DCA00MA006

NTSB accident investigation · Boeing 767-366-ER · Atlantic Ocean (Atlantic Ocean) · October 31, 1999

Accident · FatalClass 1 · MajorFinal report
Date
October 31, 1999, 01:52 local (06:52 UTC)
Place
Atlantic Ocean (Atlantic Ocean)
Injuries
217 fatal
Damage
Destroyed
Aircraft
SUGAPBoeing 767-366-ER
Weather
Visual (VMC) · Night
Status
Completed · report March 25, 2002
Report
Board-adopted at Board Meeting
Investigation class
Class 1
NTSB office
Major Investigations Division
Case key
47655

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 National Transportation Safety Board determines that the probable cause of the EgyptAir flight 990 accident is the airplane's departure from normal cruise flight and subsequent impact with the Atlantic Ocean as a result of the relief first officer's flight control inputs. The reason for the relief first officer's actions was not determined.

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.

Undetermined

Analysis

The Board's full report is available at http://www.ntsb.gov/publictn/publictn.htm.

On October 31, 1999, about 0152 eastern standard time, EgyptAir flight 990, a Boeing 767-366ER, SU-GAP, crashed into the Atlantic Ocean about 60 miles south of Nantucket, Massachusetts. EgyptAir flight 990 was being operated under the provisions of Egyptian Civil Aviation Regulations Part 121 and U.S. 14 Code of Federal Regulations Part 129 as a scheduled, international flight from John F. Kennedy International Airport (JFK), New York, New York, to Cairo International Airport, Cairo, Egypt. The flight departed JFK about 0120, with 4 flight crewmembers, 10 flight attendants, and 203 passengers on board. All 217 people on board were killed, and the airplane was destroyed. Visual meteorological conditions prevailed for the flight, which operated on an instrument flight rules flight plan.

Factual narrative

The Board's full report is available at http://www.ntsb.gov/publictn/publictn.htm.

On October 31, 1999, about 0152 eastern standard time (EST), EgyptAir flight 990, a Boeing 767-366ER (767), SU-GAP, crashed into the Atlantic Ocean about 60 miles south of Nantucket, Massachusetts. EgyptAir flight 990 was being operated under the provisions of Egyptian Civil Aviation Regulations (ECAR) Part 121 and U.S. 14 Code of Federal Regulations Part 129 as a scheduled, international flight from John F. Kennedy International Airport (JFK), New York, New York, to Cairo International Airport, Cairo, Egypt. The flight departed JFK about 0120, with 4 flight crewmembers, 10 flight attendants, and 203 passengers on board. All 217 people on board were killed, and the airplane was destroyed. Visual meteorological conditions prevailed for the flight, which operated on an instrument flight rules (IFR) flight plan.

On October 30, 1999, the accident airplane departed Los Angeles International Airport (LAX), Los Angeles, California, as EgyptAir flight 990, destined for Cairo, with a scheduled intermediate stop at JFK. EgyptAir flight 990 landed at JFK about 2348 eastern daylight time (EDT) and arrived at the gate about 0010 EDT on October 31, 1999.

Because of the 10-hour scheduled en route flight time from JFK to Cairo, ECAR Part 121, Subpart Q, required that the accident flight have two designated flight crews (each crew consisting of a captain and first officer). According to the EgyptAir flight dispatcher who accompanied the two accident flight crews from their hotel in New York City to the airport, they departed the hotel about 2330 EDT on October 30 and arrived at JFK about 40 minutes later, about the same time as the airplane, inbound from LAX, arrived at the terminal gate.

According to air traffic control (ATC) records, by 0101, the pilots of EgyptAir flight 990 had requested, received, and correctly read back an IFR clearance from ATC. ATC transcripts further indicated that between about 0112 and 0116, air traffic controllers issued a series of taxi instructions to EgyptAir flight 990. At 0117:56, the pilots advised the local controller that they were holding short of the departure runway (runway 22 right [22R]) and that they were ready for takeoff. The local controller instructed EgyptAir flight 990 to taxi into position and hold on runway 22R and, at 0119:22, cleared the accident flight for takeoff. The first officer acknowledged the takeoff clearance, and, about 0120, the airplane lifted off runway 22R.

