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Garuda Mishap at Yogyakarta Airport

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Garuda Airlines Boeing 747-400 caught fire after overshooting the runway at Yogyakarta airport in Indonesia on March 7.

 

 

Hmmm... a 747-400 thought it was a 737-400 some mistake there

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Hmmm... a 747-400 thought it was a 737-400 some mistake there

 

the general press always ignorant about the facts in their reports...this what makes non-aviation readers confuse

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Candid interview with the DG for Air Transportation.

 

I can only give you examples. We have found that manuals to be used only in classrooms are being used as operation manuals, which is ridiculous. During my inspection, I also found that some female flight attendants lived in cramped boarding houses. How can they work properly if they do not get enough sleep. The same is true for our pilots. Here, pilots are required to follow the wishes of company owners, not the flight manual. A flight simulator should be used by two pilots only, but to cut costs they are used by up to six pilots who are given their certificate after a 70-hour simulation.

 

We will give them three months to improve their performance.

Six pilots in the simulator, all six get their cert after 70 hours of sharing sim training? How can they let these people fly for the next 3 months? Crazy!

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Six pilots in the simulator, all six get their cert after 70 hours of sharing sim training? How can they let these people fly for the next 3 months? Crazy!

Each gets an average of 11 hours sim training. :blink: Go WAY low cost and you get low (poor) quality out of it!! :angry:

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Psychiatrist to scrutinise Garuda tapes

 

Mark Forbes

Herald Correspondent in Jakarta

April 3, 2007

 

A MILITARY psychiatrist will analyse the cockpit conversations of two Garuda pilots in the moments before their plane crashed and burst into flames at Yogyakarta airport, killing 21 people, including five Australians.

 

The psychiatrist and senior pilots began listening to the cockpit recordings yesterday, the chief investigator, Mardjono Siswosuwarno, said.

 

The psychiatrist would help determine if the Garuda pilots were being truthful and study the "human performance" of those involved in the March 7 crash, Mr Siswosuwarno said.

 

The head of Indonesia's Transport Safety Commission, Tatang Kurniadi, yesterday refuted comments featured on the Australian television program Sunday suggesting the pilots were arguing before the crash. Mr Kurniadi claimed he had been misquoted.

 

A preliminary report of the crash would point towards pilot error, Mr Siswosuwarno indicated. The Boeing 737 overshot the runway and burst into flames.

 

"The speed was too high - and not just a little bit - and also the altitude was too high," Mr Siswosuwarno said. "The question is why such an experienced pilot would make such an improper landing."

 

The jet's flaps were not properly extended for landing, although he said the speed of the aircraft could have prevented the pilots lowering them.

 

Mr Siswosuwarno said the co-pilot had suggested aborting the landing seconds before the plane hit the runway, but the suggestion came too late to prevent the crash.

 

All other conversations were unexceptional, he said. "There was no argument, it was normal."

 

Mr Kurniadi said that in his opinion the crash could have been averted but it could not be stated definitely that it was caused by pilot error. "We have to find out more. We are not investigating the case simply to find out who's to blame and bring the person to justice. We are investigating the case in order to prevent the same crash from happening again in the future."

 

Mr Kurniadi yesterday said there was "no quarrel or arguments" in the cockpit.

 

"There was dialogue in the last few minutes. It is true that co-pilot suggested something to the pilot however it was already seconds [before landing] so it was not possible to be executed."

 

 

http://www.smh.com.au/news/world/psychiatr...366158422.html#

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The chief Indonesian investigator Tatang Kurniadi today said the plane's black box recordings show the pilot and co-pilot were involved in an argument over the plane's speed and wing flaps moments before the crash.

 

 

Mr Kurniadi yesterday said there was "no quarrel or arguments" in the cockpit.

 

Look at the word argument(s):

 

This is a contradiction said by the very same man; it will make all his future 'remarks' unreliable :angry:

 

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Look at the word argument(s):

 

This is a contradiction said by the very same man; it will make all his future 'remarks' unreliable :angry:

So my guess is: there probably WAS an argument of some sort. This guy made it public, his boss scolded him for premature commentary, and he came out and deferred, claiming that it was a misquote. :unknw:

 

But as Pieter said, his credibility has gone under.

