- Date
- September 15, 2019, 10:00 local (15:00 UTC)
- Place
- Kennett, MO
- Injuries
- 2 uninjured
- Damage
- Substantial damage
- Phase of flight
- Prior to flight
- Aircraft
- N4584NCessna L19
- Defining event
- Prior to flight: Aircraft servicing event
- Weather
- Visual (VMC) · Day
- Status
- Completed · report March 17, 2020
- Report
- Approved by Office Director
- NTSB office
- General Aviation Accidents
- Parties
- FAA
- FAA report
- 20190915013159A
- Case key
- 100274
From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.
On this page
Probable cause
The pilot's failure to install the engine oil filler cap before the first flight of the day; his subsequent failure to conduct a preflight check before the accident flight, which resulted in his failure to note that the cap was not installed; and his improper landing flare during a precautionary landing, which resulted in a bounced landing and ground loop.
Findings · 5
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.
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 pilot reported that, during takeoff for the accident flight, which was the second flight of the day, he saw that the oil pressure was falling and realized it was likely due to his failure to install the engine oil filler cap after checking the oil during the first flight of the day. He did not conduct a preflight checklist before the accident flight. He subsequently made a precautionary landing at a nearby airport. During the landing, the airplane bounced, and the landing gear collapsed. The airplane bounced again, skidded off the right side of the runway, and ground looped. The left wing struck the ground before the airplane stopped. The airplane sustained substantial damage to the main rotor blades. The pilot reported that there were no preaccident mechanical failures or malfunctions with the airplane that would have precluded normal operation.
Factual narrative
The pilot in the tailwheel-equipped airplane reported that, during post-flight maintenance he left the oil filler cap off. Subsequently, during takeoff, he realized that the oil filler cap was not installed. The pilot noticed a decrease in oil pressure and made a precautionary landing at a nearby airport. During landing, the airplane landed hard, bounced, and the landing gear collapsed. The airplane skidded off the right side of the runway, and ground looped to the right. The left wing struck the ground before the airplane stopped. The airplane sustained substantial damage to the main rotor blades. The pilot reported that there were no preaccident mechanical failures or malfunctions with the airplane that would have precluded normal operation.
Aircraft
- Registration
- N4584N
- Reported as
- Cessna L19 (E)
- Category
- Airplane
- Serial number
- 24565
- Built
- 1944
- Airframe hours
- 6,375.2
- Engine
- Continental O-470-15, 213 hp, reciprocating
- Damage
- Substantial damage
- Flight
- Personal · Part 91
- Airworthiness certificate
- Standard, Normal
- Last inspection
- Annual · October 5, 2018
- Departed
- M05 · Caruthersville, MO
- Destination
- M05 · Caruthersville, MO
- Airport
- TKX · Kennett Memorial, runway 20, 5,000 × 75 ft, concrete
- Equipment
- ADS-B, Handheld GPS
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
As NTSB recorded them. NTSB leaves out names.
- Role
- Pilot
- Age
- 71
- Injuries
- None
- Certificate
- Commercial
- Airplane ratings
- Multi-engine land, Single-engine land
- Instrument ratings
- Airplane
- Medical
- Class 3, With waivers/limitations
- Last flight review
- January 10, 2019
- Seat
- Front
- Restraint
- 4-point
- Flight hours
- 1,872.8 total · 46 in this make and model · 14 in the last 90 days · 5 in the last 30 days · 1 in the last 24 hours
Weather
- Conditions
- Visual (VMC) · Day
- Wind
- 210° at 6 knots
- Visibility
- 10 statute miles
- Temperature
- 88 °F, dew point 72 °F
- Altimeter
- 30.13 inHg
- Observed at
- KTKX
Docket · 2
The files NTSB released with the investigation on January 3, 2020, on NTSB’s docket system: statements, records, photos and specialists’ reports. 3.8 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 N4584N · 1
Matched to the same aircraft by N-number and date.