Shortly after liftoff, the pilots of EgyptAir flight 990 contacted New York Terminal Radar Approach (and departure) Control (TRACON). New York TRACON issued a series of climb instructions and, at 0126:04, instructed the flight to climb to flight level (FL) 230 and contact New York Air Route Traffic Control Center (ARTCC). According to ATC and cockpit voice recorder (CVR) records, at 0135:52, New York ARTCC instructed EgyptAir flight 990 to climb to FL 330 and proceed directly to DOVEY intersection.

According to the CVR transcript, about 0140 (20 minutes after takeoff), as the airplane was climbing to its assigned altitude, the relief first officer suggested that he relieve the command first officer at the controls, stating, "I'm not going to sleep at all. I might come and sit for two hours, and then…," indicating that he wanted to fly his portion of the trip at that time. The command first officer stated, "But I…I slept. I slept," and the relief first officer stated, "You mean you're not going to get up? You will get up, go and get some rest and come back." The command first officer then stated, "You should have told me, you should have told me this, Captain [relief first officer's surname]. You should have said, '[command first officer's first name]…I will work first.' Just leave me a message. Now I am going to sit beside you. I mean, now, I'll sit by you on the seat. I am not sleepy. Take your time sleeping and when you wake up, whenever you wake up, come back, Captain."

The relief first officer then stated, "I'll come either way…come work the last few hours, and that's all." The command first officer responded, "No…that's not the point, it's not like that, if you want to sit here, there's no problem." The relief first officer stated, "I'll come back to you, I mean, I will eat and come back, all right?" The command first officer responded, "Fine, look here, sir. Why don't you come so that…you want them to bring your dinner here, and I'll go to sleep [in the cabin]?" The relief first officer stated, "That's good." The command first officer then stated to the command captain, "With your permission, Captain?"

At 0140:56, the CVR recorded the sound of the cockpit door operating. About 1 second later, the command first officer stated in a soft voice, "Do you see how he does whatever he pleases?" At 0141:09, the command first officer stated, "No, he does whatever he pleases. Some days he doesn't work at all." At 0141:51, the CVR again recorded the sound of the cockpit door operating. Sounds recorded during the next minute by the CVR (including a whirring sound similar to an electric seat motor operating, a clicking sound similar to a seat belt operating, and some conversation) indicated that the command first officer vacated and the relief first officer moved into the first officer's seat.

Flight data recorder (FDR) and radar data indicated that the airplane leveled at its assigned altitude of FL 330 at 0144:27. At 0147:19, New York ARTCC instructed EgyptAir flight 990 to change radio frequencies for better communication coverage. The command captain of EgyptAir flight 990 acknowledged and reported on the new frequency at 0147:39.

At 0147:55, the relief first officer stated, "Look, here's the new first officer's pen. Give it to him please. God spare you," and, at 0147:58, someone responded, "yeah." At 0148:03, the command captain stated, "Excuse me, [nickname for relief first officer], while I take a quick trip to the toilet…before it gets crowded. While they are eating, and I'll be back to you." While the command captain was speaking, the relief first officer responded, "Go ahead please," and the CVR recorded the sound of an electric seat motor as the captain maneuvered to leave his seat and the cockpit. At 0148:18.55, the CVR recorded a sound similar to the cockpit door operating.

At 0148:30, about 11 seconds after the captain left the cockpit, the CVR recorded an unintelligible comment. Ten seconds later (about 0148:40), the relief first officer stated quietly, "I rely on God." There were no sounds or events recorded by the flight recorders that would indicate that an airplane anomaly or other unusual circumstance preceded the relief first officer's statement, "I rely on God."

