# NTSB ERA13CA350: Cessna 172S, N645PD, Portsmouth, NH, August 3, 2013

- Type: NTSB accident investigation
- Classification: Accident · No injuries · Data collection · Final report
- Date: August 2, 2013, 23:20 local (Aug 3, 2013, 03:20 UTC)
- Place: Portsmouth, NH
- Coordinates: 43.077777, -70.823059 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=43.0778&lon=-70.8231&mi=10
- Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping)
- Defining event: [Initial climb: Loss of control in flight](https://openairdocs.org/ntsb-events/240)
- Highest injury: No injuries
- Injuries: 2 uninjured
- Status: Completed, report September 12, 2013
- Report: Approved by Office Director
- NTSB office: Eastern Region Aviation
- Parties: FAA/FSDO
- NTSB case key (mKey): 87686
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA13CA350
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/87686/pdf
- NTSB docket: https://data.ntsb.gov/Docket?ProjectID=87686
- Page: https://openairdocs.org/ntsb/ERA13CA350

## Probable cause

The pilot’s inadequate preflight inspection resulting in his failure to remove the pin he used to lock the flight controls in place of the approved control lock.

## Findings

NTSB's coded findings; those marked are part of the probable cause.

- [Flight control system: gust lock or damper](https://openairdocs.org/ntsb-findings/01022770): Aircraft › Aircraft systems · Inadequate inspection (probable cause); cases with it: [Cessna 172S, 1 case](https://openairdocs.org/ntsb-findings/01022770/cases.md?model=2072439), [All aircraft, 14 cases](https://openairdocs.org/ntsb-findings/01022770/cases.md)
- [Inspection: preflight inspection](https://openairdocs.org/ntsb-findings/02061510): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Cessna 172S, 2 cases](https://openairdocs.org/ntsb-findings/02061510/cases.md?model=2072439), [All aircraft, 551 cases](https://openairdocs.org/ntsb-findings/02061510/cases.md)

## Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event best describes what happened.

- [Prior to flight: Preflight or dispatch event](https://openairdocs.org/ntsb-events/030); cases with it: [Cessna 172S, 6 cases](https://openairdocs.org/ntsb-events/030/sequence.md?model=2072439), [All aircraft, 355 cases](https://openairdocs.org/ntsb-events/030/sequence.md)
- [Initial climb: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [Cessna 172S, 49 cases](https://openairdocs.org/ntsb-events/240/sequence.md?model=2072439), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md)
- [Uncontrolled descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Cessna 172S, 118 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=2072439), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md)

## Analysis

The pilot stated that in preparation for a night flight, he flew earlier that same evening. He inspected the airplane and noted the control lock was not installed in the control column. While searching for the control lock he located a “straight pin” in a seatback pocket and installed it. He left the airport and returned later than evening, and performed a preflight inspection of the airplane removing the straight pin. He departed and flew to his destination airport where he landed uneventfully. After landing he went to a fixed base operator and filed a flight plan for the return flight, then returned to the airplane and started the engine. He taxied to the run-up area of runway 34 where he performed the before takeoff checklist but did not check that the flight controls were free and clear for fear of having his tablet knocked off the yoke mount. He advised the controller that he was ready for departure and was cleared for takeoff. He taxied onto the runway and applied power noting the airspeed increased normally. After the airplane rotated it climbed to an altitude of about 3 feet and settled back down on the runway and bounced. Confused as to what was occurring, he added nose up trim to assist in the climb. At this point the airplane climbed to about 10 feet, then the nose pitched downward and the nose wheel struck the runway. After coming to a stop he switched the headlamp he was wearing from red to white and noticed the pin used to secure the flight controls was in the control lock hole. He removed the pin and retained possession of it. Post accident inspection of the airplane by a FAA inspector revealed substantial damage to the firewall.

## Factual narrative

The pilot stated that in preparation for a night flew earlier that same evening, he inspected the airplane and noted the control lock was not installed in the control column. While searching for the control lock he located a “straight pin” in a seatback pocket and installed it. He left the airport and returned later than evening, and performed a preflight inspection of the airplane removing the straight pin. He departed and flew to his destination airport where he landed uneventfully. After landing he went to a fixed base operator and filed a flight plan for the return flight, then returned to the airplane and started the engine. He taxied to the run-up area of runway 34 where he performed the before takeoff checklist but did not check that the flight controls were free and clear for fear of having his tablet knocked off the yoke mount. He advised the controller that he was ready for departure and was cleared for takeoff. He taxied onto the runway and applied power noting the airspeed increased normally. After the airplane rotated it climbed to an altitude of about 3 feet and settled back down on the runway and bounced. Confused as to what was occurring, he added nose up trim to assist in the climb. At this point the airplane climbed to about 10 feet, then the nose pitched downward and the nose wheel struck the runway. After coming to a stop he switched the headlamp he was wearing from red to white and noticed the pin used to secure the flight controls was in the control lock hole. He removed the pin and retained possession of it. Post accident inspection of the airplane by a FAA inspector revealed substantial damage to the firewall.

