ASN Wikibase Occurrence # 317425
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| Date: | Monday 17 December 2007 |
| Time: | |
| Type: |  Airbus A320-232 |
| Owner/operator: | TAM Linhas Aéreas |
| Registration: | PR-MBB |
| MSN: | 2737 |
| Year of manufacture: | 2006 |
| Engine model: | IAE V2527-A5 |
| Fatalities: | Fatalities: 0 / Occupants: 74 |
| Aircraft damage: | None |
| Category: | Serious incident |
| Location: | near Natal, RN -
 Brazil
|
| Phase: | En route |
| Nature: | Passenger - Non-Scheduled/charter/Air Taxi |
| Departure airport: | Natal-Augusto Severo International Airport, RN (NAT/SBNT) |
| Brasília-Presidente Juscelino Kubitschek International Airport, DF (BSB/SBBR) | |
| Investigating agency: | CENIPA |
| Confidence Rating: |  Accident investigation report completed and information captured |
TAM Linhas Aéreas flight JJ 3371, an Airbus A320-232 had just reached the intended cruise level (FL 380) when the pilots initially noticed an uncommanded reduction in speed, followed by the perception of the loss of power in both engines of the aircraft, as well as the electrical system, due to the disconnection of the two generators.
The pilots carried out the procedures to restart the engines (with the aircraft in descent), succeeding, after losing approximately 6,000 feet of altitude.
The aircraft returned to SBNT and landed safely. There was no damage to the aircraft and no injuries to crew and passengers.
Contributing factors
Concerning the operation of the aircraft
a) Cockpit coordination - contributed.
The pilots' coordination of the aircraft checks was inadequate as it allowed the aircraft to depart, take-off and climb with all fuel pumps switched off.
b) Pilot forgetfulness - contributed.
Failure to activate the fuel pumps before starting the engines caused the engines to lose power due to lack of fuel pressure when flight level 380 was reached.
c) Low pilot experience - undetermined.
It may have influenced the co-pilot's failure to notice the fuel pump off alert during the first engine start.
d) Management oversight - contributed.
The air activity supervision process did not notice the occurrence of forgetfulness related to the activation of the fuel pumps, thus failing to implement corrective measures. The maintenance of the captain at the aircraft door to welcome passengers moments before the flight concentrated the tasks on the copilot, thus reducing the chances of detecting and correcting possible errors.
Concerning the aircraft
a) Design - undetermined.
The lack of a specific check item for the fuel pumps in the "before pushback or start" check or in the subsequent checks until the climb into flight may have influenced the forgetting to turn on the pumps, since the OEB 178/2 bulletin provided for their shutdown before refueling and the only item that provided for the check of connected pumps was in the "cockpit preparation".
The inhibition of the pumps off alarm at the start of the second engine, since canceled by the pilots at the first start, may also have influenced the lack of perception regarding the situation of the pumps, since the start situation with these turned off remained, but there was no alarm.
Accident investigation:
 |
|
Sources:
I-099/CENIPA/2012
Revision history:
| Date/time | Contributor | Updates |
|---|---|---|
| 15-Jul-2023 07:11 | harro | Updated |
Corrections or additions? ... Edit this accident description
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