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Spin doctors hard at work!

 

+++

 

Jakarta Post

April 03, 2007

Foreign media 'got Garuda report wrong'

 

National News - Tuesday, April 03, 2007

 

National Transportation Safety Commission chief Tatang Kurniadi said Monday that foreign media reports quoting him on the causes of the recent deadly Garuda crash in Yogyakarta were misleading.

 

"The Australian media have made their own conclusions," Tatang told The Jakarta Post.

 

Australian media reported that Tatang said the crash was caused by an argument between the co-pilot and pilot of the jetliner just before it crashed on landing at Yogyakarta's Adi Sucipto airport on March 21, killing 23 people.

 

The media reports, which originated on Australian network Channel Nine's Sunday program, quoted Tatang as saying "absent mindedness" on the part of the pilots was behind the crash.

 

Australian media reports had Tatang as saying the Boeing 737-400's cockpit voice recorder -- part of its black box -- showed an argument occurred between the pilot and co-pilot over whether to land the plane or to go around and attempt another landing. The pilot and co-pilot of the plane had never flown together before.

 

The reports also said that Tatang believed that the airplanes flaps -- which are meant to provide lift on slow speed for landing -- did not jam and it would have been possible for the plane to go around. When the plane crashed its flaps were not extended to the position necessary for landing.

 

Tatang confirmed he made the statements on the pilots' "absent mindedness". He also did not back away from his reported statement that the flaps were not jammed.

 

However, Tatang said the Australian reports portrayed his comments as conclusive while investigations were still underway.

 

"The foreign media misinterpreted me. It's not possible that I could make a straight conclusion from the aircraft's cockpit voice recorder alone," he said.

 

The KNKT has said it will conclude its investigation into the crash and produce a preliminary report within two to three weeks.

 

"The fact is that there was an overspeed that produced an overshoot (of the runway)," Tatang was quoted as saying by Detik.com news portal.

 

Expert and KNKT member Mardjono Siswosumarno said both he and Tatang had heard the cockpit conversation.

 

The badly burnt cockpit voice recorder was deciphered by its maker Honeywell in Seattle, Washington state, after the KNKT and the Australian Transport Safety Bureau were unable to retrieve its data. The Australian safety bureau had earlier managed to decipher the flight data recorder, which is the second part of the aircraft's black box.

 

Meanwhile, Transportation Minister Hatta Radjasa said the KNKT had told him that no quarrel occurred in the cockpit between the pilot and co-pilot.

 

Garuda operational director Ari Sapari confirmed that the flight was the first time pilot M. Marwoto and co-pilot Gagam S. Rahman had flown together. However, Ari said this was not a relevant fact to the crash investigation.

 

Garuda pilots always engaged in communication during flight, whether they were an old or new pair, Ari told Detik.com. -- JP

 

http://www.thejakartapost.com/detailnation....H06&irec=5

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410kmh? Still not as fast as the TGV.

 

+++

 

Brisbane Times

 

Jet hit at twice the usual speed

Mark Forbes in Jakarta | April 7, 2007

 

A Garuda Boeing 737 was travelling at 410kmh, nearly double normal landing speed, when it slammed into Yogyakarta Airport's runway last month, bouncing, bursting into flames and killing 21 people, the crash investigators' report says.

 

The confidential report, which Indonesian authorities are trying to suppress, points towards pilot error as the cause of the crash. Aviation experts confirmed speed and flap warnings would have been sounding in the cockpit and the pilot should have aborted the landing and "gone around".

 

The preliminary report of Indonesia's Transport Safety Committee also reveals that:

 

- Yogyakarta's runway does not meet international safety standards. Its safety run-off is only a quarter the recommended length.

 

- The pilots reported a fault in the reverse thrust of one of the engines shortly before take-off.

 

- Cockpit data recordings revealed no mechanical problems before the landing.

 

- The weather was calm, contradicting the pilot's claims of a massive down draught.

