AAIU Report 2014 001 by Rooney Media

Air Accident Investigation Unit Ireland FORMAL REPORT ACCIDENT Fairchild Aircraft Corporation SA 227-BC Metro III, EC-ITP Cork Airport, Ireland 10 February 2011

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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

(( 2 BD@ ,3 1, 3%., * %5%* 5% 3%., 1# ,%9 3%.,> ,, 7 TV 3. 3$ .,5 ,3%., ., ,3 1, 3%., * %5%* 5% 3%.,> %1 % ,3 , , % ,3 ,5 23%# 3%.,A U !/& .#)( : ; ) JJG8CABA ." 3$ 41./ , 1*% + ,3 , ." 3$ .4, %* ." US 3. 1 USTS ., 3$ %,5 23%# 3%., , /1 5 ,3%., ." % ,32 , %, % ,32 %, %5%* 5% 3%.,A V EGA ) CAAJ@ %1 5%# 3%., H .3%"% 3%., , ,5 23%# 3%., ." % ,32> 1%.42 , % ,32 , , % ,32I #4* 3%.,2 USS\A

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@ ..1 %, 3 ,%5 12 * %+ H 04%5 * ,3 3. *. * 3%+ 36 , VT 3 USTS , UZ 1 $ USTTIA Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT )(. (.-

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAZ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAZ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[ TA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\ TAT

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TATAT + # 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATT TATAU 22 ,# 1 ,3 15% 62 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATU TATAV

, *%,# # ,3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATU TAU ,(41% 2 3. 12.,2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV TAV + # 3. %1 1 "3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV TAW 3$ 1 + # AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV TAX 12.,, * ,".1+ 3%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV TAXAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV TAXAU %1 1 "3 .++ , 1 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV TAXAV .F/%*.3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATX TAXAW 438 , 23 1%. 2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATY TAXAX 12.,, *AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATZ TAY %1 1 "3 ,".1+ 3%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATZ TAYAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATZ TAYATAT %1"1 + AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT[ TAYATAU 3 , 1 3%,# 8.43 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT[ TAYATAV ,#%, 2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT[ TAYATAW 1./ ** 12 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT[ TAYATAX ,#%, .,31.*2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT\ TAYATAY *%#$3 .,31.*2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUS TAYATAZ 4 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUT TAYATA[ ,,4, % 3.1 , *AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUT TAYATA\ 3 ** 5.% , 823 + AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUT TAYAU F ,".1+ 3%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUU TAYAUAT 3%,# * 8.43 %, F AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUU TAYAUAU %. , 5%# 3%., * 04%/+ ,3AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUV TAYAV %#$3 , * , AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUW TAYAW 1 5%.42 5 ,32 ,5.*5%,# F AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUW TAYAX %,3 , , AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUW TAYAXAT %,3 , , %23.18 ." F AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUX TAYAXAU .,3%,4%,# %16.13$%, 22 , # + ,3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUY TAYAXAV %1 1 "3 %,3 , , .,31 3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUZ TAYAXAW %,3 , , 1.#1 ++ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUZ TAYAXAX ,3 %,3 , , $ )2 1".1+ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAU[ TAYAXAY %, %,3 , , AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVS TAZ 3 .1.*.#% * ,".1+ 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVS TA[ % 2 3. 5%# 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVU

TA[AT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVU TA[AU 15% %*%38 ." 04%/+ ,3AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVU TA[AV %,%+ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVV TA[AW .6 %2% %*%38 1. 41 2 H 2I AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVW TA[AX 2 # 1 %,# 5%# 3%., % 2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVW TA\ .++4,% 3%.,2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVW TATS 1. 1.+ ,".1+ 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVX TATT *%#$3 .1 12AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVX TATTAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVX TATTAU . )/%3 .% .1 1AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAVX TATTAV *%#$3 3 .1 1 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWU TATU 1 ) # , +/ 3 ,".1+ 3%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWW TATUAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWW TATUAU 42 * # AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWW Y TATUAV %,#2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAWZ TATUAW ,#%, 2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAW[ TATUAWAT ,#%, .A T H "3I E FZSUSW AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAW[ TATUAWAU ,#%, .A U H %#$3I E FZST[\ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAW\ TATUAX 1./ ** 12 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAW\ TATUAY *%#$3 .,31.*2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAW\ TATUAZ , %,# 1 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXS TATUA[ .,31.*2 , , % 3.12AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXS TATUA\ %1 1 "3 . 4+ ,3 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXT TATUATS .5 18 / 1 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXU TATV % * , 3$.*.#% * ,".1+ 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXV TATVAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXV TATVAU *%#$3 1 6 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXV TATVAV 22 ,# 12 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXV TATW %1 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXV TATX 415%5 * 2/ 32AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXW TATY 232 , 2 1 $AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXZ TATYAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXZ TATYAU 1./ ** 12 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAXZ TATYAV .,31.* , 22.1% 2 7 +%, 3%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAX[ TATYAW .1 ,#%, 1 + 3 12 41%,# 3$ %, * ., 2 ." 3$ *%#$3 AAAAAAAAAAAAAAAAAAAAAX\ TATYAX . )/%3 ,2314+ ,3 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAYT TATYAY 11 %, 6 1 , 22 1,%,# 823 + H I AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAYW TATZ 1# ,%9 3%., * , , # + ,3 ,".1+ 3%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAYW TATZAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAYW TATZAU % ) 3 ** 1AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAYY TATZAV ,3 1, 3%., * %1 1 ,2/.13 22. % 3%., H I %1*%, . 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAY\ TATZAW %1 1 "3 6, 12$%/AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAY\ TATZAX $ / 1 3.1AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAZT TATZAY 5% 3%., " 38 5 12%#$3AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAZU

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

TATZAYAT 5% 3%., " 38 5 12%#$3 F AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAZV TATZAYAU 5% 3%., " 38 5 12%#$3 F 41./ , ,%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAZW TATZAYAV 5 12%#$3 8 + 1 3 3 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[S TATZAYAW 5 12%#$3 8 / %, AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[U TATZAZ 2/.,2% %*%3% 2 ." , %1 11% 1AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[W TAT[ %3%., * ,".1+ 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[Z TAT[AT / 1 3.1 ,3 15% 62AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[Z TAT[ATAT , 1 * , # 1 H IAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[Z TAT[ATAU 4 *%38 , # 1 H I , / 1 3%.,2 4 *%38AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[Z TAT[ATAV %,3 , , , # 1 H I AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[[ TAT[ATAW % ,3 1 5 ,3%., , *%#$3 " 38 , # 1 H I AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[[ TAT[ATAX 1 %,%,# , # 1 H I AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[[ TAT[ATAY $% " ,2314 3.1 H IAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[\ TAT[ATAZ .23 1 .F/%*.3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA[\ TAT[AU .+/.2%3%., ." *%#$3 1 6AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\S TAT[AV / 1 3.1D2 .++ , 1 %,%,# 1. 41 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\S TAT[AW / 1 3.1D2 .,%3.1 //1. $ 1. 41 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\T TAT[AX 1 6 2.41 , # + ,3 H IAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\U TAT[AY / 1 3.1D2 4 %3 ., .++ , + ,3 ." 3$ / 1 3%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\U TAT[AZ *%#$3 , 438 %+ %+%3 3%.,2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\V TAT[A[ ,%5 12 * " 38 5 12%#$3 4 %3 1.#1 ++ H IAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\X TAT[A\ 3 3 3 , 1 %2 3%., ,2/ 3%.,2 8 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\X TAT[ATS %1 " 38 .++%33 H I AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\Y TAT[ATT 4 +%22%., "1.+ 3$ / 1 3.1 3. %1 " 38 .++%33 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\[ TAT[ATU 4 *% 15% *%# 3%., H IAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\\ TAT[ATV %1 1 ""% .,31.* * 1 , 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSS TAT[ATW $ ,# 2 3. 3$ *%#$3 * , .1+ 3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSS TAT[ATX ,"1%,# + ,32 ." *%#$3 %+ %+%3 3%.,2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSS TAT[ATY 7 +%, 1 5 12%#$3 1.#1 ++ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSS TAT\ 2 "4* .1 "" 3%5 ,5 23%# 3%., $,%04 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATST TAT\AT 1. 8, +% 34 8 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATST TAT\AU 4+ , 3.12AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATST UA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSU UAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSU UAU 5 15% 6 ." 3$ % ,3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSU UAV 22 ,# 1 ,3 15% 62AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSU UAW 1 ) # , +/ 3 , *82%2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSU UAX .22 ." .,31.*AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSV UAXAT *%#$3 .,31.*2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSW UAXAU *%#$3 ,2314+ ,32AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSW UAXAV ,2314+ ,3 , %,# 823 + AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSX UAXAW /3%., , %2/* 8 ." %#, *2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSX UAXAX , / %3 3%., ." 3$ *%#$3 1 6AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSY UAXAY .6 1/* ,3AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSY

UAXAZ .22 ." .,31.* 4++ 18 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATSZ UAY / 1 3%., * 224 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATS[ UAYAT 1 6 1 %,%,# , 4 *%"% 3%.,2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATS[ UAYAU *%#$3 1 6 .23 1AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATS\ UAYAV *%#$3 1 6 438 %+ 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATS\ UAYAVAT .++ , 1 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATTS UAYAVAU .F/%*.3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATTU UAYAVAV 4++ 18AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATTW UAYAW 3 .1.*.#% * %34 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATTW UAYAX *%#$3 * ,,%,#AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATTX UAYAY ., 4 3 ." 3$ *%#$3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATTY UAYAZ .++ , %2%., )%,# AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATTZ UAYA[ 1 %,%,# , 7/ 1% , AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATT\ UAZ %,3 , , 224 2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUU UAZAT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUU UAZAU %1 1 "3 .,"%#41 3%., $ ,# 2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUU UAZAV .1 %,# , .,31.* ." %1 1 "3 " 32 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUU UAZAW %1 1 "3 " 32 G +/ 3 ., / 1 3%.,2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUW UAZAX 13 TWX %, %,3 , , 4//.13 2/.,2% %*%3% 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUW UAZAY %,3 , , 5% 6 %, %,#2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUX UA[ 5 12%#$3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUY UA[AT , 1 * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUY UA[AU 5 12%#$3 8 / 1 3.1 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATUZ UA[AV / 1 3.1D2 *%#$3 " 38 , # + ,3AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVS UA[AW / 1 3%., * . 4+ ,3 3%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVT UA[AX 5 12%#$3 8 3$ .+/ 3 ,3 43$.1%38 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVV UA[AXAT , 1 *AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVV UA[AXAU / 1 3%,# % , AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVW UA[AXAV %1 / 1 3.1 13%"% 3 H I AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVX UA[AY 5 12%#$3 8 3$ 1 43$.1%3% 2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVY UA[AZ 5 12%#$3 8 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVZ UA[A[ 5 12%#$3 8 3$ 41./ , ,%.,AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATVZ UA[A\ ,3 1, 3%., * %+ ,2%., AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV\ UA\ %1 1 ""% .,31.* AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV\ UATS *%#$3 * , .1+ 3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATV\ UATT %#$3 , * , AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWS UATU *%#$3 3 .1 1AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWS UATV 2 4 , %1 %#$3%,#AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWS UATW 415%5 %*%38 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWT UATX **. 3%., ." 32 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWU UATY 7 +%, 3%., ." 4+ , 3.12 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWU UATZ 4++ 18 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWW UATZAT .22 ." .,31.* AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWX UATZAU / 1 3%., * 224 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWX UATZAV 1# ,%2 3%., * 224 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWX UATZAW #4* 3.18 5 12%#$3 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWY Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT UATZAX

,31 F .++4,%38 %1 15% 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATWY VA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATW[ WA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATXV // , %7 @ .1 ." "*%#$32 1 6 8 3$ .++ , 1 .1 .F/%*.3 AAAAAAAAAAAAAAAAAAAAAAAAAAAATXX // , %7 @ *%#$32 / 1 3 8 F , F AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATXY // , %7 @ 5% 6 ." .,3%,4%,# %16.13$%, 22 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATX\ // , %7 @ ,#%, 1.4, 4, .1)2$ 3AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT[T // , %7 @ $ 2 + %,3 , , 11% .43 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT[U // , %7 @ 34 * , .1 23 3 .1.*.#% * /.132 ".1 1%2$ %1/.132AAAAAAAAAAAAAAAAAAAAAT[V // , %7 @ 1 ,2 1%/32AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT[X // , %7 @ 3 ".1 "%, * //1. $ 2 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT\V // , %7 @ 1%2 % * AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT\Y // , %7 @ 4++ 18 ." 1./ ** 1 7 +%, 3%., /.13AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAT\[ // , %7 @ 4++ 18 ." 23 /.13 ., .A U H %#$3I ,#%, UE U ,2.1AAAAAAAAAAAAAAAAAAUSV // , %7 @ ,5 23%# 3%., ." .1 ,#%, 1 + 3 12AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUSZ // , %7 @ 731 3 "1.+ 41./ , .++%22%., #4* 3%., H I . [X\EUSS[ AAAAAAAAAAAAUUY // , %7 @ //.%,3+ ,3 ." .++ , 1 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUUZ // , %7 @ 4 +%22%., + 8 3$ / 1 3.1 3. 3$ %1 " 38 .++%33 AAAAAAAAAAAAAAAAAUVS AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUVW AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAUV[

.1) %1 1 ""% .,31.* H I ,.3%"% 3$ 3 TSASX $12A .41 ,2/ 3.12 ." %1 % ,32 /*.8 3. .1) %1/.13> 36. 8 1%2$ %1 .1/2 $ *% ./3 1 , 36. 8 1. A "%"3$ ,2/ 3.1 (.%, 3$ ,5 23%# 3%., * 3 1 3$ 3 8A $ ,5 23%# 3%., 6 2 ., 4 3 %, .1 , 6%3$ 3$ /1.5%2%.,2 ." ,, 7 TV> #4* 3%., H I . \\YEUSTS , 3 343.18 ,2314+ ,3 .A WYS ." USS\A , ,.3%"% 3%., ." 3$ % ,3> 3$ ".**.6%,# 3 3 2 //.%,3 1 %3 /1 2 ,3 3%5 2> 5%2.12 , 7/ 132 3. 3$ ,5 23%# 3%.,@ $ *'#/#+( (3 /0#! #+( # (0 / ( # (0 / 3# #+( #3#& H I ." / %,> 2 3 3 ." #%2318 , 3$ / 1 3.1? 3$ 3%., * 1 ,2/.13 3%., " 38 . 1 H I , 1 * 5% 3%., +%,%231 3%., H I ." 3$ ,%3 3 3 2> 2 3 3 ." 2%#, , ,4" 341 ? 3$ %1 % ,32 ,5 23%# 3%., 1 , $ H I ." 3$ ,%3 %,# .+ 2 3 3 6$% $ 24"" 1 " 3 *%3% 2 , /1.5% 7/ 13%2 ? 3$ %,%2318 ." 1 ,2/.13> 5% 3%., , % ,32 , % ,32 ,5 23%# 3%., H I 21 *> 2 3 3 ." 8/ 13%"% 3 .* 1A

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

$ %1 1 "3> F H ").) )7 BI 6 2 .6, 8 / ,%2$ ,) , * 2 3. / ,%2$ 4, 13 )%,# H %,! 2 !1 2 , *4 & > 31 %,# 2 %1 IA 2 %3 6 2 3$ ,3%38 6%3$ %1 3 .,31.* ." 3$ %1 1 "3> %1 %2 $ , ".13$ 1 " 11 3. 2 3$ C 6, 1DA 3 6 2 24 * 2 3. , ./ 1 3 8 %"" 1 ,3 / ,%2$ .+/ ,8 H *%#$3*%, A AI> 3$ $.* 1 ." , %1 / 1 3.1 13%"% 3 H I $ , ".13$ 1 " 11 3. %, 3$ /.13 2 3$ C / 1 3.1DA $ 4, 13 )%,# 2 **%,# 3$ / 22 ,# 1 %1 31 ,2/.13 2 15% 6 2 , 2* ." , 2 .+/ ,8 H ,7UI> $ , ".13$ 1 " 11 3. %, 3$ /.13 2 3$ C % ) 3 ** 1DA %,3 , , ".1 3$ %1 1 "3 6 2 /1.5% 8 ,.3$ 1 / ,%2$ .+/ ,8 H 1.3 ,% 2 A AI> $ , ".13$ 1 " 11 3. %, 3$ /.13 2 3$ C %,3 , , 1.5% 1DA *%#$32 ./ 1 3 8 F , %32 2%23 1 31. F %, 3$ > 1 * , , 3$ 2* ." , 1 1 " 11 3. 2 3$ C / 1 3%.,DA $ *%#$3 1 6 1 1 " 11 3. %, 3$ /.13 2 3$ .++ , 1 , 3$ .F/%*.3 42%,# /%3 *%2 3 1+2A " 1 , 2 42%,# ,.,F /%3 *%2 3 1+2 1 # , 1% A

