# NTSB GAA19CA326: Cessna 172, N1589D, Orlando, FL, June 8, 2019 - Type: NTSB accident investigation - Classification: Accident · No injuries · Data collection · Final report - Date: June 8, 2019, 12:51 local (16:51 UTC) - Place: Orlando, FL - Coordinates: 28.293611, -81.440002 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=28.2936&lon=-81.4400&mi=10 - Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping) - Defining event: [Takeoff: Loss of control on ground](https://openairdocs.org/ntsb-events/230) - Highest injury: No injuries - Injuries: 3 uninjured - Status: Completed, report November 6, 2019 - Report: Approved by Office Director - NTSB office: General Aviation Accidents - Parties: FAA - NTSB case key (mKey): 99583 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=GAA19CA326 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/99583/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=99583 - Page: https://openairdocs.org/ntsb/GAA19CA326 ## Probable cause The student pilot's excessive rudder application during takeoff and the flight instructor's delayed remedial action, which resulted in a loss of directional control, a runway excursion, and subsequent substantial damage. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Performance/control parameters: directional control](https://openairdocs.org/ntsb-findings/01062020): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Cessna 172R, 37 cases](https://openairdocs.org/ntsb-findings/01062020/cases.md?model=2072401), [All aircraft, 3,958 cases](https://openairdocs.org/ntsb-findings/01062020/cases.md) - [Flight control system: rudder control system](https://openairdocs.org/ntsb-findings/01022720): Aircraft › Aircraft systems · Incorrect use/operation (probable cause); cases with it: [Cessna 172R, 1 case](https://openairdocs.org/ntsb-findings/01022720/cases.md?model=2072401), [All aircraft, 93 cases](https://openairdocs.org/ntsb-findings/01022720/cases.md) - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Student/instructed pilot (probable cause); cases with it: [Cessna 172R, 75 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=2072401), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Action: delayed action](https://openairdocs.org/ntsb-findings/02041025): Personnel issues › Action/decision · Instructor/check pilot (probable cause); cases with it: [Cessna 172R, 7 cases](https://openairdocs.org/ntsb-findings/02041025/cases.md?model=2072401), [All aircraft, 894 cases](https://openairdocs.org/ntsb-findings/02041025/cases.md) - [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Student/instructed pilot (probable cause); cases with it: [Cessna 172R, 6 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=2072401), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Takeoff: Loss of control on ground](https://openairdocs.org/ntsb-events/230) (defining event); cases with it: [Cessna 172R, 40 cases](https://openairdocs.org/ntsb-events/230/sequence.md?model=2072401), [All aircraft, 4,585 cases](https://openairdocs.org/ntsb-events/230/sequence.md) - [Takeoff: Attempted remediation/recovery](https://openairdocs.org/ntsb-events/060); cases with it: [Cessna 172R, 10 cases](https://openairdocs.org/ntsb-events/060/sequence.md?model=2072401), [All aircraft, 1,422 cases](https://openairdocs.org/ntsb-events/060/sequence.md) - [Takeoff: Runway excursion](https://openairdocs.org/ntsb-events/300); cases with it: [Cessna 172R, 39 cases](https://openairdocs.org/ntsb-events/300/sequence.md?model=2072401), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) - [Takeoff: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Cessna 172R, 46 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=2072401), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The flight instructor reported that, while the student pilot was practicing soft-field takeoffs, the student added full power and maintained back pressure. He told the student to add right rudder, but the airplane veered left. The instructor told the student to add right rudder again, then the student abruptly added right rudder. The airplane veered right, the instructor attempted to correct, but the airplane exited the runway to the right, and the right wing and right horizontal stabilizer impacted the ground. The airplane sustained substantial damage to the right wing and right horizontal stabilizer. The instructor reported that there were no preaccident mechanical failures or malfunctions with the airplane that would have precluded normal operation. ## Factual narrative The flight instructor reported that, while the student pilot was practicing soft field takeoffs, the student added full power and maintained back pressure. He told the student to add right rudder, but the airplane veered left. The instructor told the student to add right rudder again, then the student abruptly added right rudder. The airplane veered to the right, the instructor attempted to correct, but the airplane exited the runway to the right, and the right wing and right horizontal stabilizer impacted the ground. The airplane sustained substantial damage to the right wing and right horizontal stabilizer. The flight instructor reported that there were no preaccident mechanical failures or malfunctions with the airplane that would have precluded normal operation. ## Aircraft - Registration: [N1589D](https://openairdocs.org/aircraft/N1589D), registered now, S/N 17281255, built 2005 (OpenAirDocs) - Reported make and model: Cessna 172 (R) - Registry model: [Cessna 172R](https://openairdocs.org/model/cessna-172r) (registry code 2072401) (OpenAirDocs) - Registry engine: [Lycoming IO-360-L2A](https://openairdocs.org/engine/lycoming-io-360-l2a) (registry code 41597, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 17281255 - Year built: 2005 - Airframe hours: 4266.7 - Engines: Lycoming IO-360-L2A 160 horsepower reciprocating - Damage: Substantial damage - Flight: Instructional, Part 91 - Operator: Pan Am Ab Initio Training Inc. - Registered owner: Christiansen Aviation Inc - Airworthiness certificate: Standard, Normal - Last inspection: 100 hour, April 12, 2019 - Departed: ISM, ORLANDO, FL - Destination: ISM, ORLANDO, FL - Airport: ISM, Kissimmee Gateway, runway 15, 6,001 × 100 ft, asphalt - Equipment: None ## Flight crew As NTSB recorded them. NTSB leaves out names. - Flight instructor; age 23; injuries: none; commercial, flight instructor; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 3, without waivers/limitations; last flight review October 11, 2018; seat: right; restraint: 3-point; flight hours: 409 total, 244 in this make and model, 325 as pilot in command, 115 in the last 90 days, 47 in the last 30 days, 6 in the last 24 hours - Student pilot; age 24; injuries: none; medical: class 2, with waivers/limitations; seat: left; restraint: 3-point; flight hours: 28 total, 28 in this make and model, 28 in the last 90 days, 16 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 160° at 4 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 84 °F, dew point 75 °F - Altimeter: 29.92 inHg - Observed at: ISM, 1 nm away ## 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 20190608006229A](https://openairdocs.org/incident/20190608006229A), Jun 8, 2019: Cessna 172R, Kissimmee, FL, Substantial damage. On June 8, 2019, at approximately 12.50 local time, a student pilot lost control of N1589D, a Cessna 172R, during a takeoff on runway 15 in Kissimmee, Florida… ## Docket (3 files) The files NTSB released with the investigation on July 18, 2019, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=99583. 4.0 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 3.8 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40474284&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Student Pilot's Statement (item 2, .PDF, 93 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40474285&FileExtension=.PDF&FileName=Student%20Pilot%27s%20Statement-Master.PDF - Accident Photos (item 3, .PDF, 2 photos, 193 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40474286&FileExtension=.PDF&FileName=Accident%20Photos-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. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.