Serious incident Beechcraft 1900D N192GL,
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ASN Wikibase Occurrence # 370388
 
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Date:Saturday 23 August 2003
Time:19:19 LT
Type:Silhouette image of generic B190 model; specific model in this crash may look slightly different    
Beechcraft 1900D
Owner/operator:Great Lakes Aviation
Registration: N192GL
MSN: UE-192
Total airframe hrs:17493 hours
Engine model:Pratt & Whitney PT6A-67D
Fatalities:Fatalities: 0 / Occupants: 16
Aircraft damage: Minor
Category:Serious incident
Location:Denver, CO -   United States of America
Phase: En route
Nature:Unknown
Departure airport:Denver International Airport, CO (DEN/KDEN)
Destination airport:Santa Fe Airport, NM (SAF/KSAF)
Investigating agency: NTSB
Confidence Rating: Accident investigation report completed and information captured
Narrative:
The first officer reported that as part of the first flight of the day, he performed the cabin/cargo door checks. He said, "All checks of the cabin and cargo door circuitry appeared normal." The first officer said that the airstair door operated normally during the three previous flights that day. He reported that on the incident flight, he "did not note any abnormalities as far as the operation/locking of the forward airstair door." He said that the cabin door annunciator light went out as normal after closing and locking the cabin door. He and the captain verified that the doors were closed and the annunciator lights were out. The captain reported that approximately 5 minutes into the flight and passing 8,000 feet msl, the cabin door warning light illuminated. The captain said they ran the checklist, which directed the passengers to ensure their seat belts were fastened. The captain said he directed the first officer to tell approach control that they were returning to the airport. The captain said they did not declare an emergency at that time. The captain said that approximately 2 minutes after the cabin door warning light illuminated, he initiated a 20 to 25 degree bank left turn to take them back to the airport. During the turn, the captain said he heard a pop and the cabin door came open causing damage to the door, doorframe, and left propeller. The captain said they declared an emergency and landed with the cabin door open. An examination of the cabin airstair door showed no anomalies with the locking mechanism and circuitry. An examination of the door sensor to the forward cabin door warning light showed that the door handle could be placed in a position where the door's pressure lock plunger was just engaging the latch plate, but had not dropped into the "keyhole," and the warning light would go out. When moving the handle through the closed position so that the handle could no longer move forward, the pressure lock plunger would fully engage in its "seated position" and the warning light would go out.



Probable Cause: the first officer's improper preflight preparation in failing to ensure the cabin airstair door was fully locked and secure. Factors relating to the incident were the cabin airstair door handle not being fully secure and the forward cabin door warning light not illuminating until the airplane was in flight.

Accident investigation:
cover
  
Investigating agency: NTSB
Report number: DEN03IA147
Status: Investigation completed
Duration: 5 months
Download report: Final report

Sources:

NTSB DEN03IA147

Location

Revision history:

Date/timeContributorUpdates
25-Mar-2024 10:08 ASN Update Bot Added

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