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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@ %23 , 241%,# 04%/+ ,3A @ . )/%3 .% .1 1A Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT B7B7C

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

dŚĞ ŽŵŵĂŶĚĞƌ ďĞŐĂŶ ĨůǇŝŶŐ ŝŶ ϮϬϬϳ ĂŶĚ ĐŽŵƉůĞƚĞĚ ŚŝƐ ďĂƐŝĐ ƚƌĂŝŶŝŶŐ ŽŶ ƐŝŶŐůĞ ĂŶĚ ŵƵůƚŝ ĞŶŐŝŶĞ ƉŝƐƚŽŶ ƚǇƉĞƐ͖ ŚŝƐ ƚŽƚĂů ŐĞŶĞƌĂů ĂǀŝĂƚŝŽŶ ĨůŝŐŚƚ ƚŝŵĞ ǁĂƐ ϮϬϭ ŚŽƵƌƐ͘ ,Ğ ƚŚĞŶ ĐŽŵƉůĞƚĞĚ ĂŶ ^ ϮϮϲͬϮϮϳ ƚǇƉĞ ƌĂƚŝŶŐ ǁŝƚŚ Ă dǇƉĞ ZĂƚŝŶŐ dƌĂŝŶŝŶŐ KƌŐĂŶŝƐĂƚŝŽŶ ;dZdKͿ ŝŶ 1 *., , .++ , +/*.8+ ,3 2 . /%*.3 ., 3$ 38/ A ZĞĐŽƌĚƐ ƐŚŽǁ ƚŚĂƚ ďĞƚǁĞĞŶ :ƵŶĞ ϮϬϬϳ ĂŶĚ ĞĐĞŵďĞƌ ϮϬϬϵ ŚĞ ĨůĞǁ ĂƐ ĐŽ ƉŝůŽƚ ǁŝƚŚ ƚŚƌĞĞ ^ƉĂŶŝƐŚ ^ ϮϮϳ ŽƉĞƌĂƚŽƌƐ͕ ĨůǇŝŶŐ ĐŽŶĐƵƌƌĞŶƚůǇ ĨŽƌ Ăůů ƚŚƌĞĞ ŽƉĞƌĂƚŽƌƐ ŝŶ ƚŚĞ ĨŝƌƐƚ ŚĂůĨ ŽĨ ϮϬϬϵ͘ ,Ğ ĐŽŵŵĞŶĐĞĚ ĨůǇŝŶŐ ǁŝƚŚ ƚŚĞ KƉĞƌĂƚŽƌ ŝŶ ĞĂƌůǇ ĞĐĞŵďĞƌ ϮϬϬϵ͘ ĞƚǁĞĞŶ ϳ ĞĐĞŵďĞƌ ϮϬϬϵ ĂŶĚ ϭϲ ĞĐĞŵďĞƌ ϮϬϬϵ͕ ŚŝƐ ƉĞƌƐŽŶĂů ůŽŐďŽŽŬ ƐŚŽǁĞĚ ƚŚĂƚ ŚĞ ĐŽŵƉůĞƚĞĚ ŶŝŶĞ ƐĞĐƚŽƌƐ ƚŽƚĂůůŝŶŐ ϭϱ ŚŽƵƌƐ ϭϬ ŵŝŶƵƚĞƐ ĂƐ Wϭͬ^ ;WŝůŽƚ ŝŶ ŽŵŵĂŶĚ ƵŶĚĞƌ ^ƵƉĞƌǀŝƐŝŽŶͿ͘ $%2 .++ , 31 %,%,# 6 2 %2 .,3%,4 , $ 1 341, 3. "*8%,# 2 . ƉŝůŽƚ͘ ĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ KƉĞƌĂƚŽƌ͛Ɛ ƉƌŽĐĞĚƵƌĞƐ Ă ĐĂŶĚŝĚĂƚĞ ŵƵƐƚ ƐĂƚŝƐĨǇ ĐĞƌƚĂŝŶ ĐƌŝƚĞƌŝĂ ƉƌŝŽƌ ƚŽ ƉƌŽŵŽƚŝŽŶ ƚŽ ĐŽŵŵĂŶĚĞƌ͘ ZĞĐŽƌĚƐ ƉƌŽǀŝĚĞĚ ƚŽ ƚŚĞ /ŶǀĞƐƚŝŐĂƚŝŽŶ ƐŚŽǁ ƚŚĂƚ ƚŚĞ ŽŵŵĂŶĚĞƌ ƐĂƚŝƐĨŝĞĚ ƚŚĞƐĞ ƌĞƋƵŝƌĞŵĞŶƚƐ ǁŝƚŚ ĂƉƉƌŽǆŝŵĂƚĞůǇ ϭ͕ϱϳϱ ŚŽƵƌƐ ĞǆƉĞƌŝĞŶĐĞ ĂƐ Ă ĐŽ /%*.3 %, ,4 18 USTTA ,Ğ ĨůĞǁ ĂƐ Ă ĐŽ ƉŝůŽƚ ĨŽƌ ƚŚĞ KƉĞƌĂƚŽƌ ƵŶƚŝů Ϯ &ĞďƌƵĂƌǇ ϮϬϭϭ ǁŚĞŶ ŚĞ ĐŽŵƉůĞƚĞĚ ĂŶ KƉĞƌĂƚŽƌ WƌŽĨŝĐŝĞŶĐǇ ŚĞĐŬ ;KW Ϳ͕ ĚƵƌŝŶŐ ǁŚŝĐŚ ŚĞ ŽĐĐƵƉŝĞĚ ƚŚĞ ůĞĨƚ ŚĂŶĚ ƐĞĂƚ͘ dŚŝƐ KW ƚŽŽŬ ƉůĂĐĞ Ăƚ ZĞƵƐ ;> Z^Ϳ͕ ^ƉĂŝŶ ĂŶĚ ǁĂƐ ƌĞĐŽƌĚĞĚ ĂƐ ůĂƐƚŝŶŐ ϰϬ ŵŝŶƵƚĞƐ͕ ĚƵƌŝŶŐ ǁŚŝĐŚ ƚǁŽ ůĂŶĚŝŶŐƐ ǁĞƌĞ ĐŽŵƉůĞƚĞĚ͘ dŚĞ KƉĞƌĂƚŽƌ͛Ɛ KƉĞƌĂƚŝŽŶƐ DĂŶƵĂů ;KDͿ WĂƌƚ ͕ ^ĞĐƚŝŽŶ Ϯ͘ϭ͘ϱ͕ ƌĞƋƵŝƌĞƐ Ϯ ŚŽƵƌƐ ŽĨ ĂĐƚƵĂů ĨůŝŐŚƚ ƚŝŵĞ ǁŝƚŚ Ă ŵŝŶŝŵƵŵ ŽĨ ϰ ƚŽƵĐŚĚŽǁŶƐͬůĂŶĚŝŶŐƐ ĨŽƌ , 1 * 3%,# 3. //.%,3+ ,3 3. .++ , 1A &ŽůůŽǁŝŶŐ ƐĞǀĞŶ ƐĞĐƚŽƌƐ ƵŶĚĞƌ ƐƵƉĞƌǀŝƐŝŽŶ͕ ŚĞ ĐŽŵƉůĞƚĞĚ ƚǁŽ >ŝŶĞ ŚĞĐŬ ;> Ϳ ƐĞĐƚŽƌƐ͖ ŽŶĞ ƐĞĐƚŽƌ ŽŶ ϰ &ĞďƌƵĂƌǇ ϮϬϭϭ ;ϮϮ͘ϮϬ ϬϬ͘ϬϬ ŚƌƐͿ ĂŶĚ ƚŚĞ ƐĞĐŽŶĚ ƚŚĞ ĨŽůůŽǁŝŶŐ ĚĂǇ ;ϬϮ͘ϭϱ Ϭϰ͘ϬϬ ŚƌƐͿ ĂŶĚ ǁĂƐ ƉƌŽŵŽƚĞĚ ƚŽ ƚŚĞ ƌĂŶŬ ŽĨ ĐŽŵŵĂŶĚĞƌ͘ &ŽůůŽǁŝŶŐ ƚŚŝƐ ŚĞ ƚƌĂǀĞůůĞĚ ĨƌŽŵ ^ƉĂŝŶ ƚŽ ĞůĨĂƐƚ͘ ,ŝƐ ĨŝƌƐƚ ĨůŝŐŚƚ ŝŶ ĐŽŵŵĂŶĚ ǁĂƐ ŽŶ ϲ &ĞďƌƵĂƌǇ ϮϬϭϭ͕ ĨŽƵƌ ĚĂǇƐ ƉƌŝŽƌ ƚŽ 3$ % ,3A ZĞĐŽƌĚƐ ƐŚŽǁ ƚŚĂƚ ƚŚĞ ŽŵŵĂŶĚĞƌ ŽƉĞƌĂƚĞĚ ĂƐ Ă ĐŽ ƉŝůŽƚ ŝŶƚŽ / < ŽŶ ϲϭ ŽĐĐĂƐŝŽŶƐ ďĞƚǁĞĞŶ ϴ ^ĞƉƚĞŵďĞƌ ϮϬϭϬ ĂŶĚ ϯϬ :ĂŶƵĂƌǇ ϮϬϭϭ͘ ĞƚǁĞĞŶ ƚŚĞ ϲ &ĞďƌƵĂƌǇ ϮϬϭϭ ĂŶĚ ϵ &ĞďƌƵĂƌǇ ϮϬϭϭ͕ ŚĞ ŽƉĞƌĂƚĞĚ ŝŶƚŽ / < ŽŶ ϳ ŽĐĐĂƐŝŽŶƐ ĂƐ ŽŵŵĂŶĚĞƌ͘ dŚĞ /ŶǀĞƐƚŝŐĂƚŝŽŶ ĨŽƵŶĚ ŶŽ ƌĞĐŽƌĚƐ ŽĨ Ă ĚŝǀĞƌƐŝŽŶ ĨŽƌ ŽƉĞƌĂƚŝŽŶĂů Žƌ ǁĞĂƚŚĞƌ ƌĞĂƐŽŶƐ ŽŶ ĂŶǇ ŽĨ ƚŚĞƐĞ ĨůŝŐŚƚƐ ŝŶƚŽ / <͘ /Ŷ ĂĚĚŝƚŝŽŶ͕ ŚŝƐ ůŽŐďŽŽŬ ƐŚŽǁĞĚ ƚŚĂƚ ŚĞ ŚĂĚ ŶĞǀĞƌ ŽƉĞƌĂƚĞĚ ŝŶƚŽ ĞŝƚŚĞƌ /t& Žƌ /<z͘ dŚĞ .++ , 1 4, 16 ,3 3$ ĨŽůůŽǁŝŶŐ $ ĐŬƐ͗ " % 3* )/. 8 & . / 1 3.1 1."% % , 8 $ ) ^ĞǀŝůůĞ ^ĞǀŝůůĞ ϲ Ğď USTS >ŝŶĞ $ ĐŬ ĂƌĐĞůŽŶĂ ^ĞǀŝůůĞ W 8 USTS >ŝŶĞ $ ĐŬ DĂĚƌŝĚ ZŽŶĂůĚƐǁĂǇ ϳ 8 USTS >ŝĐĞŶĐĞ ƌŽĨŝĐŝĞŶĐǇ $ ĐŬ ZŽŶĂůĚƐǁĂǇ ϭϮ Ŷ USTS / 1 3.1 1."% % , 8 $ ) ZĞƵƐ Ϯ Ğď USTT >ŝŶĞ $ ĐŬ ĂƌĐĞůŽŶĂ DĂĚƌŝĚ ϰ Ğď USTT >ŝŶĞ $ ĐŬ DĂĚƌŝĚ ĂƌĐĞůŽŶĂ ϱ Ğď USTT

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@ *%#$3 1 %,%,# 1# ,%2 3%.,A Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT B7F7E

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT B7G7B7B

B7G7B7C

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT B7G7C

B7G7C7B

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT B7G7D

B7G7E 24

B7G7F

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

B7G7F7C

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@ /3 * ,2 ." .+/*% , A Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

B7G7F7F

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT B7G7F7G

B7H

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

" ' " $ ! ' " ! " ' $ " " " !% ! " " ; ' " " ; ' " $

B7I B7I7B

B7I7C

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B7I7D

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT B7I7E

B7I7F

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B7J

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B7BA

B7BB B7BB7B

B7BB7C

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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.,/' & @ %. , 5%# 3%., % ., 3$ *2$ . 23A Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT TZ@TU TZ@SY TZ@SV TY@XX TY@XU TY@XT TY@W\ .1) //1. $ 3$ % 3. .,3%,4 #' .) ( ) , ), #(! :'#(6- ; TY@SW

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT #' .) ( ) , ), #(! :'#(6- ; [@WW

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

B7BB7D

S@S\

S@SZ

S@SX S@SW S@SW S@SW S@SU S@SU S@SS

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

B7BC B7BC7B

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT %* 1., .,31.* .,3%,4%38 6 2 ,.3 23 *%2$ %, %32 ,3%1 38 4 3. 3$ 73 ,2%5 + # 2423 %, 3. 3$ 1%#$3 6%,# , %* 1., 6$% $ $ 2 5 1 A

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

B7BG7G

B7BH 64

B7BH7B

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT <2<B2=

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT " ) /' (. : ,) /, > ,# #(!- .) -- (! ,-; #( &/ 7 = # ! 05 .$ ! 0# 0 /#*1' 1/ $/ 0 $' '*3: $'0 ..$1 ' $ / ) " )0' ( ) ) 3 ' *( *) * . 0#$/ )4I; *( !'$"#0 *, . 0 5 B , . 0*. ) ( <C>

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

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

= # !! 0$2 !1) 0$*)$)" *! *((1)$05 $2$' 2$ 0$*) / ! 05 / # ( $) 0# !$ ' / *2 . 5 0#$/ "1' 0$*) . -1$. / /0. )"0# ) **, . 0$*) 03 ) 0# *(($//$*)8 0# ( . 0 0 / ) 0# " ) 5 0* 0 0 1)/ ! *) $0$*)/ ) 0 & . ( $ ' ( /1. / / ,,.*,.$ 0 ;> = .0$ ' H; #$/ "1' 0$*) /# '' ,,'5 0*: <B C , ./*)) ' ) *." )$/ 0$*)/ $)2*'2 $) 0# *, . 0$*) *! $. . !0;>

.0$ ' I; H; # ,.$) $, ' * % 0$2 *! 0#$/ "1' 0$*) $/ 0* /0 '$/# ) ( $)0 $) #$"# 1)$!*.( ' 2 ' *! $2$' 2$ 0$*) / ! 05 $) 1.*, ;> ,.# & JI5 0 ,-#!". ( ( ), ' (. -. . -7

H; # ( . 0 0 /8 0# *(($//$*) ) 0# " ) 5 /# '' **, . 0 3$0# 2$ 3 0* )/1.$)" 0# 0 )5 ,.* 1 08 , ./*) *. *." )$/ 0$*) /1 % 0 0* 0#$/ "1' 0$*) *(,'$ / 3$0# $0/ ,.*2$/$*)/ ) 3$0# $0/ $(,' ( )0$)" .1' /;

I; *. 0# ,1.,*/ / *! 0# $(,' ( )0 0$*) *! , . ". ,# H8 ( . 0 0 / /# ''8 $) $0$*) 0* 0# $. *2 ./$"#0 *! .0$!$ 0 / 0# 0 0# 5 # 2 $//1 8 *) 1 0 $)2 /0$" 0$*)/8 $) '1 $)" . (, $)/, 0$*)/8 ) /# '' 0 & )5 ( /1. 8 $) '1 $)" 0# ".*1) $)" *! $. . !08 0* ,. 2 )0 0# *)0$)1 0$*) *! ) $)!.$)" ( )0;>

!/& .#)( ? @ ) RON<KIJK5 1"# " 1 - (). #( ), . ." .#' ) ." # (.5 )(. #(- - . ) #'*& ' (.#(! ,/& - /( , !/& .#)( ? @ ) KJO<KIIQ8

>2 +" * %$ 7 8 % <;;C4=;;C -. . -5 $)0 . '$ 7 = $. ..$ .> ( )/ ) 1) .0 &$)" 3$0# 2 '$ *, . 0$)" '$ ) *. -1$2 ' )09 B .0$ ' I; !$)$0$*)/C

= $. *, . 0*. .0$!$ 0 B C> ( )/ .0$!$ 0 '$2 . 0* ) 1) .0 &$)" *)!$.($)" 0# 0 0# *, . 0*. # / 0# ,.*! //$*) ' $'$05 ) *." )$/ 0$*) 0* )/1. 0# / ! 05 *! *, . 0$*)/ /, $!$ $) 0# .0$!$ 0 8 / ,.*2$ $) 0# . ' 2 )0 ,.*2$/$*)/ *! *((1)$05 *. ) 0$*) ' ' 38 / ,,'$ ' 9 B .0$ ' I; !$)$0$*)/C

= *(, 0 )0 '$ )/$)" 10#*.$05> ( )/ ) 10#*.$05 *! ( . 0 0 )0$0' 0* ". )08 . !1/ 8 . 2*& *. /1/, ) ) *, . 0$)" '$ ) $) *. ) 3$0# # ,0 .

