# NTSB NYC01IA107: Embraer EMB-145, N29917, Norfolk, VA, April 25, 2001 - Type: NTSB incident investigation - Classification: Incident · No injuries · Incident investigation · Final report - Date: April 25, 2001, 18:15 local (22:15 UTC) - Place: Norfolk, VA - Coordinates: 36.859912, -76.199913 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=36.8599&lon=-76.1999&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Highest injury: No injuries - Injuries: 53 uninjured - Status: Completed, report February 20, 2002 - Report: Approved by Office Director - Parties: FAA FSDO-21, Parker Aerospace, Embraer, Continental Express - NTSB case key (mKey): 53371 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=NYC01IA107 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/53371/pdf - Page: https://openairdocs.org/ntsb/NYC01IA107 ## Probable cause The manufacturer's inadequate quality control, which resulted in a jammed elevator trim actuator. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Airframe/component/system failure/malfunction, cruise - inadequate quality control, manufacturer (cause) - flt control syst,elevator trim/tab control - jammed ## Analysis During cruise flight, the horizontal stabilizer jammed in the (-1)-degree trim position. After an uneventful landing, the elevator trim actuator was forwarded to the manufacturer for examination under the supervision of a Safety Board investigator. The elevator trim actuator contained a primary and back-up clutch gear, and each gear had a respective torque nut and lock washer. The examination revealed that that the tabs on the lock washers were not bent over into the locked position. Additionally, there was no evidence that the tabs had ever been bent into the locked position. The back-up clutch torque nut had backed off and down the shaft, coming to rest against the clutch gear cluster bearing outer race. The backed-off nut exhibited a scratch around the outer edge of the face, consistent with fouling against the clutch gear cluster bearing outer race, subsequently jamming the unit. The manufacturer identified the isolated error in the production process. ## Factual narrative On April 25, 2001, about 1815 eastern daylight time, an Embraer EMB-145, N29917, was not damaged during an elevator trim malfunction, while in cruise flight near Norfolk International Airport (ORF), Norfolk, Virginia. The airplane was operated by Continental Express Airlines Inc. as flight 3365. There were no injuries to the 3 crewmembers and 50 passengers. Visual meteorological conditions prevailed for the flight that originated from Newark International Airport (EWR), Newark, New Jersey; destined for ORF. An instrument flight rules flight plan was filed for the air carrier flight conducted under 14 CFR part 121. The flight crew reported that they departed EWR about 1700. About 1815, at 5,000 feet, the horizontal stabilizer jammed in the (-1)-degree trim position. The flight crew completed the emergency checklist items, but the primary and secondary trim actuation systems did not respond. The flight crew then declared an emergency and landed uneventfully at ORF, at 1833. Examination of the airplane by a Federal Aviation Administration inspector revealed that the elevator trim actuator had failed. The unit was forwarded to the manufacturer's facility in Irvine, California, and examined under the supervision of a Safety Board investigator. The unit contained a primary and back-up clutch gear, and each gear had a respective torque nut and lock washer. The examination revealed that that the tabs on the lock washers were not bent over into the locked position. Additionally, there was no evidence that the tabs had ever been bent into the locked position. The back-up clutch torque nut had backed off and down the shaft, coming to rest against the clutch gear cluster bearing outer race. The backed-off nut exhibited a scratch around the outer edge of the face, consistent with fouling against the clutch gear cluster bearing outer race, subsequently jamming the unit. The manufacturer identified the error in the production process. After the examination, the manufacturer inspected all new production units in-house, and reviewed repair records on over 200 units. No discrepancies were detected during the in-house inspection or record review. The manufacturer also issued service bulletins and added quality control information and steps to the production process. ## Aircraft - Registration: [N29917](https://openairdocs.org/aircraft/N29917), registered now, S/N 145414, built 2001 (OpenAirDocs) - Reported make and model: Embraer EMB-145 - Registry model: [Embraer EMB-145LR](https://openairdocs.org/model/embraer-emb-145lr) (registry code 3260212) (OpenAirDocs) - Registry engine: [Allison AE-3007A](https://openairdocs.org/engine/allison-ae-3007a) (registry code 03030, turbo-fan) (OpenAirDocs) - Category: Airplane - Serial number: 145-414 - Airframe hours: 31 - Engines: Allison AE3100A1/3 7450 lbs thrust turbo fan; Allison AE3100A1/3 7450 lbs thrust turbo fan - Damage: No damage - Flight: Part 121 - Operator: Continental Express Inc - Registered owner: Wells Fargo Bank Northwest NA Trustee - Airworthiness certificate: Standard, Transport - Last inspection: Continuous airworthiness, April 9, 2001, 31 hours before - Departed: EWR, Newark, NJ - Destination: ORF, Norfolk, VA - Flight plan: IFR - Airport: ORF, Norfolk International Airport, runway 5, 9,001 × 150 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 31; injuries: none; airline transport; airplane ratings: multi-engine sea, single-engine land; instrument ratings: airplane; medical: class 1, valid medical--no waivers/lim.; last flight review February 4, 2001; seat: left; flight hours: 4,800 total - Co-pilot; age 23; injuries: none; commercial; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 1, valid medical--w/ waivers/lim; last flight review April 12, 2001; seat: right; flight hours: 1,400 total ## Weather - Conditions: Visual (VMC), Day - Wind: 60° at 16 knots - Visibility: 10 statute miles - Lowest ceiling: 2,400 ft broken - Temperature: 48 °F, dew point 43 °F - Altimeter: 30.18 inHg - Observed at: ORF, 50 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). - [Incident 20010425013839I](https://openairdocs.org/incident/20010425013839I), Apr 25, 2001: Emb EMB145, Norfolk, VA. (-23) The captain reported that en route from ewr to orf, the "auto trim fail" and the "pit trim #1 fail" icas captions illuminated, and approx. 15 minutes… 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.