At 0149:18, the CVR recorded the sound of an electric seat motor. FDR data indicated that, at 0149:45 (27 seconds later), the autopilot was disconnected. Aside from the very slight movement of both elevators (the left elevator moved from about a 0.7 to about a 0.5 degree nose-up deflection, and the right elevator moved from about a 0.35 degree nose?up to about a 0.3 degree nose-down deflection) and the airplane's corresponding slight nose-down pitch change, which were recorded within the first second after autopilot disconnect, and a very slow (0.5 degree per second) left roll rate, the airplane remained essentially in level flight about FL 330 for about 8 seconds after the autopilot was disconnected. At 0149:48, the relief first officer again stated quietly, "I rely on God." At 0149:53, the throttle levers were moved from their cruise power setting to idle, and, at 0149:54, the FDR recorded an abrupt nose-down elevator movement and a very slight movement of the inboard ailerons. Subsequently, the airplane began to rapidly pitch nose down and descend.

Between 0

Aircraft

Registration
SUGAP
Reported as
Boeing 767-366-ER
Category
Airplane
Serial number
24542
Airframe hours
33,354
Engine
P&W 4060, turbo fan
Damage
Destroyed
Flight
Part 129
Registered owner
Egyptair
Airworthiness certificate
Standard, Transport
Last inspection
Continuous airworthiness · October 4, 1999 · 214 hours before
Departed
JFK · New York, NY
Destination
HECA · Cairo
Flight plan
IFR

Flight crew · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
57
Injuries
Fatal
Certificate
Airline transport
Medical
Unknown, Valid Medical--w/ waivers/lim
Flight hours
14,384 total · 6,356 in this make and model
Role
Other flight crew
Age
59
Injuries
Fatal
Certificate
Commercial
Medical
Unknown, Valid Medical--w/ waivers/lim
Seat
Right
Flight hours
12,538 total · 5,191 in this make and model

Weather

Conditions
Visual (VMC) · Night
Wind
170° at 9 knots
Visibility
9 statute miles
Lowest ceiling
None
Temperature
55 °F, dew point 52 °F
Altimeter
30.38 inHg
Observed at
NAN, 120 nm away

Docket · 169

The files NTSB released with the investigation on August 15, 2000, on NTSB’s docket system: statements, records, photos and specialists’ reports.