=*, . 0$)" '$ ) > ( )/ ) 10#*.$/ 0$*) ". )0 5 0# *(, 0 )0 '$ )/$)" 10#*.$05 0* ) 1) .0 &$)"8 , .($00$)" $0 0* ,.*2$ $. / .2$ / / /0 0 $) 0# *, . 0$)" '$ ) 9 B .0$ ' I; !$)$0$*)/C * 1) .0 &$)" /0 '$/# $) 0# *((1)$05 /# '' , .($00 0* ..5 5 $. , // )" ./8 ( $' ) ?*. ."* !*. . (1) . 0$*) ) ?*. #$. 1)' // $0 # / ) ". )0 0# ,,.*,.$ 0 *, . 0$)" '$ ) ; B .0$ ' J; HC ) 1) .0 &$)" /# '' ". )0 ) *, . 0$)" '$ ) 5 0# *(, 0 )0 '$ )/$)" 10#*.$05 *! ( . 0 0 ,.*2$ 0# 0:

$0/ ,.$) $, ' ,' *! 1/$) // $/ '* 0 $) 0# 0 ( . 0 0 9 $0 #*' / 2 '$ $//1 5 ) 0$*) ' 10#*.$05 *! 0# / ( ( . 0 0 3#*/ *(, 0 )0 '$ )/$)" 10#*.$05 $/ . /,*)/$ ' !*. ". )0$)"8 . !1/$)"8 . 2*&$)" *. /1/, ) $)" 0# *, . 0$)" '$ ) *! 0# *((1)$05 $. ..$ .9 B .0$ ' K B C ) B CC

# ". )0$)" ) 2 '$ $05 *! ) *, . 0$)" '$ ) /# '' 0 )5 0$( , ) )0 1,*) 0# ,*// //$*) *! 2 '$ /, $!5$)" 0# 0$2$0$ / *2 . 5 0# *, . 0$)" '$ ) ; B .0$ ' M; HC

)5 (* $!$ 0$*) $) 0# *! *((1)$05 $. ..$ . /# '' . !' 0 8 3# . ,,.*,.$ 0 8 $) $0/ *, . 0$)" '$ ) ; B .0$ ' M; IC # *(, 0 )0 '$ )/$)" 10#*.$05 ( 5 0 )5 0$( // // 0# !$) ) $ ' , .!*.( ) *! *((1)$05 $. ..$ . 0* 3#$ # $0 # / ". )0 ) *, . 0$)" '$ ) 5 . -1 /0$)" 0# . ' 2 )0 $)!*.( 0$*); / , .0 *! /1 # ) // //( )08 0# *((1)$05 $. ..$ . $) -1 /0$*) /# '' 1, 0 0# 0 . ! .. 0* $) ,*$)0 J *! )) 4 ) ,.*2$ $0 0* 0# *(, 0 )0 '$ )/$)" 10#*.$05 1,*) . -1 /0; B .0$ ' O; KC *((1)$05 $. ..$ . /# '' )*0$!5 0# *(, 0 )0 '$ )/$)" 10#*.$05:

B C $) 2 ) *! )5 ,' )/ !*. 0# *, . 0$*) *! ) 3 $. / .2$ 0* *)0$) )0 *. 3*.' . "$*) )*0 ,. 2$*1/'5 / .2 8 *. )5 *0# . /1 /0 )0$ ' # )" $) 0# / ' *! $0/ 0$2$0$ /8 $) '1 $)"8 10 )*0 '$($0 0*8 # )" / $) 0# 05, *. )1( . *! $. . !0 1/ 9 B .0$ ' O; LC Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT ?2 +" * %$ 7 8 % =<<<4=;;@ -. . -7

)!*.( 0$*) *) 0# $ )0$05 *! 0# *, . 0$)" $. ..$ . ,*) . / .2 0$*)8 0# $. ..$ " *)0. 0*. /# '' $)!*.( 0# , // )" . *! 0# $ )0$05 *! 0# *, . 0$)" $. ..$ . *. ..$ ./8 3# 0 2 . 0# ( )/ 1/ 0* ( & 0# . / .2 0$*); "#- !/& .#)( &-) )(. #(- ." )&&)1#(! #(#.#)(-7 = *)0. 0 *! ..$ " > ( )/ *)0. 0 !*. *. $) '1 $)" $. 0. )/,*.0 / .2$ /8 $) '1 $)" *) 3# . 0# ..$ " $/ *(,*/ *! 03* *. (*. !'$"#0/ *, . 0 5 0# / ( *. $!! . )0 $. ..$ ./9

= $. ..$ " *)0. 0*.> ( )/ 0# ..$ . 3#$ # *) '1 / *)0. 0 *! ..$ " 3$0# , // )" . *.8 3# . 0# *)0. 0 *(,.$/ / , & " 8 0# 0*1. *, . 0*.; )5 0$ & 0 / '' . /# '' '/* ( ) $. ..$ " *)0. 0*.9

=0$ & 0 / '' .> ( )/ 0# / '' . *! ) $. 0$ & 0 3#* .. )" / *)0. 0 *! ..$ " 3$0# , // )" .8 3# 0# . !*. !'$"#0 *) $0/ *3) *. / , .0 *! , & " 8 *0# . 0# ) ) $. ..$ . *. 0*1. *, . 0*.9

=*, . 0$)" $. ..$ .> ( )/ ) $. ..$ . 0# 0 , .!*.(/ *. $)0 ) / 0* , .!*.( !'$"#0 1) . *)0. 0 *! ..$ " 3$0# , // )" .8 *. *) # '! *! )*0# . , ./*)8 ' " ' *. ) 01. '8 # 2$)" *)0. 0 *! ..$ " 3$0# 0# 0 , // )" .<

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

7 / " (-* .#)(- , ,,# )/. /( , ." /-*# - ) ." /,)* ( . ,#(! 2* ,. ,)/* ? @8 #(-* .#)( # (.# # - -#!(# # (. #,, !/& ,#.# -5 ." - ( , #- 1#." ." #,&#( ( ." )0 ,-#!". /."),#.38 " , #,, !/& ,#.# - " 0 ( #'' # . #'* . )( - .35 #(-* .),- ( ' ( ),, .#0 .#)( ), ." 3 &&)1 ( #, , . .) * ,.8

!/& .#)( ? @ ) KJO<KIIQ ? -. &#-"#(! :." ! ( 3;@ -. . - #( ,.# & JP5 ." -. &#-"' (. ( /( .#)(- ) ." ! ( 35 ." .7 H; *. 0# ,1.,*/ *! 0# $(,' ( )0 0$*) *! 0#$/ "1' 0$*)8 1.*, ) 2$ 0$*) ! 05 " ) 5 /# '' /0 '$/# ; I; *. 0# ,1.,*/ / *! )/1.$)" 0# ,.*, . !1) 0$*)$)" ) 2 '*,( )0 *! $2$' 2$ 0$*) / ! 058 0# " ) 5 /# '':

B C 1) .0 & )5 0 /& ) !*.(1' 0 *,$)$*)/ *) '' ( 00 ./ *2 . 5 .0$ ' HBHC9

B C //$/0 0# *(($//$*) 5 ,. , .$)" ( /1. / 0* 0 & ) !*. 0# $(,' ( )0 0$*) *! 0#$/ "1' 0$*); # . 0# / *(,.$/ 0 #)$ ' .1' / ) $) , .0$ 1' . .1' / . ' 0$)" 0* *)/0.1 0$*)8 /$") ) *, . 0$*) ' /, 0/8 0# *(($//$*) ( 5 )*0 # )" 0# $. *)0 )0 3$0#*10 ,.$*. **. $) 0$*) 3$0# 0# " ) 5; # " ) 5 /# '' '/* ,.*2$ 0# *(($//$*) 3$0# 0# ) // .5 0 #)$ '8 / $ )0$!$ ) ($)$/0. 0$2 /1,,*.0 0* ..5 *10 $0/ 0 /&/9

B C 0 & 0# ) // .5 ( /1. / 3$0#$) 0# ,*3 ./ *)! .. *) $0 5 0#$/ "1' 0$*) *. *0# . *((1)$05 ' "$/' 0$*)9

B C *) 1 0 $)/, 0$*)/ ) $)2 /0$" 0$*)/ / ) // .5 0* !1'!$' $0/ 0 /&/9

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

% %$, $* %$7 ( #(. ,( .#)( & !, ' (. ')(! -. . - #(#.# &&3 -#!( #( JRMM5 - ..#(! )/. ,. #( *,#( #*& - ( ,, (! ' (.- #( ), , ." . #(. ,( .#)( & #0#& 0# .#)( ' 3 0 &)* #( - ( ), ,&3 ' (( , ( ." . #(. ,( .#)( & #, ., (-*),. - ,0# - ' 3 -. &#-" )( ." -#- ) +/ &#.3 ) )**),./(#.3 ( )* , . -)/( &3 ( )()'# &&38 Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

7 8 # ( * * ) " ' , . . - --) # . 1#." ." * , .#)( 1 , 7 * #(6 ." . . ) !#-.,3 ( ." * , .),8 , & ( 1" , ." # (. ) /,, 8 (#. #(! )' 1" , ." &#!". ),#!#( . 8

( #.#)(5 ." # % . && , 1 - )'* (3 - #( ." -& ) ( ( ." * , .#)( 1 - &-) - ." , 8 " -& ) ( #- ,)1( * ( ( 35 ( #(. ,( &&3 - & = !)0 ,(#(! * ( (. . ,,#.),3 ) ." ,#.#-" ,)1(5 1"# " #- (). * ,. ) ." (#.

#(! )' ), ." /,)* ( (#)(8 " -& ) ( " - #.- )1( * ,&# ' (. ( #0#& 0# .#)( '#(#-., .#)( ? = -& ) (@ 1")- 1 -#. -. . -7 = # $/ . /,*)/$ ' !*. )/1.$)" 2$ 0$*) ' "$/' 0$*) $) 0# /' *! ) ( 0/

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

=<BJC *")$/$)" 0# ,*0 )0$ ' '$)& 03 ) 0# !$) ) $ ' # '0# *! ) $. ..$ . ) / ! 058 (*. /0.$)" )0 (*)$0*.$)" *! 0# !$) ) $ ' /$01 0$*) *! $. ..$ ./ /#*1' /0 '$/# ;

BKC $2 ) 0# ".*3$)" $(,*.0 ) *! $. ..$ ./ 3$0# *, . 0$*) ' / / $) / 2 . ' ( ( . /0 0 / ) 0# ) 0* )/1. 0# !!$ $ )0 /1, .2$/$*) *! 0# / $. ..$ ./8 0# / ( ( . 0 0 /#*1' . /,*)/$ ' !*. 0# *2 ./$"#0 *! 0# $. *, . 0*. .0$!$ 0 ) *! 0# *, . 0$)" '$ ) ;>

,.# & JN -. . -7 H; *((1)$05 $. ..$ ./ /# '' )0$0' 0* *, . 0 $)0. @ *((1)$05 $. / .2$ /;

I; ( . 0 0 / /# '' )*0 /1 % 0 0# *, . 0$*) *! $)0. @ *((1)$05 $. / .2$ / 5 *((1)$05 $. ..$ . 0* )5 , .($0 *. 10#*.$/ 0$*); ( . 0 0 / /# '' )*0 . -1$. *((1)$05 $. ..$ ./ 0* ,.*2$ )5 * 1( )0/ *. $)!*.( 0$*) 3#$ # 0# 5 # 2 '. 5 /1,,'$ 0* 0# *(, 0 )0 '$ )/$)" 10#*.$058 ,.*2$ 0# 0 0# . ' 2 )0 $)!*.( 0$*) ( 5 * 0 $) !.*( 0# *(, 0 )0 '$ )/$)" 10#*.$05 $) 1 0$( ;

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(-* .#)(- 3 - ) )." , ' , . . -6 ( ' &3 ,' (3 ( , & ( 8 " , 1 , #( #(!- )( )." #(-* .#)(-8

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT /,#(! )( #(-* .#)(5 . !),3 L #( #(! 1 - ' 1" , : // 0* ( ." ) 5 4$0/ 3 . $(, 5 "" " *. ."*; ( ." #, , . 1 - (). &&)1 .) * ,. /(.#& * -- (! , !- 1 , , ')0 ,)' ." - .- ( *& #( ." ")& 8 " , 1 - () #(-* .#)( )( / . )( #." , #, , . 3 ." 8

<2<B2A2? , () * / & $

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#- - & =' ( !#(! -. . ! ( 3 1#." , -*)(-# #&#.3 ), ( )'* . ( - #(7

0# .#)( - .3 ,.# # .#)( #(. ( ( # (- - * , .#)(- #, , . , !#-., .#)( , ), - , #(#(! #, ( 0#! .#)( #, ,!)

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7 .2$ $*/ 5 /01 $*/ , . ' 2 " $+) . 5 ' "1.$ .*) 10$ 8

#( ),' ." (0 -.#! .#)( ." . ." - #, , . 1 , ., (- ,, )(.) ." )&&)1#(! ( **&# .#)( 3 ." * , .),6 ."#- " (! #( ." #(! . ,' :-. ( , 0 ,# .#)(;8 -. . ." . ( 0 ,# .#)( #- (),' &&3 **&# ), &)(! 1#." , 0#-#)( ) ." * , .#)(- (/ &6 * ( #(! )( ." - )* ) ." 0 ,# .#)( ( #(=-#./ #(-* .#)( ( <), ) /' (. ,3 #(-* .#)( #- ( /,#(! ." 0 &/ .#)(8 " . "(# & 0 &/ .#)( ) ." 0 ,# .#)( ) ." * , .),;- 1 - ,,# )/. 3 ." --#!( .) ." * , .), 1") 1 - ) -#)( &&3 --#-. 3 ()." , 8 " --#!( " ( '#&#. ,3 *#&). 1") - ,0 #( ." * (#-" #, ), ( & . , ' *. #( 1#." ' $), * (#-" #,&#( 8 " /'/& . #( 2 -- ) KI5III &#!". ")/,- #( "#- , , ( ' . ." , +/#, ' (.- ) ) /' (. QLLN ), &#!". * , .#)(- (-* .),8

(-* .#)(- 1 , ,,# )/. 3 < )( ." * , .), - * ,. ) ." )(.#(/#(! /,0 #&& ( & ( ), ." */,*)- ) ' #(. #(#(! ." 0 &# #.3 ) ." 8 " - 1 , * , ),' #( 3 KIIR ( 3 KIJI ( #(-* .#)(- )0 ,#(! -* # # , - 1 , ,,# )/. #( , " KIIR ( .) , KIIR8 ( ." 3 , *,#), .) ." # (.5 .). & ) Q / #.- ( (-* .#)(- )( ." * , .),;- &#!". * , .#)(- 1 , )( / . .1 ( JJ ,/ ,3 KIJI ( JM (/ ,3 KIJJ6 1#." P / #.- ( (-* .#)(- )( #(. ( ( ( #,1),."#( --8 ( #.#)(5 JO MI (-* .#)(- 1 , ,,# )/. 3 8 - # ." . #.- -/* ,0#-#)( ) ." * , .), 1 - #( &/ #( ." *,)!, '' ( #'*& ' (. / #.-5 1" ( 0 &/ .#)( 1 - ' )( ")1 ." #,&#( #.- & ')(#.),- ( )(.,)&- #.- )* , .#)(-8 &-) 0 &/ . 1 , , ), - ),, -*)( #(! .) -/ " .#0#.# - - , 1 ., #(#(!5 &#!". .#' &#'#. .#)(- ( &#!". *& ((#(! , ), -8 -. . ." . /,#(! ." #,-. **&# .#)( ), ( ( #( !, (.#(! ( * , .#(! # ( ." , #- ( 2 " (! ) #( ),' .#)( .1 ( ." )* , .#)( & ( )'' , # & #, .), . - ) 8 ( ( 0 ,# .#)( *,) --5 ." * , .#)( & #, .), . ) ) - (). )( / . )0 ,-#!". , ! , #(! ." #( ( # & , -)/, - ) ( )* , .), ( ." #, &#(%- 1#." ." * , .#(! # ( 5 - ." /,#.3 ( - , ,). .#)( #, .), . ) * , ),'- +/ ,. ,&3 )()'# -/* ,0#-#)( ) ." #, )* , .),-8 ! , #(! ." * , .),5 & . , -. . .) ." (0 -.#! .#)( ." . #. " )&&)1 ." )()'# , ), - )( +/ ,. ,&3 -#- -#( ' , KIIQ8 ( #.#)(5 ., (- ,,#(! ." .1) .,)

- ,)' -/-* ( 1 - *. & .) - # , (. *,) /, - ( *)-.")& ,- 1 , #( *& #( ." ( 1 ")& , ?." * , .),@8 - # ." . ." * , .),;- **&# .#)( *,)0# () . #&- , ! , #(! ")1 ." #, , . 1)/& /.#&#- ( 5 . ." .#' 5 #. 1 - - ( - " ,. , )* , .#)(8 -. . ." . ., (- ,,#(! -/ " #, , . .1 ( )* , .),- 1 - (). /(/-/ & ( ." .5 #( -) , - #. 1 - 1 , 5 ." )(&3 )* , .), ), )." ) .")- #, , . 1 - ." ")& ,8 MI

7 .3 (-* .#)( ) .#)( & #, , . = ( .#)( & #(-* .#)( *,)!, '' #( * #(8 Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

<2<B2B

#( ),' ." (0 -.#! .#)( ." . #. " () %()1& ! ) ." 1( ,5 1"# " 1 - )'' , # & )'* (3 ( ." , ), (). 1#."#( #.- , !/& .),3 , '#.5 (), 1 , ." 3 1 , ) ." )(( .#)( .1 ( ." # % . && , ( ." 1( ,8 ( #.#)(5 1 - /( 1 , ." . .1) ),' , /,) )(.#( (. & #, *#&).- " ')0 1#." ." #, , . .) ." * , .),8 " #--/ & .. ,- .) ." /,) )(.#( (. & #, *#&).-5 )&&)1#(! #( # (.- #( #,-* ." . , -/&. #( ." 1#." , 1 & ) ." 5 -. .#(! ." . ." . ." 3 1)/& " 0 .) /( ,!) (!&#-" *,) # # ( 3 & (!/ ! ., #(#(!8 )1 0 ,5 ." #, *#&). &# ( - 1 , (). -/-* ( /. 1 , &#'#. .) ()(= )'' , # & #, ., (-*),. )* , .#)(-5 ( )&&)1#(! ., #(#(!5 ." &#'#. .#)(- 1 , () &)(! , )(-# , **&# & 8 -. . ." . ." , 1 - () ) &#! .#)( ), ( )* , .), .) #( ),' ." /."),#.3 , ! , #(! , '). )* , .#)(-8 . /,." , -. . ." .5 " #. %()1( ." . ." * , .#)( 1 - , '). ( ." . -/ " -' && (/' , ) * )*& 1 - #(0)&0 5 #. 1)/& " 0 . % ( !, . , #(. , -.8 " *, 0#)/-&35 /,#(! ." /,) )(.#( (. & #, )* , .#)(5 - (. .1) #(-* .),- .) ."