## Aircraft

- Registration: [N645PD](https://openairdocs.org/aircraft/N645PD), registered now, S/N 172S8644, built 2000 (OpenAirDocs)
- Reported make and model: CESSNA 172S
- Registry model: [Cessna 172S](https://openairdocs.org/model/cessna-172s) (registry code 2072439) (OpenAirDocs)
- Registry engine: [Lycoming I0360 SER A&C](https://openairdocs.org/engine/lycoming-i0360-ser-a-c) (registry code 41511, reciprocating) (OpenAirDocs)
- Category: Airplane
- Serial number: 172S8644
- Airframe hours: 5398
- Engines: LYCOMING I0-360-L2A 180 horsepower reciprocating
- Damage: Substantial damage
- Flight: Personal, Part 91
- Operator: Westfield Flight Academy
- Registered owner: Climb On LLC
- Airworthiness certificate: Standard, Normal
- Last inspection: 100 hour, June 19, 2013, 59 hours before
- Departed: PSM, Portsmouth, NH
- Destination: BAF, Westfield, ME
- Flight plan: IFR
- Airport: PSM, Portsmouth Intn'l Airport, runway 34, 11,321 × 150 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 33; injuries: none; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, without waivers/limitations; last flight review March 21, 2013; seat: left; flight hours: 204 total, 149 in this make and model, 108 as pilot in command, 13 in the last 90 days, 6 in the last 30 days

## Weather

- Conditions: Visual (VMC), Night
- Wind: 230° at 3 knots
- Visibility: 10 statute miles
- Lowest ceiling: 12,000 ft overcast
- Temperature: 68 °F, dew point 57 °F
- Altimeter: 29.82 inHg
- Observed at: PSM

## FAA reports on this event (1)

The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs).

- [Accident 20130803016509A](https://openairdocs.org/incident/20130803016509A), Aug 3, 2013: Cessna 172S, Portsmouth, NH, Substantial damage. Pilot while on take off roll heard a continuous thud or bouncing sound. Pilot decided to take off. Pilot stated that after rotation, he climbed to 10FT. At…

## Docket (9 files)

The files NTSB released with the investigation on September 4, 2013, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=87686. 4.8 MB in all.

- Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 1.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40398457&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF
- Record of NTSB Conversations (item 2, .PDF, 157 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40399708&FileExtension=.PDF&FileName=Record%20of%20NTSB%20Conversations-Redacted.PDF
- Weather Reports and Records (item 3, .PDF, 187 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40398455&FileExtension=.PDF&FileName=Weather%20Reports%20and%20Records-Master.PDF
- Cessna 172S Preflight and Before Takeoff Checklists (item 4, .PDF, 842 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40399494&FileExtension=.PDF&FileName=Cessna%20172S%20Preflight%20and%20Before%20Takeoff%20Checklists-Master.PDF
- Photograph 1: Forward View of Aircraft at Accident Site (Courtesy of FAA) (item 5, .PDF, 345 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40398458&FileExtension=.PDF&FileName=Photograph%201%3A%20Forward%20View%20of%20Aircraft%20at%20Accident%20Site%20(Courtesy%20of%20FAA)-Master.PDF
- Photograph 2: View of Airplane Cowling from Right Side (Courtesy of FAA) (item 6, .PDF, 514 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40398459&FileExtension=.PDF&FileName=Photograph%202%3A%20View%20of%20Airplane%20Cowling%20from%20Right%20Side%20(Courtesy%20of%20FAA)-Master.PDF
- Photograph 3: View of Aircraft Firewall (Courtesy of Port City Aviation) (item 7, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40399588&FileExtension=.PDF&FileName=Photograph%203%3A%20View%20of%20Aircraft%20Firewall%20(Courtesy%20of%20Port%20City%20Aviation)-Master.PDF
- Photograph 4: Photograph Provided by the Pilot's Attorney. Picture of Pin Used by the Pilot-In-Command as Control Lock (item 8, .PDF, 226 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40399981&FileExtension=.PDF&FileName=Photograph%204%3A%20Photograph%20Provided%20by%20the%20Pilot%27s%20Attorney.%20Picture%20of%20Pin%20Used%20by%20the%20Pilot-In-Command%20as%20Control%20Lock-Master.PDF
- Photograph 5: Digital Image Provided by Cessna Aircraft Company Investigative Personnel. View of a Correct Control Column Lock for Cessna 172S. (item 9, .PDF, 161 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40400058&FileExtension=.PDF&FileName=Photograph%205%3A%20Digital%20Image%20Provided%20by%20Cessna%20Aircraft%20Company%20Investigative%20Personnel.%20View%20of%20a%20Correct%20Control%20Column%20Lock%20for%20Cessna%20172S.-Master.PDF

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

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