contains
the accident. The manuals only specify a minimum appendixes, diagrams and photographs.]
altitude of 100 feet (approximately 30 meters), which
proved to be too low in the prevailing weather
conditions. Airline companies should include a References
caution in the manuals on the minimum altitude at
which the automatic pilot must be switched off in 1. The report attributed this quotation to Stuart Matthews,
poor weather conditions. … ” chairman, president and CEO, Flight Safety Foundation
(FSF). Second World Congress on Transport Safety. Delft,
The report made the following recommendation to the Netherlands, Feb. 18–20, 1998.
Netherlands Air Traffic Control Agency:
2. The report attributed this statistic to the FSF Approach-
• “In addition to the wind information for landing, ATC and-landing Accident Reduction Task Force analysis of
should provide pilots with the actual tail[wind] and 76 approach-and-landing accidents, as reported in Flight
crosswind components.” Safety Management, Measurement and Margins:
Proceedings of the 11th annual European Aviation Safety
The report made the following recommendation to the Dutch Seminar, Alexandria, Virginia, United States: Flight Safety
Minister of Transport and Public Works: Foundation, 1999.

FLIGHT SAFETY FOUNDATION • ACCIDENT PREVENTION • MARCH 2000 7


Flight Safety Foundation
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S2K: Formula for Safety


(Spreading Safety Know-how)
April 25–27, 2000
To receive agenda and registration information,
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e:mail: pammer@flightsafety.org, tel: +1(703) 739-6700, ext. 109,
or Ann Hill, hill@flightsafety.org, tel: +1(703) 739-6700, ext. 105. Adam’s Mark Hotel
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Join Flight Safety Foundation
For more information, contact Carole Pammer, director of marketing and business development,
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