Serious incident Dornier 328-110 HB-AES,
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ASN Wikibase Occurrence # 169841
 
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Date:Saturday 2 June 2012
Time:10:24 UTC
Type:Silhouette image of generic D328 model; specific model in this crash may look slightly different    
Dornier 328-110
Owner/operator:SkyWork Airlines
Registration: HB-AES
MSN: 3021
Year of manufacture:1995
Fatalities:Fatalities: 0 / Occupants:
Aircraft damage: None
Category:Serious incident
Location:Bern-Belp Airport (LSZB) -   Switzerland
Phase: Take off
Nature:Passenger - Scheduled
Departure airport:Bern-Belp (LSZB)
Destination airport:Belgrade (LYBE)
Investigating agency: SUST
Confidence Rating: Accident investigation report completed and information captured
Narrative:
On 2 June 2012 the pilot of a Mountain Flyers 80 Ltd Robinson R44 helicopter, HB-ZSA, reported at 10:21:54 UTC to Bern-Belp aerodrome control that he was ready for take-off on helipad 1 and requested an 'around the tower' departure. Air traffic control then immediately gave an instruction to take off under the pilot's own responsibility (departure approved own discretion) via taxiway (TWY) KILO 'around the tower' in the direction of departure point HOTEL.
Approximately one minute later, at 10:23:26 UTC, the crew of a SkyWork Airlines Dornier 328-100 aircraft, flight SRK700, received take-off clearance after they had backtracked to the take-off point behind a preceding departure from runway 32.
The take-off of the helicopter took place along TWY KILO. A Helvetic Airways Fokker 100 was waiting at the CHARLIE intersection. The helicopter turned right, flew around the Fokker 100 to the north-east and then turned back onto the original departure axis. This resulted in a flight path converging with the centre line of runway 32. A hazardous convergence with SRK700, taking off on runway 32, occurred, with a high risk of collision.
Before aerodrome control could give an avoidance instruction to the pilot of HB-ZSA, the latter had already turned away to the right.
The lateral distance between the two aircraft at the closest point of approach at approximately the same altitude was determined with the help of estimates to be approximately 80 to 100 metres.

Causes:
The serious incident is attributable to the fact that aerodrome control gave take-off clearance to a commercial aircraft on runway 32 without ascertaining the position of the helicopter which the controller had cleared to depart at its own discretion shortly before. The result was that a hazardous convergence with a high risk of collision occurred between these aircraft.
The following factors contributed to the occurrence of the serious incident:
- The absence of a defined final approach and take-off area (FATO) for helicopter operations.
- The absence of specified departure routes to departure points HE, H and HW.

The following factor was determined as neither causal nor contributory, but was acknowledged in the context of the investigation as a risk factor:
The checklists for operation of the Dornier 328-100 commercial aircraft unnecessarily occupy crews' attention, because the latter have to perform checklist points during taxiing which could be carried out before taxiing.

Accident investigation:
cover
  
Investigating agency: SUST
Report number: 
Status: Investigation completed
Duration: 2 years and 3 months
Download report: Final report

Sources:

http://www.sust.admin.ch/pdfs/AV-airprox/2202_e.pdf

Images:


Approximate flight path of HB-ZSA (dashed, red) and SRK700 (yellow); the red dotted representation of the flight path corresponds to the expectations of the air traffic controller

Revision history:

Date/timeContributorUpdates
14-Sep-2014 19:26 harro Added
17-May-2022 16:52 harro Updated

Corrections or additions? ... Edit this accident description

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