Accident Boeing 737-322 N388UA,
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Date:Sunday 12 September 1999
Time:08:52 LT
Type:Silhouette image of generic B733 model; specific model in this crash may look slightly different    
Boeing 737-322
Owner/operator:United Airlines
Registration: N388UA
MSN: 24663/1875
Year of manufacture:1990
Total airframe hrs:28364 hours
Engine model:CFMI CFM56-3C-1
Fatalities:Fatalities: 0 / Occupants: 86
Aircraft damage: Substantial
Category:Accident
Location:Los Angeles International Airport, CA (LAX/KLAX) -   United States of America
Phase: Pushback / towing
Nature:Passenger - Scheduled
Departure airport:Los Angeles International Airport, CA (LAX/KLAX)
Destination airport:Oakland, CA (KOAK)
Investigating agency: NTSB
Confidence Rating: Accident investigation report completed and information captured
Narrative:
The flight was being pushed back by a tug when it contacted a lavatory service truck, which had pulled up at the rear of the airplane to service the lavatories. The airline uses one person pushback operations at this station for B737's. Under the procedure, the ground handler will walk around the airplane just before the pushback to ensure that the airplane's path is clear. Once the flight crew gives the clearance, the pushback commences without the aid of wing walkers or other safety observers. The handler assigned to this flight did his walk around after the jetway bridge had been moved back. Once he was cleared by the flight crew he leaned over the tow bar for one last look and then mounted the tractor to start the push. He did not see the lavatory service truck at any time and the lavatory driver did not verbally communicate his presence or intentions. The flight crew turned on the rotating beacon just before the aircraft started to move. During the push the handler felt resistance and stopped just as the lavatory service driver ran to the front of the airplane shouting for him to stop. Three calls had been made for lavatory service on this airplane, the last one 10 minutes prior to departure. The lavatory service driver originally assigned to handle this flight was busy. Another lavatory service driver heard the service request on the radio and responded to the airplane, arriving about 7 minutes prior to departure. When he arrived, the rotating beacon was not on, which signified to him that the pushback was not imminent. He parked his service truck under the tail of the airplane and proceeded to service the aft lavatory just as the airplane began to move and it contacted his truck. The airline's ramp operations manual states, 'Before approaching aircraft to perform last-minute servicing, at or near departure time, always establish positive verbal communication with the pushback tractor driver.'

Probable Cause: The lavatory service driver's failure to follow established company procedures and directives. A factor in the accident was the airline's use of a one person pushback procedure.

Accident investigation:
cover
  
Investigating agency: NTSB
Report number: LAX99LA302
Status: Investigation completed
Duration: 1 year and 2 months
Download report: Final report

Sources:

NTSB LAX99LA302

Location

Revision history:

Date/timeContributorUpdates
08-Mar-2024 12:37 ASN Update Bot Added
08-Mar-2024 12:48 ASN Updated [Operator, Location, Nature, Departure airport, Narrative]

Corrections or additions? ... Edit this accident description

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