 

- There is no evidence of the pilots arguing in the cockpit before the crash.

 

- Fire engines and rescue vehicles were unable to reach the crash site quickly and were not properly equipped.

 

The Indonesian Transport Minister, Hatta Radjasa, has tried to block the release of the "preliminary factual aircraft accident report", insisting that Australian authorities should threaten the families of the five Australian victims with up to two years' jail if they disseminate it.

 

The Herald has obtained a full copy of the document from sources in Jakarta. It contains all the technical details of the crash, but makes no final analysis.

 

It is clear that, having ruled out mechanical faults, investigators are focusing on pilot error and possible charges against Captain Marwoto Komar and his co-pilot, Gagam Rohman.

 

Psychiatrists have been brought into the investigation to analyse why Captain Komar ignored equipment warnings and continued the landing.

 

The report also raises the prospect that the inadequate safety run-off at Yogyakarta Airport and the failure of emergency services to respond quickly could have contributed to the crash and the number of fatalities.

 

Under international safety specifications, the safety run-off at the end of the runway should be 240 metres with a minimum distance of 90 metres. Yogyakarta's safety area is only 60 metres.

 

After bouncing more than a third of the way along the runway, the Boeing 737 did not have the space to stop. It overran the safety area, ploughed through grass and across the airport fence and a road before sliding to a halt in a paddy field 210 metres away.

 

The 737's right wing was torn off as it crossed the road, severing fuel lines that ignited a fire. With front exits destroyed by the impact, most of the 21 who died were trapped near the front of the plane and perished in an "intense, fuel-fed, post impact fire". There were 119 passengers and crew who survived.

 

The report says that the airport rescue and fire fighting service was "unable to gain immediate access to the accident site" because it was outside the airport perimeter and there was no road access.

 

"The equipment used for the application of water/foam was not suitable to reach the wreckage," the report states.

 

According to cockpit recordings and radio transmissions, the conditions were calm and clear for landing, the report says.

 

With the plane approaching at much faster than normal speed, its wing flaps were not set in landing position, investigators found. They were extended only five degrees, when normally they would be set at 30. It is understood investigators found no indication of flap malfunction, but at more than 400 kmh it is considered unsafe to fully deploy the flaps, because they could jam or be ripped off.

 

An aviation consultant, Gerry Soejatman, told the Herald the plane was coming in "way too fast". Recorded warnings of "low gear, low flaps" would have been broadcast in the cockpit, he said. Normal procedure would be to abort the landing.

 

Investigators are examining why the pilot appeared to be incapacitated and ignored the warnings. Although there was no argument between the pilots on the cockpit voice recorder, it is understood the co-pilot suggested a "go-around" seconds before the crash, by which time it was too late.

 

The report states that the plane's flight data recorder demonstrates it "was making the landing approach at a faster than normal speed and the flaps were not configured for landing. The FDR data, and evidence at the accident site, has not indicated any mechanical deficiency with the aircraft."

 

It also reveals that before departure in Jakarta, the pilot contacted ground engineers and informed them that the left engine thrust reverser fault light on the cockpit instrument panel had illuminated. "The engineers reset the thrust reverser in the engine accessories unit and the fault light extinguished," the report states. The plane was then classified airworthy.

 

In their initial recommendations, investigators called for the upgrading of Yogyakarta's runway to meet international standards and a review of the equipment and procedures of airport rescue and firefighting services.

 

The report states that the "investigation is continuing and will include further examination and analysis of the aircraft and the flight and voice recorders. Evidence from the wreckage and the recorders will be examined and analysed, along with flight operations and aircraft records, and this detailed analysis is expected to take months."

 

http://www.brisbanetimes.com.au/news/world...ge#contentSwap1

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Reminds me of the Fokker crash at the old TWU airport in the 90s.

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Brisbane Times

 

Jet hit at twice the usual speed

Mark Forbes in Jakarta | April 7, 2007

...

The confidential report, which Indonesian authorities are trying to suppress, points towards pilot error as the cause of the crash. Aviation experts confirmed speed and flap warnings would have been sounding in the cockpit and the pilot should have aborted the landing and "gone around".

