CHI92FA201

NTSB accident investigation · Cessna 172N · St Paul, MN · July 7, 1992

Accident · FatalField investigationFinal report
Date
July 7, 1992, 16:48 local (21:48 UTC)
Place
St Paul, MN
Injuries
4 fatal
Phase of flight
Approach
Aircraft
N6376FCessna 172NN5279RCessna 172M
Weather
Visual (VMC) · Day
Status
Completed · report May 28, 1993
Report
Approved by Office Director
Case key
15297

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

Inadequate visual lookout by the pilots of both airplanes, which resulted in their failure to see-and-avoid conflicting traffic, and failure of the relieving controllers to use the radar display to identify and sequence an airplane entering the pattern. Factors related to the accident were: an inadequate briefing by the off-going controller, and inaccurate position reports by the pilot-in-command of N5279R.

Inadequate visual lookout by the plots of both airplanes, which resulted in their failure to see-and-avoid conflicting traffic, and failure of the relieving controllers to use the radar display to identify and sequence an airplane entering the pattern. Factors related to the accident were: an inadequate briefing by the off-going controller, and inaccurate position reports by the pilot-in-command of N5279R.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Midair collisionApproach - vfr pattern - final approach
Crew/group briefing - inadequateAtc personnel(lcl/gnd/clnc)Factor
Weather condition - haze/smoke
Identification of aircraft visually - not obtainedAtc personnel(lcl/gnd/clnc)
Radio communications - inaccuratePilot of other aircraftFactor
Identification of aircraft on radar - not performedAtc personnel(lcl/gnd/clnc)Cause
Visual lookout - inadequatePilot in command(cfi)Cause
Visual lookout - inadequateDual studentCause
Visual lookout - inadequatePilot of other aircraftCause
In flight collision with terrain/waterDescent - uncontrolled
Midair collisionApproach - vfr pattern - base leg/base to final
Crew/group briefing - inadequateAtc personnel(lcl/gnd/clnc)Factor
Weather condition - haze/smoke
Identification of aircraft visually - not obtainedAtc personnel(lcl/gnd/clnc)
Radio communications - inaccuratePilot in commandFactor
Identification of aircraft on radar - not performedAtc personnel(lcl/gnd/clnc)Cause
Visual lookout - inadequatePilot in commandCause
Visual lookout - inadequatePilot of other aircraftCause
In flight collision with terrain/waterDescent - uncontrolled

Analysis

A student & an instructor (CFI) in Cessna 172, N6376F (76F), were practicing touch-&-go lndgs as Cessna 172, N5279R (79R), was arriving (transporting blood for the red cross). At 1640 CDT, 79R rprtd 7 mi se for lndg. The twr ctlr saw a target in that vcnty (using d-brite radar); he told 79R to enter a left dwnwnd for rwy 12 & rprt 2 mi se. He was relieved at 1643 by a developmental ctlr (DC) & a full performance ctlr (fpc). He briefed them on psns of acft in the pattern & told them 79R (still out of sight) was inbound fm the se, but he didn't show them its psn on radar drg the briefing. At 1644:55, 79R made a call, saying the acft was 'practically straight east of the airport.' 79R never rprtd on dwnwnd, altho told again to do so. The ctlrs were working svrl acft; they neither sighted 79R, nor used radar to find it. At 1647:06, 79R called turning base for rwy 12. At that time, 79R was tracking inside the flt path of 76F, as 76F was in a left turn to final apch for rwy 14. Abt 25 sec ltr, the 2 converged, collided, then crashed to the gnd.

A student & an instructor (CFI) in Cessna 172, N6376F (76F), were practicing touch-&-go lndgs as Cessna 172, N5279R (79R), was arriving (transporting blood for the red cross). At 1640 CDT, 79R rprtd 7 mi se for lndg. The twr ctlr saw a target in that vcnty (using d-brite radar); he told 79R to enter a left dwnwnd for rwy 12 & rprt 2 mi se. He was relieved at 1643 by a developmental ctlr (DC) & a full performance ctlr (fpc). He briefed them on psns of acft in the pattern & told them 79R (still out of sight) was inbound fm the se, but he didn't show them its psn on radar drg the briefing. At 1644:55, 79R made a call, saying the acft was 'practically straight east of the airport.' 79R never rprtd on dwnwnd, altho told again to do so. The ctlrs were working svrl acft; they neither sighted 79R, nor used radar to find it. At 1647:06, 79R called turning base for rwy 12. At that time, 79R was tracking inside the flt path of 76F, as 76F was in a left turn to final apch for rwy 14. Abt 25 sec ltr, the 2 converged, collided, then crashed to the gnd.

Aircraft · 2

Registration
N6376F
Reported as
Cessna 172N
Category
Airplane
Serial number
17273210
Airframe hours
4,658
Engine
Lycoming O-320-H2AD, 160 horsepower, reciprocating
Damage
Destroyed
Flight
Instructional · Part 91
Operator
Wings, Inc.
Registered owner
Wings, Inc.
Airworthiness certificate
Standard, Normal; Standard, Utility
Last inspection
100 hour · May 21, 1992 · 96 hours before
Departed
STP
Destination
STP
Airport
STP · Downtown Holman Field, runway 14, 6,711 × 150 ft, asphalt

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.

Registration
N5279R
Reported as
Cessna 172M
Category
Airplane
Serial number
17263493
Airframe hours
5,262
Engine
Lycoming O-320-E2D, 150 horsepower, reciprocating
Damage
Destroyed
Flight
Part 91
Operator
Clara J. & Arnold R. Johansen
Registered owner
Clara J. & Arnold R. Johansen
Airworthiness certificate
Standard, Normal; Standard, Utility
Last inspection
Annual · August 14, 1992 · 94 hours before
Departed
87D · Dodge Center, MN
Destination
STP · St Paul, MN
Airport
STP · Downtown Holman Field, runway 12, 4,115 × 150 ft, asphalt

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
Pilot, aircraft N6376F
Age
42
Certificates
Commercial, Flight instructor
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Right
Toxicology
Performed
Flight hours
560 total · 300 in this make and model · 495 as pilot in command · 240 in the last 90 days · 80 in the last 30 days · 7 in the last 24 hours
Role
Pilot, aircraft N5279R
Age
77
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 2, Valid Medical--w/ waivers/lim
Seat
Left
Toxicology
Performed
Flight hours
2,226 total · 1,955 as pilot in command · 22 in the last 90 days · 4 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
150° at 5 knots
Visibility
5 statute miles
Lowest ceiling
10,000 ft overcast
Temperature
75 °F, dew point 66 °F
Altimeter
29.00 inHg
Observed at
STP, 1 nm away

FAA reports on this event · 2

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

Other investigations on N6376F · 1

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