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

K; = $. / .2$ > ( )/ !'$"#0 *. / .$ / *! !'$"#0/ ..5$)" , // )" ./8 ."* ) ?*. ( $' !*. . (1) . 0$*) ) ?*. #$. 9 <

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B C 0# .$"#0 0* 1/ '' *. , .0 *! 0# // 0/ *! ) 1) .0 &$)"9

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IH; = ( . 0 0 B/C $)2*'2 > ( )/ 0# ( . 0 0 B/C *) .) ) 0# ( . 0 0 B/C 3# . 0# $. ..$ .B/C *, . 0$)" 0# $. / .2$ $/ B . C '$ )/ 9 <

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!/& .#)( ? @ ) RON<KIJK ) N .) , KIJK ?-/ - +/ (. .) ." # (.@ & 3#(! )1( . "(# & , +/#, ' (.- ( '#(#-., .#0 *,) /, - , & . .) #, )* , .#)(- */,-/ (. .) !/& .#)( ? @ ) KJO<KIIQ #( -7 =*, . 0$*) ' *)0.*'>KH ( )/ 0# . /,*)/$ $'$05 !*. 0# $)$0$ 0$*)8 *)0$)1 0$*)8 0 .($) 0$*) *. $2 ./$*) *! !'$"#0 $) 0# $)0 . /0 *! / ! 059 MJ

& ( * %$ " %$*(%"7 "#& * , .#)( & )(.,)& #- (., & .) )." (( 2 O ( = 5 ."#- #- ." #,-. .#' ." . ." (0 -.#! .#)( )/( ." . ,' #( #( !/& .#)(-8 Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT ! , #(! )* , .#)( & )(.,)&5 !/& .#)( ? @ ) QNR<KIIQ5 J8JRN , +/#, - ." . ( )* , .), -" &&7 B C /0 '$/# ) ( $)0 $) ( 0#* *! 4 . $/$)" *, . 0$*) ' *)0.*' ,,.*2 5 0# 10#*.$059 )

B C 4 . $/ *, . 0$*) ' *)0.*' *2 . )5 !'$"#0 *, . 0 1) . 0# 0 .(/ *! #$/ ;

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

( , ! , .) ." )'*)-#.#)( ) &#!". , 1 = J8RMI ? @ M -. . -7 = .* 1. / . /0 '$/# ,0 ' 0* 0# 10#*.$058 0* ,. 2 )0 0# . 3$)" 0*" 0# . *! $) 4, .$ ) !'$"#0 . 3 ( ( ./>

( , ! , .) ." - & .#)( ) &. ,( . -5 = J8KRN -. . -7 :9? C ) *, . 0*. (1/0 / ' 0 03* /0$) 0$*) '0 .) 0 .* .*( / 3# ): H; 0# ,,.*,.$ 0 3 0# . . ,*.0/ *. !*. /0/ !*. 0# /0$) 0$*) .* .*( 8 *. )5 *( $) 0$*) 0# . *!8 $) $ 0 0# 0 1.$)" , .$* *(( ) $)" *) #*1. !*. ) ) $)" *) #*1. !0 . 0# /0$( 0 0$( *! ..$2 '8 0# 3 0# . *) $0$*)/ 3$'' '*3 0# ,,'$ ' ,' ))$)" ($)$( B/ H;IPNB CC9 *. I; )* ( 0 *.*'*"$ ' $)!*.( 0$*) $/ 2 $' ' <>

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

" ? )-.")& ,@ -. . ." . ." 1( , *,) / , . ,)-. , ), &#!". , 1 1"# " ." * , .),5 /-#(! )'' , # & &#!". *& ((#(! *,)!, ' .) ')(#.), ,)-. ,- ,/& -5 1)/& ." ( " (! - , +/#, .) (-/, ." . ." &#!". .#' &#'#. .#)( ,/& - 1 , )'*&# 1#."8

(3 ,)-. , " (! , +/#, 3 &#!". , 15 . , ." ,)-. , 1 - */ &#-" 5 " .) **,)0 . - 8 ( ." - ) ." # (. &#!". () " (! - " ( **,)0 ( ." * , .), 1 - /( 1 , ." . ." )=*#&). " -1)** )(.) ." &#!". /(.#& . , ." # (.8 MK

+(% %$*(%"7 " /,)* ( #(. ,!)0 ,(' (. & #, ., # ' ( ! ' (. ),! (#- .#)(8 %+$* " $ (7 ( )* , .), '/-. ()'#( . ( )/(. & ' ( ! ,5 *. & .) ." /."),#.35 1") " - ),*), . /."),#.3 .) (-/, ." . && )* , .#)(- ( ' #(. ( ( .#0#.# - ( #( ( ( ,,# )/. .) ." -. ( , , +/#, 3 ." /."),#.3 ? = J8JPN@8 ML

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

" &#!". , 1 #(-.,/ .#)( , ! , #(! ' %#(! ,)-. , " (! , +/ -. 1 - #( * (#-" ( () (!&#-" ., (-& .#)( 1 - )/( 8 " - # ." . ." - ), && ." , 1 1 - , &)( ( ." . ." )'' ( , " -% ), ." &#!". *& (- .) - (. .) & -. ." 0 (#(! ), 8 <2<C2<2> $* $ $ $ ( 7

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT <2<C2=

%#&%) * %$ % " * ( - !/& .#)( ? @ ) QNR<KIIQ ? = @ J8RMI , -- - )'*)-#.#)( ) &#!". , 1 ( -. . -5 $)0 . '$ 7 =B C ) *, . 0*. /# '' )/1. 0# 0:

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

<2<C2@

<2<C2A

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT BILC ) '$"#0 *! 0# 0$*)/ 1) .0 & ) 5 0# *(, 0 )0 10#*.$0$ / *! , $) $) . /*'2$)" 0# $ )0$!$ / ! 05 !$ $ ) $ / *! '$"#0'$) ) *0# . , )$/# $. ..$ ./ $0 $/ // // 0# 08 0 0#$/ 0$( 8 )* !1.0# . 0$*) $/ ) // .5;

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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101

Fairchild SA 227-BC Metro III EC-ITP

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10 February 2011

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

105

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT =2@2@

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112

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( ! ( , &5 *#&).- ) . #( ." & . -. 1 ." , *,#), .) * ,.#(! )( ." ( 2. - .),5 -* # &&3 1" ( ." 1 ." , #- *)), . ." -.#( .#)(8 " , #- () , ), ) ." &#!". , 1 " 0#(! )( -) . ( #. #- *)--# & ." . ." 3 1 , #-., . ,)' ."#- . -% )(-# ,#(! ." . * -- (! , ) , #(! 1 - & 3 / .) ." &#!". , 1 " 0#(! .) 1),% )( * -- (! , - .#(! #( ." #(8 &. ,( .#0 &3 #. #- *)--# & ." . ." &#!". , 1 1 , /( 1 , ")1 *)), ." ./ & 1 ." , )( #.#)(- 1 , . 8 ( (3 - 5 1" ( ." &#!". * ,. (=,)/. .) ." &#!". , 1 1 - #( +/ . &3 *, * , , ! , #(! ' . ),)&)!# & #( ),' .#)(8 %$ + * % * " * " , ), #(!-5 1"# " )(. #( ." #( & KQ '#(/. - ( NR - )( - ) ." &#!".5 *,)0# ( #(-#!". #(.) ." )* , .#)( ( )( / . ) ." &#!".8 " , ), #(! )'' ( - ." #, , . (. , ." ")& #(! * .. ,( . 8 " .')-*" , )( ." &#!". %5 &.")/!" )/.1 , &3 &#!".=" ,. 5 1 - -3'*.)' .# ) #( , -#(! -., -- & 0 &- - ." -#./ .#)( 0 &)* 8 (. ,= , 1 )''/(# .#)(- , 0 & & . ) %*#. /."),#.3 !, # (.5 1#." &#..& ),' & )'' ( #( 0# ( 8 &.")/!" ) %*#. " %- 1 , )'*&#-" 5 ." - " %- 1 , (). )'*&#-" #( ),' & ' (( ,5 .",)/!" " && (! ( , -*)(- 8 " , 1 - &#'#. ),' & 0 &/ .#)( ) ." 1 ." , )( #.#)(- ), #- /--#)( ) 0 #& & )*.#)(-8 ( , &&3 #( -/ " 1 ." , )( #.#)(-5 )( ) ." /( .#)(- ) ." #- .) *,)0# ( /* . ) ." - ) ( , 3 #,*),.-8 " , 1 - () 0# ( ) ."#-8 . #- ** , (. ." . ." , 1 1 , )(. (. .) )(.#(/ .) ")& ( 1 #. ), ( #'*,)0 ' (. #( ." 1 ." ,5 1"# " 1 - ( )*.#)( )(-# ,#(! ." . ." 3 " +/ . / &8 "#& ." #, , . 1 - )(.#(/#(! .) ")& 5 ),% (+/#, - .) ." &. ,( . ,) ,)' 8 "#- 1 - !#0 ( - ( 1 ." , 1 - -)/!". 3 . ." , +/ -. ) ." &#!". , 18 - 1 - &)1 &#'#.- ." &#!". , 1 ()1 & , ." #, - )( &. ,( . - ( ! #( (+/#, , ! , #(! #.- 1 ." ,8 )( #.#)(- 1 , &-) &)1 &#'#.-8 . ." *,)'*.#(! ) ." 1 ." , )( #.#)(- .

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FINAL REPORT ( ) ." .))&- )'' ( , ( /- #- .) '*&)3 ." *,#( #*& - ) 8 " )'' ( , )'*& . ., #(#(! ((/ &&3 /,#(! "#- )'' , # & &3#(! , ,5 /. 1#." *). (.# & )'' ( #''#( (.5 ( #(= *." /( ,-. ( #(! ) ." - *,#( #*& - 1 - * , ')/(.8 ( (/ ,3 KIJJ5 ." ! 0 !,)/( #(-.,/ .#)( .) &#!". , 1- )( -* .- ) 8 #(-.,/ .#)( - * ,. ) ." )'' ( *,) -- 1 - , +/#, .) ) JI ")/,- /, .#)( )0 , * ,#) ) K 3- /. ." )'' ( , , #0 **,)2#' . &3 KW ")/,-5 1"# " 1 - (). +/ . #." , #( #.- /, .#)( ), #.- )(. (.8

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( ." 3 ) ." # (.5 ." )'' ( , & 1 1#." ." )=*#&). 1") " )(&3 $)#( ." )* , .#)( 1 1 %- ), ( 1") " (). )'*& . "#- #(#.# & &#( " % ?-/ - +/ (. .) ." *,) # # ( 3 " %@ 1#." ." * , .),8 1&3 **)#(. )'' ( ,- ' 3 #( #,-. &#!".- #( )'' ( " && (!#(!5 - #-#)(- , ! , #(! ." &#!". , ()1 -)& &3 ." #,-5 3 . ." 3 ) (). *)-- -- 2* ,# ( ." . #- ! #( 1#." .#' 8 ) ."#- ( 5 )* , .),- , , +/#, .) (-/, ." . ( 1&3 *,)'). )'' ( ,- , )(&3 - " /& .) &3 1#." 2* ,# ( )=*#&).-5 1") &.")/!" (). " 0#(! 2 /.#0 /."),#.3 ), ." &#!".5 *)-- -- ,)/. 2* ,# ( ( *,)0# -/**),. .) ." ( 1 )'' ( ,-8 " * , .), " () , -.,# .#)( #( #.- , ! , #(! ."#- , +/#, ' (.5 )(., ,3 .) = 8

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" (0 -.#! .#)( (). - ." . ." *,)0#-#)(- ) !/& .#)( ? @ ) JJPQ<KIJJ5 1"# " " (). (. , #(.) ), . ." .#' ) ." # (.5 - .#- 3 )( ,(- , ! , #(! ." #( * ( (. 0 &/ .#)( ) &#!". " %- ( ." #, ( +/ . **, #- & ) ( # . ;- * , ),' ( 8 " , ), 5 () .3 )'' ( .#)( #- , +/#, 8

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

( #&#(! .) , -- -/ " #--/ - ." * , .), 1 - (). ' .#(! #.- ) &#! .#)(- - ( )* , .), (! ! #( )'' , # & #, ., (-*),. .) )'*&3 1#." ." *,)0#-#)(- ) ,. 8 (* <?@ $ $* $ $ +&&%(* )&%$) " * ) " ' #(. ( ( )(., . , +/#, ." #(. ( ( ,)0# , .) * , ),' &#( ' #(. ( ( ), ." * , .), . , &)( #,*),.5 /- #,*),.5 #,)( = )-. , 0 #,*),. ( && #,*),.5 ( . = )5 *0# . $.,*.0 0# 0 0# , . 0*. . -1 /0/8 3$0# 0# 3.$00 ) ,,.*2 ' *! 0# $)0 $) .>8

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= J8IJPN D J8ILP8

Air Accident Investigation Unit Report 2014-001

127

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT "#& ." "#-.),# & , ), - ) , 1 /.# - ( - 1 , ' ( ! 3 ." * , .), )&&)1#(! , ./,( ) ." , ), -5 #. #- & , ." . ." 3=.)= 3 , 1#(! ,, (! ' (.- 1 , #(! ),! (#- &) &&3 #( ." -& ) ( /( , ." )(.,)& ) ." 1( ,8 )(- +/ (.&35 -/* ,0#-#)( ) , 1 ,)-. ,- 3 ." ")& , 1 - (). - .#- .),38

" * , .),;- *,) /, ), , 1 ' ' ,- .) , +/ -. " (! ) /.# - 1 - *,)'/&! . .) , 1- #( * (#-" ( () 0# ( ) ( (!&#-" 0 ,-#)( 1 - )/( 8 " )=*#&).;- , (. )(. #( () #( # .#)( ." . " " (3 )'* . ( 3 #( * (#-" ( && #(. ,= , 1 )(0 ,- .#)(- , ), )( ." 1 , )( / . #( (!&#-"8 . #- ." , ), /( & , # ." )=*#&). 1 - 1 , ) ." * , .),;- *,) /, ( ."#- #&&/-., . - ." # # /&.# - ) ( .#0 (!&#-" -* %#(! , 1' ' , )'#(! )(0 ,- (. 1#." *,) /, - , . )(&3 #( * (#-"8

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128

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Air Accident Investigation Unit Report 2014-001

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT ), #(!&35 ." /.# - ( , -*)(-# #&#.# - ) ." ")& ,5 /( , 1")- /."),#- .#)( ." #, , . 1 - )* , .#(!5 1 , (). ,,# )/. #( ), ( 1#." = 8 "#- -#./ .#)(5 1" , )'' , # & #, - ,0# 1 - #(! )* , . 1#."#( ." ( ." #, ,,# , 1 - (). ." : #, , . )* , .),;5 1 - #( )(., 0 (.#)( ) !/& .#)( ? @ ) JIIQ<KIIQ8