...

The Indonesian Transport Minister, Hatta Radjasa, has tried to block the release of the "preliminary factual aircraft accident report", insisting that Australian authorities should threaten the families of the five Australian victims with up to two years' jail if they disseminate it.

 

+++

http://www.brisbanetimes.com.au/news/world...ge#contentSwap1

 

Clarification from ATSB:

 

Garuda crash report not suppressed: ATSB

April 7, 2007 - 5:19PM

 

A preliminary report into last month's Garuda plane crash in which 21 people died has not been suppressed by Indonesia, Australia's air safety authority says.

...

Fairfax media reported that Indonesian Transport Minister Hatta Radjasa had tried to block the release of the "preliminary factual aircraft incident report".

...

http://www.smh.com.au/news/National/Garuda...5366524674.html

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Speed indicator gone haywire? I mean, twice the speed of approach - the pilots would have picked it up. They had 10 miles out to configure the a/c and make sure everything was okay before landing! This is interesting and I'd certainly read through the investigation report, if I get hold of one...

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Investigator says Indonesian crash plane was flying too fast

 

2007-04-07 HKT 19:04

Investigators probing the crash-landing of an Indonesian airliner a month ago, in which 21 people died, say the plane was flying at up to 425 kilometres per hour - or almost double the normal landing speed when it attempted to touch down at Yogyakarta airport. A preliminary accident report has not yet determined, however, if pilot error caused the Boeing 737-400 to overshoot the runway, skid into a rice field and burst into flames.

 

RTHK ON INTERNET

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I'm afraid it will come to this conclusion.....

 

Botch up the top-of-descend calculation. End up high on descend. Have to charge down to get to profile but build up speed instead. As speed is too high the flap cannot be deployed. An orbit or a go-around will save the situation, but pilots are reluctant to do so as it is an admission of their error. Or pressing on to keep up to schedule.

 

SOP is there but you don't follow SOP to the letter as each flight is different. Experience will tell you how much you can bend the rule, and when to admit defeat and go-around. The chicken lives on to fight another day.

 

Sad..... :(

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Sad indeed. But Radzi, if you said experience will tell you how far you can bend the rules, those two pilots are quite senior in GA aren't they? :unknw:

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Sounds like we'll never get the truth. We definately would have had the ATSB investigated the crash rather than 'assist' in the investigation..

 

Double the normal approach speed and they continued to approach?? That sounds insane and absurd at the same time!

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I'm afraid it will come to this conclusion.....

 

Botch up the top-of-descend calculation. End up high on descend. Have to charge down to get to profile but build up speed instead. As speed is too high the flap cannot be deployed. An orbit or a go-around will save the situation, but pilots are reluctant to do so as it is an admission of their error. Or pressing on to keep up to schedule.

 

SOP is there but you don't follow SOP to the letter as each flight is different. Experience will tell you how much you can bend the rule, and when to admit defeat and go-around. The chicken lives on to fight another day.

 

Sad..... :(

 

Captain,

In this high and fast situation, is orbiting a common practice? I assume got to be above MSA rite?

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Right, you have to be above MSA. Orbiting works if you realized your situation much earlier. Otherwise a go-around is the only solution.

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From The Jakarta Post

April 10, 2007

 

KNKT to release findings on Garuda

 

JAKARTA: The National Transportation Safety Commission (KNKT) will release Wednesday its preliminary findings on a March 7 accident involving a Garuda Indonesia airplane that killed 21 people, including five Australians, according to the commission's spokesperson, J.A. Barata.

 

"The draft of the report has been completed and will be immediately sent to the International Civil Aviation Organization, the aircraft producer (Boeing) and the Australian government," Barata said, as quoted by the detik.com news portal.

 

Barata refused to elaborate further, but previous media reports have indicated that the plane had exceeded the normal speed during landing. -- JP

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Fuel saver theory on Garuda crash

 

Mark Forbes, Jakarta

April 12, 2007

 

A NEW Garuda Airlines policy of limiting fuel use may have influenced a pilot not to abort a Boeing 737 landing in Yogyakarta last month that resulted in 21 deaths, the head of the airline's pilots' association says.

