The Australian Transport Safety Bureau did not conduct an on
scene investigation of this occurrence.
Sequence of events
On 22 July 2004, the pilot of the Cessna Aircraft Company Titan,
registered VH-ANM, was conducting a charter flight from Goulburn
Island to Darwin with 12 passengers. He tracked the aircraft for
landing at Darwin via a position 5 NM on final approach for runway
29.
The pilot reported that he normally completed his pre-landing
checks when about 5 NM from Darwin. In this instance, that
coincided with the pilot's attempt to fault-analyse a problem with
the aircraft instrument landing system. He reported being
established on final approach for runway 29 at 4.3 NM from
Darwin.
The pilot reported that in order to avoid the expected jet
thrust turbulence from a Mirage fighter, which had been cleared for
takeoff from runway 29, he amended his approach profile to touch
down further along the runway. He reported that consideration and
execution of that amended profile coincided with when he normally
completed his PUFF1
checks. The pilot was subsequently cleared to land on runway 29,
with a requirement to hold short of the crossing runway 36
intersection. Later on final approach, the pilot noted the unusual
nature and content of a radio transmission from the pilot of a
following C-130 Hercules aircraft. Consideration of that radio call
by the pilot coincided with where he normally carried out the last
check of his aircraft configuration in preparation for landing.
The pilot reported that, as he realised that he was 'a bit low'
during the flare for landing, and that the aircraft's wheels should
have contacted the runway, he heard a radio transmission stating
`no gear, no gear, no gear'. The pilot advanced the throttles and
raised the aircraft's nose, but was unable to prevent the aircraft
contacting the runway. Shortly thereafter, the pilot lowered the
landing gear, with the initial intent of landing in the remaining
available runway. The pilot noted 'that he had three
greens2', but after
consideration of the requirement to hold short of runway 36, and of
the remaining runway length, decided to go around for another
landing. The pilot and passengers were not injured.
Damage to the aircraft was confined to the tips of the
propellers, the wing flaps, main landing gear tyres, and the left
rear automatic direction finder antenna. Superficial damage to the
runway surface was identified over a distance of about 11 m,
commencing at about 1,000 m upwind from the landing threshold, and
displaced about 3 m to the left of the runway centreline. That
damage was consistent with a number of propeller tip strikes.
The pilot was appropriately qualified for the operation and
complied with company duty requirements. While the pilot reported
being medically fit for the flight, he indicated a number of
personal and other factors that may have adversely affected his
recent sleeping and eating patterns, to the extent that `he didn't
feel 100% in himself'.
Royal Australian Air Force, Darwin Air Traffic Control personnel
followed published procedures during this occurrence. There was no
evidence that any environmental factors were relevant to the
circumstances of the occurrence.
The pilot reported that the aircraft landing gear operated
normally on the previous landing at Goulburn Island, and on the
second landing at Darwin. In addition, the company chief pilot
reported that, when tested by company engineers after the
occurrence, the landing gear warning horn3 operated normally. The pilot did not
recall hearing the warning horn during the occurrence.
It was likely that the pilot's personal and other problems, and
the resulting interrupted sleeping and eating patterns diminished
the pilot's ability to manage the tasks necessary to prepare the
aircraft for landing. That degradation in performance was
compounded by the in-flight distractions that coincided with when
the pilot would have normally conducted his sequence of pre-landing
actions and checks. The result was that the pilot unwittingly
omitted to lower the aircraft's landing gear.
1 A personal mnemonic applied
by the pilot that checked completion of the actions necessary to
confirm that the aircraft was in the landing configuration,
including: set propeller pitch, undercarriage down, and flaps full
down.
2 Three landing gear position
indicator lights are located just left of centre of the aircraft
instrument panel. Those lights illuminate when each landing gear is
fully extended and locked.
3 The landing gear warning horn
can be independently activated by either the throttle position or
wing flap position switch. That switch activates the horn if the
flaps are lowered past the take-off and approach position, with the
landing gear in any position except extended and locked.