/ - +/ (. .) ." # (.5 ." * , .), #( #.- * , .#)( & .. , )8 M<JJ5 - . )/. " (! - .) #.- )* , .#)( & )(.,)& *,) /, - #( &/ #(! : &#!". #-* . " ( )(.,)&;8 " " (! - - - . )/. #( ."#- & .. , , -- # # ( # - #( #.- )* , .#)(8 ! , #(! . ,. ( )(.#(/ .#)( ) **,) "5 ." * , .), -. . ." . :$) / *! ($// ,,.* # !.*( ($)$(1( 2 '1 / 1 0* 3 0# . 1/ /8 ,.* 0* 0# '0 .) 0$2 >; "

(0 -.#! .#)( #- )( ,( ." . , +/#,#(! #0 ,-#)( . , -#(!& **,) " #- (). #( ." #(. , -.- ) # # ( 3 ), - .3 -#( #. )/& *, --/,#- &#!". , 1 #(.) )'*& .#(! ( #( **,)*,# . & ( #(! 1" ( #. 1)/& 1#- , .) ")& ( &&)1 ." 1 ." , .) #'*,)0 8 )(- +/ (.&35 ." (0 -.#! .#)( #--/ - .3 )'' ( .#)( .) ." * , .), .) , 0# 1 #.- *,) /, - #( ."#- , ! , 8

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130

" * , .), " ()'#( . &#!". .3 ( ! , ? @ 1")5 #( #.#)( .) )." , /.# -5 1 - . -% 1#." ." , -*)(-# #&#.3 ) ')(#.),#(! ." - .3 ) ." )* , .#)(8 ) ., #(#(! #( ." ,)& ) #, - .3 ), # (. *, 0 (.#)( 1 - !#0 ( .) ."#- #( #0# / & ( )'*& .#)( ) , )!(#- # (. #(0 -.#! .#)( -"),. )/,- 1)/& " 0 ( "#!"&3 ( # # &8 "#- & . ." 1#." ." /( (0# & . -% ) .,3#(! .) & ( ." *,). .#)( ( *,) / .#)( ) ." )* , .#)( 1#.")/. (3 ., #(#(! ( &#..& , -)/, -8 ), #(!&35 " # (). " 0 +/ . )'* . ( # - --) # . 1#." "#- *)-#.#)(8

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*/ %## $ * %$ %2 @

. #- , )'' ( ." . &#!".&#( 8 8 -")/& #'*& ' (. -/#. & ( **,)*,# . ., #(#(! ), * ,-)(( & , -*)(-# & ), &#!". - .3 ( # (. *, 0 (.#)(8 ? =;<?;;@@

=2C2?

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Fairchild SA 227-BC Metro III EC-ITP

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10 February 2011

FINAL REPORT

132

" (0 -.#! .#)( #- ) ." )*#(#)( ." . ." # % . && ,5 ( : #, ,,# ! )(., .),; - #( #( !/& .#)( ? @ ) KJJJ<KIIN5 ,.# & K ? @5 1 - *),., 3#(! #.- & - ( #,&#( 8 " (0 -.#! .#)( /,." , )(-# ,- ." . #( ." 3 - ) ." ., 0 &&#(! */ &# 5 ( #,&#( #- -3()(3')/- 1#." ( #, ,,# ,5 ( (.#.3 1"# " #- , +/#, .) ")& 0 &# )* , .#(! &# ( 8 / " ( )* , .#(! &# ( ( )(&3 " & 3 ." ")& , ) 0 &# 8 " # % . && , 1 - ()'#( . - $)#(. : ,0# ,)0# ,; #( ." #, ,0# )'* (- .#)( !, ' (. !, (. ), #(! .) !/& .#)( ? @ ) JIIQ<KIIQ8 "

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!/& .#)( ? @ ) JIIQ<KIIQ8

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133

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10 February 2011

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2 2 >;A 7 87 * , .),- "(# & )! 3-. ' !/& .#)( KIMK<KIIL8 Air Accident Investigation Unit Report 2014-001

135

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FINAL REPORT =2C2A

136

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!/& .#)( ? @ ) KJO<KIIQ5 " *. ,

8 Air Accident Investigation Unit Report 2014-001

137

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FINAL REPORT

138

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139

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Cork Airport

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FINAL REPORT

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140

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141

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142

-- (! , - .- , -#!( .) *,)0# *,). .#)( ), ." ) /* (.- #( ." 0 (. ) ( # (. 1#." & * -., *- *,)0# #(! , -., #(. ! #(-. & , .#)(8 ) *, = # (. .- 1 , # (.# # 1#." ." * -- (! , - .-5 - . &)), , #&-5 & * -., *- ), & * -., * .. "' (. #..#(!-8 ""% * %$ % *) / .) ." ()(= &&) .#)( ) - .- . " %=#( ." (0 -.#! .#)( 1 - /( & .) . ,'#( 1#." ,. #(.3 1" , && * -- (! ,- 1 , - . 8 " *, .# ) #, ,,# ,- (). *,)0# #(! &&) . - .- ' 3 *, - (. -#!(# # (. " && (! - .) /./, - .3 #(0 -.#! .#)(-8 . # $ * %$ % +# $ *%() . ." *, = &#!". *& ((#(! -. ! 5 ." &#!". , 1 1 - *,) &3 1 , ." . ." ., ( ?' -/, . IO8II ",-@ 1 - /*1 , - . ." . .#' 8 "#- ' 3 " 0 *,)0# -/ # # (. , --/, ( , ! , #(! ." 1 ." , )( #.#)(- . 8 )1 0 ,5 &)- , - ,/.#(3 ) ." ( -")/& " 0 ! ( , . )( ,(- ." . )( #.#)(- '#!". (). -/#. & ), ( **,) "5 1#." LII ' 0#-# #&#.3 ), -.8

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

1 - -"),. #-. ( 1 38 " ) %*#. !, # (. 1 - & .6 . () *)#(. # ." )'' ( , . % " ,! ), ) $ .#0 &3 -- -- ." -#./ .#)(8 #." , 1 - ." , -.,/ ./, )(-# , .#)( ) (3 *& ( )." , ." ( .) & ( . ." -.#( .#)(8 )(-# ,#(! ." -. ( , ) "#- )'' ( ., #(#(! ( "#- &#'#. )'' ( 2* ,# ( 5 ."#- #- (). ( -- ,#&3 , & .#)( )( ." )'' ( , /. *,) &3 '), -3'*.)' .# ) ." #( +/ . ., #(#(! *,)0# 8

" #(*/. ( --#-. ( ." . )/& *,)0# 3 ." )=*#&). 1 - &#'#. / .) ." )(.#(/ & ' ( - ) &3#(! ." #, , . ' (/ &&3 )( , 1= . #(-.,/' (.-8 #-#)(- ** , .) " 0 ( ' )( , .#0 -#-5 - , -/&. ) ." /( )& #(! 0 (.-5 , ." , ." ( *,)= .#0 &3 - * ,. ) ( )0 , && *& (8 .. , &. ,( .#0 5 1"# " *, - (. #.- & 1" ( ." 1 ." , )( #.#)(- .

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"#& #( ." ")& 5 ." )*.#)( .) #0 ,. 1 - )(-# , 3 ." )'' ( , /. " 1 - , &/ . (. .) ) -)8 #." ." - #'*,)0#(!5 ." )'' ( , *,) &3 &. ." . ()." , **,) " " .. , " ( ) -/ --5 -*#. ." -.#&& *)), )( #.#)(-8 0 ( # ."#- ."#, **,) " 1 - /(-/ -- /& ." )*.#)( .) #0 ,. 1)/& -.#&& ." , - / & 1 - (). ( #--/ 8 ( .. '*.#(! ."#, **,) " ." , 1 - )(-# , & *, --/, .) "# 0 & ( #(!8 " )* , .#)( ) ." *)1 , & 0 ,- 3 ." )( ." #( & **,) " 1 - *,) &3 ( .. '*. 3 ." )'' ( , .) , / ." 1),%&) )( ." 5 - ." )/& ." ( )( (., . )( )(.,)& ) ." &#!". * ." ( *)-#.#)(#(! ." #, , . /, . &38 " ( ." #, , . , " ." )'' ( , .)& ." .) : )(.#(/ ;8 "#- *& ." #( # # /&. *)-#.#)(5 - ." *)#(. . 1"# " .) )'' ( !)= ,)/( ()1 ' /( & ,8 &.#' . &35 1#." ." #, , . . 0 ,3 &)1 " #!". ." ! ( .) & 0 & ." #, , .5 *,) &3 (.# #* .#(! !)= ,)/( &&8 #.")/. #, . )(.,)& ) ." *)1 , & 0 ,- ." 1 - /( & .) #, .&3 . !)= ,)/( 8 . ."#- *)#(. ." *)1 , & 0 ,- 1 , , . , #(.) ." . , (! 5 ( .#)( ." . 1 - (). *)--# & 1#.")/. #,-. &# .#(! ." . & . " -8 "#& &# .#(! ) ." . & . " - , +/#, #(. (. ( ' 3 " 0 ( / .) ." (.# #* .#(! & ( #(!5 #. ((). -. . #(#.#0 &3 1" ." , ." , . , .#)( ) ." *)1 , & 0 ,- #(.) ." . , (! 1 - #(. (.#)( & ), ().8

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FINAL REPORT &.")/!" ." -. && 1 ,(#(! "),( -)/( -"),.&3 . ,1 , -5 ."#- 1 - (). )'' (. )( 3 ." &#!". , 1 1")- /&& .. (.#)( 1 - *,) &3 0). .) .,3#(! .) --#'#& . 1"3 ( 1" . ." #, , . 1 - )#(!5 .) ." 2. (. ." . ." 3 ' 3 (). " 0 0 ( ( 1 , ) ." -)/( 8

" +/ -.#)( ,#- - - .) 1"3 '#(#' 1 , , * . &3 , " 3 -/ " ( #( 2* ,# ( , 15 * ,.# /& ,&3 1"#& &3#(! ( #, , . +/#** .) &3 *, #-#)( **,) " - 1#." -/ " -# #(-.,/' (. .#)( ( +/#*' (.8 " (0 -.#! .#)( (). - ." . ." # (). , ), (3 #- /--#)( , ! , #(! ." )(.#(/ .#)( ) ." .", **,) " - 1#.")/. " 0#(! ." , +/#, '#(#'/' - ), - (. #( &)1 8

. #- *)--# & ." . -/ " #- /--#)( ) /,, *,#), .) ." , ), #(! )'' ( #(! -#( 1" ( ." #, , . , " ." )'' ( , - # : )(.#(/ 5; ."#- 1 - (). +/ ,# 3 ." )=*#&). 1") %()1& ! ." #(-.,/ .#)( ( )(.#(/ .) - ( 8 " , ), ." . ." )'' ( ,;- **,) " ,# #(! #( &/ ." ( '#(#' #(! - . ( *").)!, *"# 0# ( )( #,'- ." . ."#- 1 - )( ),, .&38

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147

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FINAL REPORT >2

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10 February 2011

FINAL REPORT 7 8

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Fairchild SA 227-BC Metro III EC-ITP Cork Airport 10 February 2011

FINAL REPORT

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160

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10 February 2011

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). -/ $ . .) , 0# 18

6 6C@A ('-"'."' "+0(+-!"' ,, ,$, " #, , . )(.#(/#(! #,1),."#( -- ( ." - ,0# #&#.3 ) )." )* , .#)( & ( ' ,! ( 3 +/#*' (. -" && (-/, 37 L8 " )'*&#-"' (. ) *, > &#!". #(-* .#)(-6 < 6 6C@C6A %",-, -2)" % -"(', ' ,, +2 -( ',.+ -! - -! "+ + - ", "- -( & $ -! "'- ' %" !-=6

M8 " , .# # .#)( #( ), ( 1#." ." . -* # # #( *)#(. 8 8NKO ( =), *)#(. 8 8OKL5 - **&# & 5 ) (3 . ( ' ! .#(! - )* , .#)(5 . %#(! #(.) )/(.5 ), && & ,! #, , . ), #, , . /- ), )'' , # & #, ., (-*),.5 ." '#(#'/' +/#*' (. &#-. ( )( #!/, .#)( 0# .#)( &#-. - **&# & .) ." #, , . .3* 6

) + -(+ (&)%" ' 8 ('9 (&)%" '

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163

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT N8 " )'*&#-"' (. ) && ' #(. ( ( 5 #( ), ( 1#." ." 8 8NKM **,)0 #, , . ' #(. ( ( *,)!, '' 6

164

). -/ $ . .) , 0# 18

O8 ), && & ,! #, , . ), #, , . /- ), )'' , # & #, ., (-*),. ." ( &3-#- ) ." .#0 ( -- ) ." 8 8NKM **,)0 ' #(. ( ( *,)!, '' 6

). -/ $ . .) , 0# 18

P8 " )'*&#-"' (. ) (3 **&# & @#A #,1),."#( -- #, .#0 5 @##A )* , .#)( & #, .#0 1#." )(.#(/#(! #,1),."#( -- #'* .5 @###A )(.#(/ #,1),."#( -- , +/#, ' (. -. &#-" 3 ." ! ( 35 @#0A ' -/, - ' ( . 3 ." )'* . (. /."),#.3 #( #'' # . , .#)( .) - .3 *,) & '6 Q8 " )'*&#-"' (. ) ') # # .#)(- ( , * #,- #( ), ( 1#." 8 8NKO6 R8 ), ()(>' ( .),3 ') # # .#)(- ( =), #(-* .#)(-5 ), && & ,! #, , . ), #, , . /- ), )'' , # & #, ., (-*),. ." -. &#-"' (. ) ( ' ) #' (. *)&# 36 S8 #(. ( ( " % &#!".- 1" ( ( -- ,38

). -/ $ . .) , 0# 18

, .) .#)( 8 8NKO8 ). -/ $ . .) , 0# 18

). -/ $ . .) , 0# 18

6 6C@B "+ + - "'- ' ' +( + && 6 6C@B; < #(. ( ( ) " #, , . -" && ),! (#- #( ), ( 1#." ( #, , . ' #(. ( ( *,)!, '' 8

6 6C@B; < " #, , . ' #(. ( ( *,)!, '' ( (3 -/ - +/ (. ' ( ' (.- -" && **,)0 3 ." )'* . (. /."),#.38

) + -(+ (&)%" ' 8 ('9 (&)%" ' #(. ( ( *,)!, '' , , ( > > MMR #.#)( L 0#-#)( K . ML=LM=MKKT 1 - , 0# 1 ( )/( ! ( , &&3 )'*&# (. 1#." 8 8NKM , +/#, ' (.-8 ) /,." , )'' (. )( 8 8NKM -/ >- .#)(- #- ." , ), , +/#, 8 " ' #(. ( ( *,)!, '' 1 - **,)0 3 5 ." )'* . (. /."),#.3 ), * #(8

6 6C@C "+0(+-!"' ,, "+ -"/ ,

). -/ $ . .) , 0# 18

6 6C@D - (+ ( " " -"(', ' ) "+, ' ! -" && -- -- ( ') # # .#)(- ( , * #,- ,,# )/. /-#(! . **,)0 3 ." ! ( 3 ), 3 ( **,)0 ,.>ML -#!( ),! (#- .#)(5 - **,)*,# . 8

6 6C@E "+ + - ('-"'."' "+0(+-!"' ,, (+ 2,- &

6 6C@F ) + -(+7, !'" % ( 2,- & 6 6C@F ; < ( ." - ) )'' , # & #, ., (-*),.5 #( #.#)( .) ." , +/#, ' (.- ) 8 8NKP5 ( )* , .), -" && /- ( #, , . . "(# & &)! -3-. ' )(. #(#(! ." )&&)1#(! #( ),' .#)( ), " #, , .7 L8 ( ),' .#)( )/. " &#!".5 ( -- ,3 .) (-/, )(.#(/ &#!". - .35 ( 6

('9 (&)%" ' (6 G

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

Air Accident Investigation Unit Report 2014-001

165

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT M8 " /,, (. ' #(. ( ( -. . ' (. !#0#(! ." #, , . ' #(. ( ( -. ./- ) 1" . - " /& ( )/. ) *" - ' #(. ( ( #- ( 2. / 2 *. ." . ." )'* . (. /."),#.3 ' 3 !, .) ." ' #(. ( ( -. . ' (. #(! % *. &- 1" , 5 ( 6 N8 && )/.-. ( #(! ,, .- , .# # .#)(- ." . . ." )* , .#)( ) ." #, , .5 ( 6

O8 (3 ( -- ,3 !/# ( #(-.,/ .#)(- )( ' #(. ( ( -/**),. ,, (! ' (.-8

166

6 6C@F ; < " #, , . . "(# & &)! -3-. ' ( (3 -/ - +/ (. ' ( ' (. -" && **,)0 3 ." )'* . (. /."),#.38 6 6C@F ; < ( )* , .), -" && (-/, ." . ." #, , . . "(# & &)! #- , . #( ), NQ ')(."- . , ." . ) ." & -. (.,38