 

Captain Stephanus Geraldus said the jet's pilot, Captain Marwoto Komar, made an "impossible" decision to continue landing at excessive speed.

 

His comments came after The Age revealed details of the preliminary crash investigation report, which found the plane was travelling at more than 400 km/h when Captain Komar hit the runway.

 

"This is a surprise, this is too fast. How could the pilot decide like that?" Captain Stephanus said. "The company is making extra payments to pilots if they can conserve fuel. Maybe this is bothering the pilot."

 

Captain Stephanus, who interviewed Captain Komar soon after the accident, said the pilot should have "gone around" and "there must be some human factor problem".

 

Indonesian officials released the accident report yesterday,after Transport Minister Hatta Radjasa tried to suppress its details.

 

The report finds the plane approached at "faster than normal speed with the flaps not configured for landing" and reveals the runway safety area at Yogyakarta does not meet international standards.

 

It also says fire and rescue vehicles were inadequately equipped and could not reach the scene quickly enough.

 

Several passengers are believed to have been burnt alive while airport fire trucks were unable to reach the jet, which caught fire from a ruptured fuel line soon after overshooting the runway.

 

The report rules out mechanical failure and weather conditions as causes of the crash, which left 21 people dead, including five Australians.

 

The report, by Indonesia's National Transport Safety Commission, calls for runways at major regional airports, including Yogyakarta, to be upgraded.

 

Chief investigator Mardjono Sisowosuwarno said a longer runway would not have prevented the crash as the plane was travelling too fast, "but it could have been less severe".

 

Commission chairman Tatang Kurniadi denied the pilots had argued in the cockpit about the need to abort the landing. He ruled out calling for prosecutions.

 

A separate Indonesian police investigation into the crash is continuing.

 

The report does not include a transcript of the flight's cockpit voice recorder, which is central to the ongoing investigation.

 

However, The Age believes the recording does not support claims that the pilot and co-pilot were arguing about aborting the landing during the plane's descent.

 

Only in the seconds before touchdown did the co-pilot suggest that the jet "go around" and re-attempt the landing.

 

Captain Komar continued to land, despite the jet's computer systems broadcasting warnings during the approach.

 

It is believed the voice recording includes an alarm and aural computerised warnings that sounded "whoop, whoop, pull up".

 

As the plane was travelling more than 160 km/h faster than safe landing speed, its wing flaps could also not be configured for landing.

 

Captain Stephanus said that "there must be some problem, it is not a good decision — there should be a go-around".

 

He said a new Garuda policy to pay pilots a3 per cent bonus if they conserved fuel could hamper flight safety.

 

Garuda did not return calls.

 

http://www.theage.com.au/news/world/fuel-s...5971180204.html

 

===

 

MORE STORIES

 

Probe says Garuda jet descended too fast

 

April 11, 2007 - 10:40PM

 

An Indonesian airliner that crashed at Yogyakarta airport last month killing 21 people, including five Australians, came down too fast and at a sharp angle, preliminary results from a crash investigation show.

 

The chief of the country's Transport Safety Commission said the Garuda Indonesia operated Boeing 737-400 plane bounced and skidded off the runway before bursting into flames.

 

"When the plane was about to land, it looked too high over the runway coming down with a quite high speed," Tatang Kurniadi told a news conference.

...

 

CONTINUE AT http://news.brisbanetimes.com.au/probe-say...074911-71v.html

 

===

 

Fatal Garuda flight went too fast

 

April 12, 2007 12:00

Article from: The Daily Telegraph

 

THE Garuda airliner that crashed in Indonesia last month did not have its wingflaps fully extended and was travelling at double the speed it should have been, a report into the disaster has found.

 

The 21-page preliminary accident report into the March 7 crash of GA-200 makes five safety recommendations and is critical of the safety procedures and safety equipment at the airport.

 

It said the "safety run-off" at the end of the runway was too short and did not meet international standards.

...

 

CONTINUE AT http://www.news.com.au/dailytelegraph/stor...5007132,00.html

 

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