Operations 2-group chairman factual reportItem 1 · PDF · 84 pages · 1.3 MBOperations 2-addendum 1Item 2 · PDF · 44 pages · 1.4 MBOperations 2-addendum 2Item 3 · PDF · 177 pages · 45.2 MBOperations 2-addendum 3Item 4 · PDF · 7 pages · 574 KBOperations 2-egyptian delegation comments on operational factors group addendum 3Item 5 · PDF · 3 pages · 50 KBATC 3-group chairman factual reportItem 6 · PDF · 10 pages · 51 KBATC 3-attachment aItem 7 · PDF · 54 pages · 1.4 MBATC 3-attachment bItem 8 · PDF · 3 pages · 310 KBATC 3-attachment cItem 9 · PDF · 2 pages · 103 KBATC 3-attachment dItem 10 · PDF · 2 pages · 131 KBATC 3-attachment eItem 11 · PDF · 17 pages · 728 KBATC 3-attachment fItem 12 · PDF · 2 pages · 534 KBATC 3-attachment gItem 13 · PDF · 2 pages · 161 KBATC 3-attachment hItem 14 · PDF · 1 page · 126 KBATC 3-attachment IItem 15 · PDF · 1 page · 304 KBATC 3-attachment jItem 16 · PDF · 3 pages · 179 KBATC 3-attachment kItem 17 · PDF · 284 pages · 466 KBATC 3-attachment lItem 18 · PDF · 6 pages · 128 KBATC 3-attachment mItem 19 · PDF · 12 pages · 254 KBATC 3-attachment nItem 20 · PDF · 32 pages · 903 KBATC 3-addendum 1Item 21 · PDF · 3 pages · 41 KBATC 3-addendum 2Item 22 · PDF · 1 page · 30 KBATC 3-letter from egyptian civil aviation to FAAItem 23 · PDF · 4 pages · 107 KBATC 3-comments from egyptian delegation on air traffic control group reportItem 24 · PDF · 40 pages · 2.9 MBMeteorology 5-group chairman factual reportItem 25 · PDF · 6 pages · 206 KBMeteorology 5-attachment 1Item 26 · PDF · 3 pages · 488 KBMeteorology 5-attachment 2Item 27 · PDF · 1 page · 250 KBMeteorology 5-attachment 3Item 28 · PDF · 1 page · 275 KBMeteorology 5-attachment 4Item 29 · PDF · 1 page · 292 KBMeteorology 5-attachment 5Item 30 · PDF · 1 page · 293 KBMeteorology 5-attachment 6Item 31 · PDF · 1 page · 273 KBMeteorology 5-attachment 7Item 32 · PDF · 1 page · 283 KBMeteorology 5-attachment 8Item 33 · PDF · 1 page · 197 KBMeteorology 5-attachment 9Item 34 · PDF · 1 page · 207 KBMeteorology 5-attachment 10Item 35 · PDF · 1 page · 235 KBMeteorology 5-attachment 11Item 36 · PDF · 1 page · 224 KBStructures 7-group chairman factual reportItem 37 · PDF · 21 pages · 73 KBStructures 7-appendix a-major assembly breakdownItem 38 · PDF · 2 pages · 64 KBStructures 7-appendix b-hangar lay outItem 39 · PDF · 2 pages · 20 KBStructures 7-appendix c-fuselage stationsItem 40 · PDF · 2 pages · 108 KBStructures 7-appendix d-wing stationsItem 41 · PDF · 2 pages · 99 KBStructures 7-appendix e-engine pylon diagramItem 42 · PDF · 2 pages · 61 KBStructures 7-appendix f-horizontal stabilizer stationsItem 43 · PDF · 2 pages · 100 KBStructures 7-appendix g-vertical fin stationsItem 44 · PDF · 2 pages · 85 KBStructures 7-appendix H-27 photographsItem 45 · PDF · 15 pages · 4.7 MBStructures 7-appendix i-tablesItem 46 · PDF · 2 pages · 24 KBStructures 7-group chairman factual report-addendum 1Item 47 · PDF · 4 pages · 34 KBStructures 7-group chairman factual report-addendum 1-appendix A-11 photo'sItem 48 · PDF · 7 pages · 11 photos · 1.4 MBPowerplants 8-group chairman factual reportItem 49 · PDF · 20 pages · 71 KBPowerplants 8-appendix 1-photographsItem 50 · PDF · 17 pages · 29 photos · 5.0 MBPowerplants 8-appendix 2-egyptair engineering section's life limited component list for PW4060 engine sn 724127Item 51 · PDF · 1 page · 210 KBPowerplants 8-appendix 3-materials laboratory report 00-030Item 52 · PDF · 7 pages · 164 KBPowerplants 8-appendix 4-saybolt laboratory results of testing jfk fuelItem 53 · PDF · 1 page · 37 KBPowerplants 8-appendix 5-core laboratory results of testing lax fuelItem 54 · PDF · 1 page · 53 KBPowerplants 8-appendix 6-Boeing letter regarding engine fuel flow FDR dataItem 55 · PDF · 5 pages · 271 KBPowerplants 8-appendix 7-P-W letter regarding effects of negative-g operation on PW4060 engine and copy of type certItem 56 · PDF · 7 pages · 227 KBPowerplants 8-appendix 8-Boeing data sheet on results of 767-PW4000 negative-g flight testItem 57 · PDF · 1 page · 91 KBPowerplants 8-comments from egyptian delegation on powerplants group factual reportItem 58 · PDF · 3 pages · 74 KBPowerplants 8-letter from pratt-whitney regarding clarification on electronic engine control channel switchoverItem 59 · PDF · 3 pages · 157 KBSystems 9-group chairman factual reportItem 60 · PDF · 20 pages · 64 KB
All 169 files on NTSB’s docket