('9 (&)%" ' (6 A@ " /,, (. ' #(. ( ( -. . ' (. ), ." )'*& . #, , . 1 - (). &) . #( ." "(# & )! ), ." #, , . ) /' (. .#)( )& , ( 1 - (). &) . )( ." #, , .8 ('9 (&)%" ' (6 AA " /,, (. ")& #. ' &#-. @ A B&#-. ) ,, .-C 1 - (). &) . #( ." "(# & )! ), ." #, , . ) /' (. .#)( )& , ( 1 - (). )/( #( ." #, , .8 ('9 (&)%" ' (6 AB " #, , . "(# & )! # (). )(. #( (3 ( -- ,3 !/# ( #(-.,/ .#)(- )( ' #(. ( ( -/**),. ,, (! ' (.- ), " #, , .8 ). -/ $ . .) , 0# 18

). -/ $ . .) , 0# 18

6 6C@G + ', + ( "+ + - ('-"'."' "+0(+-!"' ,, + (+ ,6

). -/ $ . .) , 0# 18

6 6D@A "'- ' ' - 6 6D@A; < " * ,-)( ), ),! (#- .#)( ' #(. #(#(! ( #, , . -" && " 0 -- .) ( /- )(&3 **&# & /,, (. ' #(. ( ( . #( ." * , ),' ( ) ' #(. ( ( #( &/ #(! ') # # .#)(- ( , * #,-8

) + -(+ (&)%" ' 8 ('9 (&)%" ' ). -/ $ . .) , 0# 18

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

). -/ $ . .) , 0# 18

). -/ $ . .) , 0# 18 ('9 (&)%" ' (6 G

. )/& (). -. &#-" ." . . **,)0 3 ), 3 ( **,)0 ,.>ML -#!( ),! (#- .#)( 1 - 0 #& & .) -/**),. ." , !/& , , )( #!/, .#)( ) ." #, , . ,)' * -- (! , .) ,!) )* , .#)(- ( 0# 0 ,- 8 ). -/ $ . .) , 0# 18 ). -/ $ . .) , 0# 18

167

) + -(+ (&)%" ' 8 ('9 (&)%" ' ('9 (&)%" ' (6 A " , )( #!/, .#)( ) ." #, , . 1 - * , ),' 3 /( /."),#- * ,-)(( & 1#.")/. , , ( .) **,)0 . ( 1 - (). , ), ), ,.# # 8

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT @ A && ' #(. ( ( -" && * , ),' /-#(! ." .))&-5 +/#*' (. ( ' . ,# & -* # # #( ." 8 8OKL ' #(. ( ( . /(& -- )." ,1#- -* # # 3 ,.> LOP8 " , ( -- ,35 .))&- ( +/#*' (. -" && )(.,)&& ( &# , . .) ( ) # # &&3 , )!(#- -. ( ,

168

). -/ $ . .) , 0# 18

@ A " , #( 1"# " ' #(. ( ( #- ,,# )/. -" && 1 && ),! (#- ( & ( #( , -* . ) #,. ( )(. '#( .#)(8

). -/ $ . .) , 0# 18

@ A && ' #(. ( ( -" && * , ),' 1#."#( (3 (0#,)(' (. & &#'#. .#)(- -* # # #( ." 8 8OKL ' #(. ( ( . 8

). -/ $ . .) , 0# 18

@ A ( - ) #( & ' (. 1 ." , ), & (!."3 ' #(. ( ( 5 *,)* , #&#.# - -" && /- 8

). -/ $ . .) , 0# 18

@ A . , )'*& .#)( ) && ' #(. ( ( ! ( , & 0 ,# # .#)( '/-. ,,# )/. .) (-/, ." #, , . ), )'*)( (. #- & , ) && .))&-5 +/#*' (. ( (3 )." , 2., ( )/- * ,.- ( ' . ,# &5 ( ." . && -- * ( &- , ')0 " 0 ( , #.. 8

). -/ $ . .) , 0# 18

6 6D@C "+ + - -, @ A (3 #, , . . ." . " 4 , - - ,#)/-&3 ." &#!". - .3 -" && , .# # ), /,." , &#!".8 @ A (&3 ." /."),#- ,.# 3#(! -. 5 ), #(! .) *)#(.- 8 8SKL @ A L5 8 8SKL @ A M5 8 8SKL @ A5 8 8SKL @ A ), (( 2

@ ,.>LOPA ( # 5 /-#(! 8 8OKL ' #(. ( ( . 5 1" ." , ( #, , . . " 4 , - - ,#)/-&3 ." &#!". - .3 ( ." , ), # 1" ( ( 1"# " , .# # .#)( .#)( -" && . % ( ), /,." , &#!". ( 1"# " . , .# # .#)( ( ,, 8 )1 0 ,5 ."#- ) - (). **&3 1" (7

) + -(+ (&)%" ' 8 ('9 (&)%" ' + -( ('9 (&)%" ' , B ' C6 + -( ('9 (&)%" ' , B ' C6

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

). -/ $ . .) , 0# 18 ). -/ $ . .) , 0# 18 + -( ('9 (&)%" ' , B ' C6

+ -( ('9 (&)%" ' , B ' C6

). -/ $ . .) , 0# 18 ). -/ $ . .) , 0# 18

* , .), )'*&# ( = )(> )'*&# ( 8 169

). -/ $ . .) , 0# 18 ) + -(+ (&)%" ' 8 ('9 (&)%" ' , .) ),' LO **,)0 & , , ( 8 8KNO . LR=KT=KT8

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT 6 6G@C; < ).1#."-. ( #(! * , !, *" @ A5 ), )'' , # & #, ., (-*),.5 ." **,)0 & -" && * ,. ) ." #, )* , .), ,.# # . #--/ 3 ." )'* . (. /."),#.35 ), ." #, , . )* , . 8 6 6G@C; < " - )* ) 1),% ' .) )(-.#./. ." **,)0 & -" && -* # # #( ." )(.#(/#(! #,1),."#( -- ' ( ! ' (. 2*)-#.#)( #( ), ( 1#." *)#(. 8 8RKO8 6 6G@D ('-"'."' "+0(+-!"' ,, ' & '- 1)(,"-"(' 6 6G@D; < " )(.#(/#(! #,1),."#( -- ' ( ! ' (. ),! (#- .#)( -" && *,)0# )(.#(/#(! #,1),."#( -- ' ( ! ' (. 2*)-#.#)( )(. #(#(! ." )&&)1#(! #( ),' .#)(7

170

" * , .),5 ) > >NO #--/ 3 8

#.#)( K , 0#-#)( LR . KL=KM=MKLL .#)( K8M , ,-8

) + -(+ (&)%" ' 8 ('9 (&)%" ' #.#)( K , 0#-#)( LR . KL=KM=MKLL **,)0 3 )( KM=KM=MKLL 1 - .#0 )( ." . ) ." # (.8 ('9 (&)%" ' (6 AC " 1 - )/( .) " 0 ." )&&)1#(! #- , * ( # -6 .#)( K8M ) - (). - ,# ." .3* ) )* , .#)( ( ' % - () , , ( .) ." )* , .#)( ) ." >MMR #, , . #( ." -& ) (5 (

, & ( 8 .#)( P8O ) - (). &#-. )(., . ,.> LOP ' #(. ( ( ),! (#- .#)(-8 " , #- () &#-. ) **,)0 ' #(. ( ( *,)!, '' - )(. #( #( ." 8

L8 -. . ' (. -#!( 3 ." )/(. & ' ( ! , .) )( #,' ." . ." ),! (#- .#)( 1#&& 1),% #( ), ( 1#." ."#- ,. ( ." 2*)-#.#)( . && .#' -5 ( 6

, .) .#)( L8L8

M8 " ),! (#- .#)(D- - )* ) 1),%5 ( 6 N8 " .#.& @-A ( ( ' @-A ) * ,-)(@-A , ,, .) #( *)#(.- 8 8RKQ@ A5 8 8RKQ@ A5 8 8RKQ@ A ( 8 8RKQ@#A5 ( 6

, .) .#)( K8M8 , .) .#)( L8N

O8 ( ),! (#- .#)( " ,. -")1#(! --) # . " #(- ) , -*)(-# #&#.3 .1 ( && ." * ,-)(@-A , ,, .) #( *)#(.- 8 8RKQ@ A5 8 8RKQ@ A5 8 8RKQ @ A ( 8 8RKQ@#A5 ( 6

, .) .#)( K8O ( L8P8

P8 &#-. ) ." #,1),."#( -- -. , ,, .) #( *)#(. 8 8RKR5 -* # 3#(!5 1" , **&# & 5 ." -. /."),#- .) #--/ * ,'#.- .) &3 #( ), ( 1#." *)#(. 8 8RLL@ A5 ( 6

, .) .#)( T8L8M8

Q8 ! ( , & - ,#*.#)( ( &) .#)( ) ." #&#.# -5 ( 6

, .) .#)( L8S8

R8 ,) /, - -* # 3#(! ")1 ." )(.#(/#(! #,1),."#( -- ' ( ! ' (. ),! (#- .#)( (-/, - )'*&# ( 1#." ."#- ,.5 ( 6

, .) .#)( M8

S8 " )(.#(/#(! #,1),."#( -- ' ( ! ' (. 2*)-#.#)( ' ( ' (. *,) /, -5 ( 6

, .) .#)( L8LL8

T8 " &#-. ) **,)0 #, , . ' #(. ( ( *,)!, '' -5 ),5 ), #, , . (). #(0)&0 #( )'' , # & #, ., (-*),.5 ." &#-. ) 9! ( ,# : ( 9 - &#( : ' #(. ( ( *,)!, '' -8

+ -( '('9 (&)%" ' (6 AC

6 6G@D; < " )(.#(/#(! #,1),."#( -- ' ( ! ' (. 2*)-#.#)( ( #.- ' ( ' (.- -" && **,)0 3 ." )'* . (. /."),#.38 6 6G@D; < ).1#."-. ( #(! * , !, *" @ A5 '#(), ' ( ' (.- .) ." 2*)-#.#)( ' 3 **,)0 #( #, .&3 .",)/!" ( #( #, . **,)0 & *,) /, 8 " #( #, . **,)0 & *,) /, -" && #( ." '#(), ' ( ' (. &#!# & 5 -. &#-" 3 ." )(.#(/#(! #,1),."#( -- ' ( ! ' (. ),! (#- .#)( - * ,. ) ." 2*)-#.#)( ( **,)0 3 ." )'* . (. /."),#.3 , -*)(-# & ), ." . )(.#(/#(! #,1),."#( -- ' ( ! ' (. ),! (#- .#)(8

#.#)( K , 0#-#)( LR . KL=KM=MKLL **,)0 3 )( KM=KM=MKLL8 ). -/ $ . .) , 0# 18

Air Accident Investigation Unit Report 2014-001

171

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT 6 6G@E "%"-" , 6 6G@F +,('' % *."+ & '-, 6 6G@G "+0(+-!"' ,, /" 0 - 6 6G@H ('-"'."' "+0(+-!"' ,, ' & '- 6 6G@H; < && )(.#(/#(! #,1),."#( -- ' ( ! ' (. -" && ,,# )/. ), #(! .) ." *, - ,#*.#)(- ) 8 / * ,. 8

172

). -/ $ . .) , 0# 18 ). -/ $ . .) , 0# 18 ). -/ $ . .) , 0# 18 ) + -(+ (&)%" ' 8 ('9 (&)%" ' , .) / * ,. 8

6 6G@H ; < ), 0 ,3 #, , . ' ( ! 5 ." **,)0 )(.#(/#(! #,1),."#( -- ' ( ! ' (. ),! (#- .#)( -" &&7

L8 0 &)* ( )(.,)& ' #(. ( ( *,)!, '' ), ." #, , . ' ( ! #( &/ #(! (3 **&# & , &# #&#.3 *,)!, '' 5

, .) 8 8NKM@ A8

M8 , - (. ." #, , . ' #(. ( ( *,)!, '' ( #.- ' ( ' (.- .) ." )'* . (. /."),#.3 ), **,)0 &5 /(& -- )0 , 3 ( #( #, . **,)0 & *,) /, #( ), ( 1#." *)#(. 8 8NKM@ A5 ( *,)0# )*3 ) ." *,)!, '' .) ." )1( , ) #, , . (). #(0)&0 #( )'' , # & #, ., (-*),.5

, .) 8 8NKM@ A8

N8 ( ! ." **,)0 & ) ') # # .#)( ( , * #,-5

, .) 8 8NKL8Q8

O8 (-/, ." . && ' #(. ( ( #- ,,# )/. #( ), ( 1#." ." **,)0 ' #(. ( ( *,)!, '' ( , & - #( ), ( 1#." 8 8 / * ,. 5

, .) 8 8NKL8N8 ( / * ,. 8

P8 (-/, ." . && **&# & #,1),."#( -- #, .#0 - ( )* , .#)( & #, .#0 - 1#." )(.#(/#(! #,1),."#( -- #'* .5 , **&# 5

, .) 8 8NKL8P8

Q8 (-/, ." . && .- #- )0 , /,#(! - " /& ' #(. ( ( ), , *),. , ),, . 3 ( **,)*,# . &3 **,)0 ' #(. ( ( ),! (#- .#)(5

, .) 8 8NKL8M8

R8 (-/, ." . ." #, , . #- . % ( .) ( **,)*,# . &3 **,)0 ' #(. ( ( ),! (#- .#)( 1" ( 0 , ( -- ,35 S8 )), #( . - " /& ' #(. ( ( 5 ." **&# .#)( ) #,1),."#( -- #, .#0 -5 ." , *& ' (. ) - ,0# &# &#'#. * ,.-5 ( )'*)( (. #(-* .#)( .) (-/, ." 1),% #- ,,# )/. *,)* ,&35

+ -( '('9 (&)%" ' (6 A

T8 ( ! ( , "#0 && )(.#(/#(! #,1),."#( -- , ), - ( =), )* , .),D- . "(# & &)!8

, .) 8 8NKP ( 8 8NKQ8

LK8 (-/, ." . ." #!". ( & ( -. . ' (. , & .- ." /,, (. -. ./- ) ." #, , .8

, .) ." #(. ( ( #&#.3 @ )&)!( A 1 #!"#(! , *),. ) LL .) , MKLK ), #, , . 1 #!". 1#." * -- (! , - .- , ')0 ( ." #(. ( ( ,)0# , 1 #!"#(! , *),. ) LM=LL=MKLK ), #, , . 1 #!". 1#." * -- (! , - .- #(-. && 8

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+ -( '('9 (&)%" ' (6 A

173

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT M )'*)( (. ' #(. ( ( 5 #( &/ #(! (!#( ' #(. ( ( 5 ." )(., . - , ,, .) #( * , !, *" @ A ' 3 #( ." ),' ) #( #0# / & 1),% ), ,- , -- .) ." ,.>LOP ' #(. ( ( ),! (#- .#)(8

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+ -( ('9 (&)%" ' , A4 B ' C6 175

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

176

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+ -( '('9 (&)%" ' (6 AD

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, .) ,.>LOP8 8PK8

177

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

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FINAL REPORT

% (6 B 9 .&& +2 ( + , ( ('9 (&)%" '

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT AC6

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181

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

183

Fairchild SA 227-BC Metro III EC-ITP

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FINAL REPORT

# % # # % " ! # # % # # % # *//1(' &0 % 2&+*' % &,(-'(' &0 ! &/ ).++.3/ # ! "

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Air Accident Investigation Unit Report 2014-001

185

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

186

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Air Accident Investigation Unit Report 2014-001

187

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

188

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189

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT KT8NP7NR KT8NT7PL

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191

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

192

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

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Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT )) ' "1

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Air Accident Investigation Unit Report 2014-001

197

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT )) ' "1 .&& +2 ( +() %% + 1 &"' -"(' )(+-

