CEN11LA368

NTSB accident investigation · Cessna 152 · Ann Arbor, MI · May 25, 2011

Accident · Serious injuriesLimited investigationFinal report
Date
May 25, 2011, 10:30 local (14:30 UTC)
Place
Ann Arbor, MI
Injuries
1 serious, 1 uninjured; on the ground: 1 serious
Damage
No damage
Phase of flight
Standing
Aircraft
N222UMCessna 152
Defining event
Standing-engine(s) operating: AC/prop/rotor contact w person
Weather
Visual (VMC) · Day
Status
Completed · report November 7, 2012
Report
Approved by Office Director
NTSB office
Central Region
Parties
Federal Aviation Administration
FAA report
20110525030159A
Case key
79288

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The flight instructor’s failure to maintain clearance from the propeller when exiting the airplane. Contributing to the accident were the instructor’s decision not to shut down the engine before exiting the airplane and the operator’s lack of a policy prohibiting any person from entering or exiting an airplane with its engine operating.

Findings · 4

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Action: lack of actionPersonnel issues › Action/decision · Instructor/check pilotCessna 152: 11 casesAll aircraft: 792 casesProbable cause
AircraftAircraft › Aircraft propeller/rotor · Not specifiedCessna 152: 1 caseAll aircraft: 11 casesProbable cause
Policy/procedure: availability of policy/procOrganizational issues › Management · OperatorCessna 152: 1 caseAll aircraft: 28 casesProbable cause
Info processing/decision: decision making/judgmentPersonnel issues › Action/decision · Instructor/check pilotCessna 152: 33 casesAll aircraft: 3,098 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

The flight instructor exited the airplane with the engine operating in preparation for a student pilot to perform his second solo flight. The flight instructor was struck by the rotating propeller as she walked toward the front of the airplane. The flight instructor stated that the operator's flight instructors would typically exit and walk toward the back of an airplane when they were going to have student pilots perform their solo flights. However, instead of walking toward the rear, she walked toward the front where her car was parked. After the accident, the operator adopted a policy prohibiting anyone from entering or exiting an airplane with the engine operating.

Factual narrative

On May 25, 2011, about 1030 eastern daylight time, a Cessna 152, N222UM, was standing with the engine operating when the flight instructor exited the airplane with a student pilot at the controls. The flight instructor was struck by the propeller and sustained serious injuries. The airplane was registered to and operated by University of Michigan Flyers Inc. under the provisions of 14 Code of Federal Regulations Part 91 as an instructional flight. Visual meteorological conditions prevailed at the time of the accident. The instructional flight began about 0800 and was to remain in the traffic pattern of Ann Arbor Regional Airport, Ann Arbor, Michigan. The flight instructor stated she had four hours of sleep before arriving at the airport at 0620 to begin providing flight instruction for the student pilot's second supervised solo flight. She provided ground instruction to the student pilot while waiting for rain showers to clear the area. Once the weather cleared, they began the flight and performed takeoff and landings at the airport. Upon completion of the takeoffs and landings, they taxied to the ramp where the flight instructor exited the airplane with the engine operating. The flight instructor stated that instead of walking toward the rear of the airplane, as would normally be done to allow a student pilot to solo, the flight instructor walked toward her car, which was toward the front of the airplane. The flight instructor held her headset with its cords dangling in her left hand with her jacket and flight bag in her right hand. The headset cord was caught by the moving propeller, turning her into the propeller. The flight instructor stated that the operator's flight instructors would typically have the airplane pointed in the direction that it was going to taxi in for a solo flight. Flight instructors would then exit toward the rear of the airplane with the engine operating. The flight instructor stated that the operator's post accident policy/procedure is to not allow passengers/personnel to enter and/or exit from aircraft with the engine operating. Advisory Circular 91-42D, Hazards of Rotating Propeller and Helicopter Rotor Blades, section 8. Flight Personnel and Flight Instructors, states: a. The engine of a fixed-wing aircraft or a helicopter should be shut down before boarding or deplaning passengers. This is the simplest method of avoiding accidents. Cessna Pilot Safety and Warning Supplement, Potential Hazards, Propellers, states: Pilots can be most effective in ensuring that his or her passengers arrive and depart the vicinity of the airplane safely by stopping the engine(s) completely at the time of loading and unloading, or by providing a definite means of keeping them clear of the propeller if it is left in motion.

Aircraft

Registration
N222UM
Reported as
Cessna 152 (NO SERIES)
Category
Airplane
Serial number
15281063
Airframe hours
18,014
Engine
Lycoming O-235-L2C, 110 horsepower, reciprocating
Damage
No damage
Flight
Instructional · Part 91
Operator
University of Michigan Flyers Inc
Registered owner
University of Michigan Flyers Inc
Airworthiness certificate
Standard, Utility
Last inspection
100 hour · March 26, 2011
Departed
ARB · Ann Arbor, MI
Destination
ARB · Ann Arbor, MI
Airport
ARB · Ann Arbor Municipal Airport

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew · 2

As NTSB recorded them. NTSB leaves out names.

Role
Flight instructor
Age
65
Injuries
Serious
Certificates
Flight instructor, Commercial
Airplane ratings
Multi-engine land, Single-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
November 17, 2010
Seat
Right
Flight hours
5,600 total · 3,000 in this make and model · 5,400 as pilot in command · 109 in the last 90 days · 66 in the last 30 days · 5 in the last 24 hours
Role
Student pilot
Age
27
Injuries
None
Certificate
Student
Medical
Class 3, With waivers/limitations
Seat
Left
Flight hours
29 total · 29 in this make and model · 0 as pilot in command · 29 in the last 90 days · 8 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
60° at 4 knots
Visibility
10 statute miles
Lowest ceiling
1,000 ft broken
Temperature
55 °F, dew point 52 °F
Altimeter
29.87 inHg
Observed at
KARB

Docket · 7

The files NTSB released with the investigation on August 1, 2012, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.9 MB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.

Other investigations on N222UM · 1

Matched to the same aircraft by N-number and date.