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" -*#(( , . ." )8 M ( )8 N & &) .#)(- 1 , .),( . ." ),1 , ( ) ." /.>)/. 1"#& ." /.>)/. . ." )8 O & &) .#)( 1 - /( ' ! 8 ) *)-#.#0 & )/(. ,1 #!". ' ,%- ), (.- 1 , (). )( ." -*#(( ,8 " /&%" 2"# #. , ,1 , #'* . ")& #( ." &) .#)( )(-#-. (. 1#." ." )/(. ,1 #!". ,)' ." )8 O *,)* && , & )(. .#(! ." /&%" 8 " ." , -*,#(! ")/- 1 - () &)(! , .. " .) ." 3&#( ,8 && )/, )&.- ." . .. " ." ." , -*,#(! ")/-#(! .) ." 3&#( , 1 , -" , ( ." #, -" (%- , ' #( 1#."#( ." 3&#( ,8 ))%#(! .",)/!" ." "/ , ./, . ." )8 L & -) % . &) .#)( , 0 & ." . && )/, *#. " " (! &#(%- 1 , -.#&& .. " .) ." *#. " " (! ,) 8 " &#(%- 1 , #-.),. /. #(. . ? ()( ) ." 3 & .- 1 , */&& .",)/!"8 " *#. " " (! ,) ** , .) #(. . ( -&#!".&3 (.8 " 9 . : ./ &) . #(-# ." *#. " " (! ,) 1 - -.#&& ., .) ." )/. , ( ) ." *#. " " (! ,) 8 +() %% + % (6 A ; -< "#- *,)* && , & 1 - )/( &))- ,)' ." "/ 8 " )/(. ,1 #!".5 ." & , . #(#(! " , 1 , 5 ( ." *#. " " (! *#( 1 , && '#--#(!8 2 '#( .#)( ) ." /.. ) ." & , 0 & ." . && O *#. " " (! *#( #(-. && .#)( )&.- -" (%- , ' #( #( ." #, , -* .#0 )&. ")& -8 " /.. ) ." & 2"# #. -#(!& " , #'* . ' ,% )( ." )..)' ( )( )( ." -# ) ." /.. ) ." & 8 " *,)* && , & 1 - )'*& . ( #(. . 1#." ." .#* ) ." & #(! ! 2"# #.#(! .1) " , #'* . ' ,%-8 " *,)* && , & 1 - (. #( ." #, .#)( )**)-#. ,). .#)( , .#(! ( 9 : -" * 1#." ." " , ( . ." MPW -* ( &) .#)( 1" , ." #, )#& 2"# #. ., #&#(! ! #'* . ( . ,8 " & #(! ! ( , ." & -" (% 2"# #. -#!(# # (. - , *#(! &)(! ." & (!." ) ." ># #(! )). 1#." ." )). -*&#. #( " & 2*)-#(! ." & /( ,( ."8 " ),1 , @.",/-.A -# ) ." & 2"# #. -)' - , * ' ,%- ,)-- ." #, )#& ( , ." ( &) .#)( ( ." . -# 2"# #. ()(> #, .#)( & - , * ' ,%- ( , ." .#*8 +() %% + % (6 B ; -< "#- *,)* && , & 1 - -.#&& .. " .) ." "/ ( 1 - (). , ')0 ), 2 '#( .#)(8 " )/(. ,1 #!". ( ." *#. " " (! *#( 1 , (). .. " ( && O , . #(#(! )&. -" (%- , ' #( #( ." #, , -* .#0 ")& -8 )1 0 , ." )/(. ,1 #!". , ' #( .. " .) ." /&%" 3 ." & .,# & 1#, -8 " /.. ) ." & 2"# #. .", #'* . ' ,%-5 )( " 03 !)/!#(! . ." ), )**)-#. .) 1" , ." *#. " " (! *#( 1 - &) . 5 )( )( ." )/. , ,#' "#( 1" , ." *#. " " (! *#( 1)/& " 0 ( &) . ( )( )( ." )/. , ,#' )**)-#. 1" , *#. " " (! *#( 1)/& &) . 8 #."#( ." /.. ' ! 5 )**)-#. 1" , ." *#. " " (! *#( 1)/& &) . @LSKG )**)-#. A5 ." , 1 - -'))." ,)/( )..)' ' ,%8 " *,)* && , & 1 - '#--#(! -' && *),.#)( ) ." & .#* ( -' && *# ) ." & #(! ! ( , ." & .#*8 " & #(! 2"# #. #'* . ' ! ( '#--#(! ' . ,# & ,)' )/. ." PKW -* ( )/. .) 1" . , ' #( ) ." & .#*8 " ., #&#(! ! 2"# #. .1) #'* . ' ,%- &) . ( , ." RPW -* ( &) .#)(8 " & 1 - ! (.&3 (. /*1 , - #( ." #, .#)( )**)-#. ,). .#)( .) , . , - (. -" * 8 (&3 ." . -# ) ." .#* 2"# #. (3 - , * ' ,%- ( ." 3 1 , ()(> #, .#)( &8

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ir Accident Investigation Unit Report 2014-001

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

( ." ,/#- 5 ." (!#( -* - , - . . TRW 8 " ), & ( #(! " %- , +/#, )( #,' .#)( ." . ." -* & 0 ,- , . #!" 8 ), & ( #(! ." *)1 , & 0 ,- , - . . &#!". & *)-#.#)( ( . , .)/ " )1( ." 3 , , . , .) ,)/( & *)-#.#)(8 , +/#, 5 ." *)1 , & 0 ,- ' 3 /,." , , . , #(.) ." 0 ,- *)-#.#)( .) --#-. #, , . & , .#)(8 0 ,- -")/& )(&3 - & . )( ." !,)/( . , . ') " - ( #( # . 3 #&&/'#( .#)( ) ." ) %*#. . &#!".5 -#!(# 3#(! ." . -/ # # (. )#& *, --/, #- /#&. #( ." *,)* && , -3-. ' .) "# 0 , 0 ,- 8 " /.#)(- 9 -- &)- + / +, 0"-! -! ,) % / +, - ( -! " ! )(,"-"(' & 2 + ,.%- "' ' ' "' (/ + - &) + -.+ (' "-"('6: ( ." #, , . " - & , . ( , 0 ,- #- () &)(! , , +/#, 5 ." *)1 , & 0 ,- , , ./,( .) ." ,)/( & *)-#.#)( ( ." -* & 0 ,- , ')0 % .) ." )1 *)-#.#)( ), . 2##(!8 " /.#)(- 9 ( '(- + - + ,) % / +, 0!"% )(0 + % / +, + - ( +(.' " % : ( &-) 9 ( '(- + - + -! ,) % / +, -( -! .%% - < (0 = )(,"-"(' .'-"% '(+& % - 1" ,) ", + ! 6: ) ' #(. #( )(-. (. (!#( -* 5 ." *,#' ,3 )(.,)& 0# - , ." / & )(.,)& (#. @ A ( ." ,)* && , )0 ,(), @ A8 " #- ." ' #( / &>' . ,#(! 0# )( ." (!#( ( #. , #0 - #(*/. -#!( &- ,)' ." *)1 , & 0 ,5 -* & 0 ,5 M= M - (-),5 ( N *, --/, - (-),8 " #( ),*), . - ." ( ( 0 ,-* )0 ,(), @ A8

" #- &31 #!". )* , . / & ' . ,#(! 0# 5 1"# " ' #(. #(- (!#( /,#(! . ') ( 1" ( ." -* & 0 , #- - & . &)1 TQW8 " ( ." -* & 0 , #- . #!" ." " - - . *)#(. ) TRW5 #8 8 # ." (!#( -* ,)*- .) TRW ." )' - .#0 ( ))-.- / & &)1 .) *, 0 (. (!#( -* ,)' /,." , ,)*8 " #- &31 #!".>.3* 5 ! , ,#0 ( - .3 0# 1"# " )(.,)&- 2 -- (!#( -* 3 , -.,# .#(! / & &)1 .) )**)- (3 2 -- (!#( -* #( , - 8 " " - - . *)#(. ) LKO8PW . .3*# & / & &)1 ) MPK & =",5 /. #. ( ./ &&3 !#( &#'#.#(! ." :- ' 2#'/' / & - " /& . LKLW8 " #- &) . /*-., ' ) ." ' #( ' . ,#(! 0 &0 8 "3 , /&# &&3 ./ . 5 )(-. (. -* 5 /&& ." ,#(! *,)* && , )(.,)& -3-. ' #- ( #(. !, & ./, ) ." NNL (!#( #(-. && .#)(8 " *,)* && , !)0 ,(#(! -3-. ' #( ),*), . - ( -3-. ' ( #- #(. , )(( . 1#." ." / & )(.,)& -3-. '8 /,#(! &#!".5 ." *,)* && , !)0 ,(#(! -3-. ' /.)' .# &&3 ' #(. #(- - . (!#( -* 3 0 ,3#(! ." *#. " (!& ) ." *,)* && , & - #( , -*)(- .) " (!#(! )( #.#)(- ) &#!".8 ( ! .#0 .),+/ #- - (- 5 ." -3-. ' 1#&& ./ . ( &&)1 ." )#& *, --/, .) /#& /* /(.#& #. #- -/ # # (. .) "3 , /&# &&3 ./ . ." ." , 0 &0 8 "#- /- - ." *,)* && , & (!& .) #( , - 5 #8 8 .) ')0 .)1 , - ." ." , *)-#.#)(5 ."/- )/(. , .#(! ." ( ! .#0 .),+/ 8 " - ,# - ." -3-. ' - )&&)1-7 8 ! ' -"/ -(+*. , ',"' ,2,- & () + - , .-(& -" %%2 ' + *."+ , '( ( $)"- ('-+(%,6 -"/ -(+*. ( .+, 0! ' / + -! )+() %% + - ' , -( +"/ -! ' "' + -! + -! ' 0! ' -! ' "' +"/ , -! )+() %% +6 ! ' ' -"/ -(+*. ", , ', 5 )+() %% + )"- ! 0"%% .-(& -" %%2 "' + , -(0 + , -! + ' -!., + . -! + ( -! 0"' &"%%"' )+() %% +69 . , & ( #(!5 ')0#(! ." *)1 , & 0 ,- &)1 ." &#!". & ! . 1)/& /- ." -3-. ' .) .#0 . 8 "#- )/& 0 ,- &3 . #, .#)( & )(.,)& )( ." !,)/( 8 ) )/(. , . ."#-5 ." -3-. ' #( ),*), . - ( ) %)/. 0 &0 8 "#- 0 &0 !#(- .) )* ( . *)1 , & 0 , (!& ) NRG ( #. #- /&&3 )* ( . *)1 , & 0 , (!& ) MLG8 " . ) &) %)/. #- .) #- & ." -3-. '8 (+ -(+2 1 &"' -"(' ( ' "' ('-+(% (&)(' '-, )&&)1#(! ." 2 '#( .#)( ) ." *,)* && ,- ( (!#( - . ." , -* .#0 ' (/ ./, ,-: #&#.# - /( , ." -/* ,0#-#)( ) ." (0 -.#! .#)(5 #. 1 - # ." . ." / & )(.,)& /(#.-5 ." *,)* && , !)0 ,(),- ( ." M= M - (-),- 1)/& - (. .) ." #&#.# - ) )) 1 , 5 ." ),#!#( & +/#*' (. ' (/ ./, ,5 ), 2 '#( .#)( /( , ." -/* ,0#-#)( ) ." (#. . . - 5 1"# " 1 - , #. .) ." (0 -.#! .#)(8 " 2 '#( .#)( ) ." M= M - (-),- )/( ." . ." &&)1- & (!." ) ." /(#. , ')0 ,)' ." )8 M (!#( 1 - K8TOR #( " -8 "#- ' -/, ' (. 1 - ,,# )/. . ,))' . '* , ./, ) **,)2#' . &3 RPG @MOG A8 " -* # # .#)( ), ."#- & (!." #- L8KMN Y K8KKM #( " - . . '* , ./, ) RPG 8 !(-( (6 A -")1- ." , & .#0 # , ( #( &&)1- & (!." .1 ( ." M= M - (-),- ,)' ." .1) (!#( -8

Air Accident Investigation Unit Report 2014-001

209

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FINAL REPORT " & (!." ) ." )8 M (!#( &&)1- #(! )(-# , &3 -"),. , ." ( -* # # #- )(-#-. (. 1#." , " ), & % 1#."#( ." -3-. '8

!(-( (6 A7 M= M - (-), &&)1- ,)' )8 L ( )8 M (!#( -

210

/,." , . -.- 1 , ,,# )/. .) - ,. #( . 1"# " ( ) ." -- ' &3 ." , " " ) /,, 8 " M= M - (-), 1 - /. '# 1 3 &)(! ." *#&& ,3 ./ .) #-)& . ." &&)1- ,)' ." *,) 8 ) & % 1 - (). ,)' ." &&)1- #.- & /. -., % ) / & - 1 - (). )'#(! ,)' ." - (-#(! ./ 8 )) 1 , #(-. && ' (# )& 1#." #&& ./ 5 )(( .#(! ." .1) - .#)(-5 ( , #&& ." - (-),8 &) 1 - **&# .) ." &&)1- 1"# " 1 - +/#0 & (. .) ." . 1"# " 1)/& 2* ,# ( 3 ." &&)1- 1" ( .. " .) ( (!#( 8 " &&)1- & (!." , / ,)' L8KNN #( " - .) K8TS #( " - )0 , * ,#) ) MTM ",-8

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

211

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( )( L5 ." .1) /,0 - -")1 ." (!#( -* - ' -/, #( ), ." )8 L (!#( @, A ( ." )8 M (!#( @*/,*& A8 " /,0 - -")1 ." . 1" ( ." -* & 0 ,- 1 , 0 ( ,)' )1 .) #!" #( *, * , .#)( ), . % >) ( ." (!#( -* - #( , - ,)' RKW .) **,)2#' . &3 TRW5 ." -* , -*)(- ) ." )8 M (!#( & !! "#( ." . ) ." )8 L (!#( 3 **,)2#' . &3 P - )( -8

Air Accident Investigation Unit Report 2014-001

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10 February 2011

FINAL REPORT 6 - (' (+*. , , (0 + / +, + / ' " ( ." (!#( -* - , -. #&#- . **,)2#' . &3 TRW 5 ( ." *)1 , & 0 ,- , 0 ( ,)' ,)/( & .)1 , - "#!" *)1 ,5 ." / & )(.,)& ., (-#.#)(- ,)' ." /( ,-* !)0 ,(), / & - " /& .) ." *)1 , & 0 , - " /& 8 " *)1 , & 0 , - " /& #- )'* (- . ), #(& . . '* , ./, @ MA #( ), ( 1#." ." " , . ,#-.# - -")1( #( " .+ (6 B8 ( ."#- - ." &)1 , ( ,&3 "),#4)(. & &#( , *, - (.- ." / & &)1 1#." ." *)1 , & 0 , . &#!". & 1"#& ." /** , &/ &#( #- ." / & &)1 1#." ." *)1 , & 0 , /&&3 ),1 , 8 )1 , & 0 , - ..#(!- .1 ( &#!". & ( ' 2#'/' *)1 , 1)/& , *, - (. 3 -#'#& , &#( - .1 ( ." .1)8 " 2> 2#- #- ." (!#( #(& . . '* , ./, #( !, - ", (" #. @G A8 " , #- ' 2#'/' &)1 -.)* . QPK & =", 1"# " #- , *, - (. 3 ." -" & % &#( 8 - ." *)1 , & 0 , #- ')0 ,)' &#!". & .) /&& ),1 , 5 1"# " #- #&&/-., . . ( , #., ,3 *)1 , & 0 , *)-#.#)( 3 ." -" , &#( 5 ." , #- *,)*),.#)( &&3 "#!" , / & &)1 .) ." )8 M (!#( ." ( .) ." )8 L (!#( 8

212

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"/-5 - ." *)1 , & 0 ,- , 0 ( ), . % >) 5 ." . ) -"),. ( &&)1- #- .) #( , - ." / & &)1 .) ." (!#( )( ." -# 1#." ." -"),. ( &&)1-5 #8 8 ." )8 M (!#( )( > 8

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

213

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"#- . ( - ( #( )( N ) " .+ (6 A 1" , ." (!#( .),+/ - , - ..&#(! &)- .) . % >) 0 &/ -5 ." .),+/ "# 0 3 (!#( )8 M #- - 0 , & * , (. ! *)#(.- !, . , ." ( ." . ), (!#( )8 L8 Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT " .+ (6 D ( " .+ (6 E *, - (. . ), .1) /,." , . % >) - ' 3 > -)' 1 %- ), ." # (. &#!".8 #'#& , " , . ,#-.# - , - (5 #( ." . ." (!#( )8 M & !- ." . ) (!#( )8 L - ." -* & 0 ,- , 0 ( #( " - 8 &-)5 ." .),+/ "# 0 3 (!#( )8 M 0 ( - " ) ." . "# 0 3 (!#( )8 L ( 5 * ,.# /& ,&3 - - ( #( " .+ (6 E5 ." )8 M (!#( .),+/ , ' #(- "#!" , ." ( ." . ) )8 L (!#( - ." #, , . -* #( , - - /,#(! #.- . % >) ,/(8

214

" .+ (6 D7 '*& ) . % >) * , ' . ,- 1 %- *,#), .) # (.

" .+ (6 E5 #.#)( & - '*& ) . % >) * , ' . ,- 1 %- *,#), .) # (.

! " '- *. ' " .+ (6 F #&&/-., . - 0 ,#)/- * , ' . ,- , ), /,#(! ." # (. - +/ ( 8 " 2> 2#- , *, - (.- .#' ' -/, #( - )( - 1#." ." ;K< *)#(. , *, - (.#(! .#' **,)2#' . &3 )( - )( ), )'' ( ' (. ) ." #'* . - +/ ( 5 1" ( ." 0 &/ - ) , ), * , ' . ,- ' /(, &# & 8

215

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" (0 -.#! .#)( - & . #0 . *)#(.- /,#(! ." #( & - )( - ) )" , (. , ), . 5 - )&&)1-7 . *)#(. L5 **,)2#' . &3 LL - )( - ), #'* .8 . *)#(. M5 1" ( ." .),+/ 0 &/ , ), )( )8 L (!#( 1 - >TW8 . *)#(. N5 )( - )( . , . *)#(. M5 1" ( ." .),+/ , ), )( )8 L (!#( 1 - XMMW8 . *)#(. O5 1" ( ." (!#( -* - 1 , ' -/, . LKOW ( LKO8LW , -* .#0 &38 . *)#(. P5 **,)2#' . &3 )( - )( ), #'* .8 (- 59 " , ), ." 0 &/ ) " ) ." (!#( * , ' . ,- )( * , - )( 8 / .) ." " , . ,#-.# - ) ." 5 " * , ' . , 1 - , ), . # , (. .#' /,#(! ." )( - )( 3 & 8

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216

(!#( )8 L -* 1 - . % ( - #(! , ), . ." -. ,. ) " 3 & 5 ." ( (!#( )8 L .),+/ 1 - , ), . K8O - )( -5 (!#( )8 M -* . K8P - )( - ( (!#( )8 M .),+/ . K8T - )( - #(.) ." , -* .#0 3 & 8 ), ."#- , -)(5 #. 1 - ( -- ,3 ), ." (0 -.#! .#)( .) #(. ,*)& . 0 &/ - . ." 0 ,#)/- . *)#(.-8 " . -")1- ." .5 - ." #, , . - ( .)1 , - ." ,/(1 3 /,#(! ." .#' * ,#) ,)' >MK - - .) **,)2#' . &3 >T - -5 ." (!#( .),+/ ), ." )8 L (!#( 1 - , ), . 0 &/ - ! ( , &&3 #( ." , (! ML .) MNW 1"#& ." . ), ." )8 M (!#( 1 - #( ." , (! MP .) MRW8 /,#(! ."#- * ,#) 5 ." (!#( -* - 1 , , ), - LKKW ), )8 L (!#( ( . 0 &/ - #( , (! .1 ( LKK8KW ( LKK8RW ), )8 M (!#( 8 " - 0 &/ - , #&&/-., . #( " .+ (6 F ,)' ." & . " ( 2#- /(.#& .#' $/-. . , . *)#(. L8 " , . , ." , ), . #( # . - ." . ." )8 L (!#( .),+/ , / .) >TW5 - -")1( . . *)#(. M5 ." ( #( , - #( )( - )( .) XMMW5 - -")1( . . *)#(. N5 . 1"# " *)#(. ." )8 L (!#( -* ,)** .)1 , - TRW8 0 &/ ) SW ), ." .),+/ )( )8 M (!#( 1 - , ), 3 ." K8P - )( - ), . *)#(. M5 0 &/ ) KW 1 - , ), )( - )( & . , ( 0 &/ ) NW /,." , )( - )( & . ,8 -#(! &#( , #(. ,*)& .#)(5 0 &/ ) OW 1 - & /& . ), )8 M (!#( . . *)#(. M ( ) L8PW . . *)#(. N8 -#'#& , ' .") )&)!3 1 - /- ), ." & /& .#)( ) (!#( -* - . ." - .1) . *)#(.-8 . . *)#(. O ." , ), . -")1- ." . )." (!#( -* - #( , - -#!(# # (.&38 " (!#( .),+/ ), ." .1) (!#( - 1 - #(. ,*)& . . ." .#' - 1" , ." (!#( -* , " ." #, , -* .#0 , ), ' 2#' 5 LKO8KW ), (!#( )8 L ( LKO8LW ), (!#( )8 M8 / .) ." , ), #(! " , . ,#-.# - ) ." 5 ." - .1) *)#(.- 1 , K8P - )( - * ,.8 . *)#(. P , *, - (.- *)#(. **,)2#' . &3 )( - )( *,#), .) ." #'* .8 % (6 A - .- )/. ." 0 &/ -5 #." , , ), ), #(. ,*)& . ,)' ." . 5 ), ." #0 . *)#(.- -")1( #( " .+ (6 F8 - ' "' ' "' ' "' ' "' ("'- (6A (6A (6B (6B (+*. (+*. ;L< ;L< ;L< ;L< L LKK8K MN8K LKK8N MQ8M M TS8K >T8K TS8Q O8K N TR8M MM8K TS8O L8P O LKO S8M LKO8L LR8K P LKK8L SN8R LKK8S LKK8M % (6 A7 .

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

% (6 B7 , ' . ,- ), (!#( )8 L - )("'- ;L< (+*. . % %(0 ;L< ;% 8!+< L LKK8N MQ8M NKT8P M TS8Q O8K MNL8O N TS8O L8P MMM8T O LKO8L LR8K NKP8T P LKK8S LKK8M PRN8T

% (6 C7 , ' . ,- ), (!#( )8 M

Air Accident Investigation Unit Report 2014-001

217

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

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218

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

" .+ (6 G7 / & &)1= )1 , 0 , (!& @ A /,0 -

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- )("'- L M N O

. % %(0 ;% 8!+< NKT8P MNL8O MMM8T NKP8T

(0 + / + ' % ;=< PK8M NN8M NM8Q >

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( -/'' ,35 ." . #( # . - ." . . . *)#(. )8 L5 )." *)1 , & 0 ,- 1 , #( ." , (! PK= .) PM=6 . . *)#(. )8 M5 ." .),+/ - ( (!#( -* - ), )." (!#( - , - ( .) , - 5 1#." ),, -*)( #(! , / .#)( #( )'*/. / & &)18 ,)' ." / & &)1= /,0 -")1( #( " .+ (6 G5 #. ( - ( ." . )." *)1 , & 0 ,- 1 , ()1 . (!& - #( ." , (! NLG .) NNG5 #8 8 ." 3 1 , )." . ( (!& &)1 @), "#( A ." &#!".

& ! . 8 . . *)#(. )8 M5 ." )8 L (!#( .),+/ 1 - , ), . >T8KW 1"#& . . *)#(. ()8 N #. " , )0 , .) XMMW8 " (!#( -* - . ." - . *)#(.- 1 , TS8KW ( TR8M W , -* .#0 &38 . . *)#(. )8 N5 ." )8 L (!#( -* " 0#(! ,)** &)- .) ." - .>*)#(. ) TR8KW5 ." / & &)1 1 - () &)(! , )( ." *)1 , & 0 , - " /& 5 /. 1 - #(! ))-. 3 ." 8 " )8 M (!#( . -* ) TS8OW 1 - -.#&& )( ." *)1 , & 0 , - " /& ( ." )'*/. / & &)1 #( # . - ) NM8QG5 #8 8 -.#&& . ( (!& &)1 ." &#!".

& ! . 8 . . *)#(. )8 O5 )." (!#( -* - #( , - .) LKOW ( ." " )' .#0 5 ), * ,.# &&3 .#0 5 #( " - .) &#'#. ." (!#( -* 8 . . *)#(. )8 P5 1" ( )." (!#( / & )(.,)&- " , ./,( .) ." *)1 , & 0 , - " /& 5 ." )'*/. / & &)1 . #( # . - ." . ." *)1 , & 0 ,- " ( 0 ( #(.) ." , (! RM8MG .) RO8PG8 (0 + / + " "'

" (0 -.#! .#)( &))% . & ( #(! 1"# " " ( ' 3 > . * (#-" #,*),. - 0 , & 1 %- ), ." # (.5 ( ), 1"# " . 1 - 0 #& & 8 " .+ (6 H #&&/-., . - ." . ), ."#- & ( #(! #( -#'#& , ),' . .) ." . -")1( ), ." # (.8 #' #( - )( - #- -")1( )( ." 2> 2#- 1"#& ." 0 ,#)/- (!#( * , ' . ,- &)(! 1#." &.#./ ( #,-* , -")1( )( ." 3> 2#-8 " .)/ " )1( ) /,, . .#' , , ( NOQK8

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-#'#& , ( &3-#- 1 - ,,# )/. ), ."#- & ( #(!5 ( ." ' (/ ./, ,:- )'*/. , ') & 1 - /- .) & /& . ." / & &)1- . . *)#(.- Q5 R ( S - -")1( #( " .+ (6 H6 " . #- -")1( ), ." )8 L (!#( #( % (6 F ( ), )8 M (!#( #( % (6 G8

221

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' +,) (/ +'(+ NMO8O & =", . TQ8KW

% (6 F7 . ), )8 L (!#( - )("'-

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. % %(0 ;% 8!+< MQM8P MNQ8O NOK8T

(0 + / + ' % ;=< OQ8N NN8O >

% (6 G7 . ), )8 M (!#(

' +,) (/ +'(+ NOK8T & =", . TR8MW

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10 February 2011

FINAL REPORT ,)' ." . 5 #. ( - ( ." . . . *)#(. Q5 **,)2#' . &3 .", - )( - . , .)/ " )1(5 )." ) ." *)1 , & 0 ,- , ' #( )0 ." &#!". & (!& ) OKG8 . . *)#(. R5 **,)2#' . &3 -#2 - )( - . , .)/ " )1(5 )." *)1 , & 0 ,- " ( ')0 .",)/!" &#!". & #(.) ." . , (! ) )* , .#)(8 " *)1 , & 0 , (!& - ), )." (!#( - 1 , **,)2#' . &3 NNG . ."#- .#' 5 *)-#.#)( 1"# " #- )'* , & .) ." (!& - & . #( &#!". /,#(! ." # (. - +/ ( 8 . , ."#-5 . . *)#(. S5 ." (!#( .),+/ - , - ( .) #( , - - , 0 ,- .",/-. #- /- .) & , . ." #, , . )( ." ,/(1 38 "#- ( &3-#- ) ." *)1 , & 0 , )* , .#)( )( *, 0#)/- -/ -- /& & ( #(! #&&/-., . - ." . ." ,#!!#(! ) ." *)1 , & 0 ,- 1 - - .#- .),3 ( ." .5 #( ."#- - 5 ." & 0 ,- 1 , ,)/!". % #(.) . , (! ,)' &#!". & . , & ( #(! .) --#-. #( & , .#(! ." #, , .8

! , #(! ." #( & **,) " ( ." .#' * ,#) ,)' >MK - )( - .) **,)2#' . &3 >T - )( -5 ." (!#( .),+/ ), ." )8 L (!#( 1 - , ), . 0 &/ - ! ( , &&3 #( ." , (! ML .) MNW 1"#& ." . ), ." )8 M (!#( 1 - #( ." , (! MP .) MRW8 /,#(! ."#- * ,#) 5 ." (!#( -* - 1 , , ), - LKKW ), )8 L (!#( ( . 0 &/ - #( , (! .1 ( LKK8KW ( LKK8RW ), )8 M (!#( 5 " .+ (6 I8

222

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ir Accident Investigation Unit Report 2014-001

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

224

. *)#(. O 1 - - & . .) -")1 ." .#' - 1" ( ." (!#( -* - 1 , , ), . ." #, ' 2#'/' 0 &/ - /,#(! ." #( & - +/ ( 5 LKO8KW )( ." )8 L (!#( ( LKO8LW ), ." )8 M (!#( 8 / .) ." " , . ,#-.# - ) ." 5 ." - .1) 0 &/ - 1 , , ), K8P - )( - * ,.8

" .),+/ )/.*/.- ) )." (!#( - , )." - ( .) #( , - , *# &3 #'' # . &3 . , . *)#(. O5 )." ,#-#(! .) #( 2 -- ) SKW 1#."#( **,)2#' . &3 N - )( -8

. . *)#(. O5 ." - 1)/& " 0 ( .#0 5 ), * ,.# &&3 .#0 5 )( )." -8 " #- /*-., ' ) ." ' #( ' . ,#(! 0 &0 ( ( )'' ( &#'#.#(! / & &)1 . ( (!#( -* ) LKLW8 "/- ." - )( )." - 1 , , -.,# .#(! ." / & &)1 .) ' #(. #( (!#( . ), &)1 ." - . *)#(. ) LKO8PW8 /- ." - 1 , .#0 5 #. #- (). *)--# & .) ,#0 ( /, . *)1 , & 0 , (!& ), . *)#(. O8 )1 0 ,5 # ." )'*/. / & &)1 #!/, ), )8 L (!#( ) MRM8T & =", . . *)#(. O #- #(- ,. #(.) ." **,)*,# . /,0 #( " .+ (6 G5 *)1 , & 0 , (!& ) **,)2#' . &3 PKG #- ,#0 8 #( ." 1 - .#0 ( 1 - , -.,# .#(! ." / & &)1 .) ."#- #!/, 5 #. ( -. . ." . ." *)1 , & 0 , (!& 1 - *,) &3 !, . , ." ( PKG8

#'#& ,&35 # ." )'*/. / & &)1 #!/, ), )8 M (!#( ) NKP8T & =", . . *)#(. O #- #(- ,. #(.) ." **,)*,# . /,0 #( " .+ (6 G5 *)1 , & 0 , (!& ) **,)2#' . &3 PKG #- ,#0 8 ! #(5 -#( ." 1 - .#0 ( 1 - , -.,# .#(! ." / & &)1 .) ."#- #!/, 5 #. ( -. . ." . ." *)1 , & 0 , (!& 1 - *,) &3 !, . , ." ( PKG8

" , ), 5 . . *)#(. O5 ." . -/!! -.- ." . )." *)1 , & 0 ,- " ( . % ( )/. ) . , (! ( 1 , #(! 0 ( .)1 , - "#!" *)1 , - ..#(!-8

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)) ' "1 1-+ - +(& .+() ' (&&",,"(' .% -"(' ; < ( HEI8B@@H4 A6D@E4 (&& ' & '- ' ('-"'. -"(' ( ))+( ! - '41 /:88-901= := ?41 ;57:? ?: B4:8 /:90@/? :2 ?41 27534? 4-> .119 01713-?10 8-D /:8819/1 -9 59>?=@819? -;;=:-/4 =13-=071>> :2 ?41 =1;:=?10 %)% )5>5.575?D .@? ?41 -;;=:-/4 >4-77 9:? .1 /:9?59@10 .1D:90 ?41 :@?1= 8-=61= := 1<@5A-719? ;:>5?5:9 52 ?41 =1;:=?10 %)% A5>5.575?D 5> 71>> ?4-9 ?41 -;;75/-.71 85958- >11 "#& . *41=1 %)% 5> 9:? -A-57-.71 %)% A-7@1> 8-D .1 01=5A10 .D /:9A1=?593 ?41 =1;:=?10 A5>5.575?D 59 -//:=0-9/1 B5?4 ;;1905C ?: "#& >@.;-=-3=-;4 4 / 2 -2?1= ;->>593 ?41 :@?1= 8-=61= := 1<@5A-719? ;:>5?5:9 59 -//:=0-9/1 B5?4 - -.:A1 ?41 =1;:=?10 %)% A5>5.575?D 2-77> .17:B ?41 -;;75/-.71 85958@8 ?41 -;;=:-/4 8-D .1 /:9?59@10 ?: := 0 *41=1 9: :@?1= 8-=61= := 1<@5A-719? ;:>5?5:9 1C5>?> ?41 /:88-901= := ?41 ;57:? ?: B4:8 /:90@/? :2 ?41 27534? 4-> .119 01713-?10 >4-77 8-61 ?41 01/5>5:9 ?: /:9?59@1 := -.-90:9 ?41 -;;=:-/4 .12:=1 01>/190593 .17:B 2? -.:A1 ?41 -1=:0=:81 :9 ?41 259-7 -;;=:-/4 >13819? 2 ?41 5> -? := -.:A1 2? -.:A1 ?41 -1=:0=:81 ?41 :;1=-?:= >4-77 1>?-.75>4 - 41534? 2:= 1-/4 -;;=:-/4 ;=:/10@=1 .17:B B45/4 ?41 -;;=:-/4 >4-77 9:? .1 /:9?59@10 52 %)% A5>5.575?D 5> 71>> ?4-9 -;;75/-.71 85958- 1 '41 -;;=:-/4 8-D .1 /:9?59@10 .17:B := -90 ?41 7-90593 8-D .1 /:8;71?10 ;=:A5010 ?4-? ?41 =1<@5=10 A5>@-7 =121=19/1 5> 1>?-.75>410 -? ?41 := -90 5> 8-59?-5910 2 '41 ?:@/4 0:B9 E:91 %)% 5> -7B-D> /:9?=:77593 2 =1;:=?10 -90 =171A-9? ?41 850 ;:59? -90 >?:; 190 %)% -=1 -7>: /:9?=:77593 '41 85958@8 %)% A-7@1 2:= ?41 850 ;:59? 5> 8 := ?41 %)% =1<@5=10 2:= ?41 ?:@/4 0:B9 E:91 52 71>> -90 8 2:= ?41 >?:; 190 := -1=:;7-91> 1<@5;;10 B5?4 - =:77 :@? 3@50-9/1 := /:9?=:7 >D>?18 ?41 85958@8 %)% A-7@1 2:= ?41 850 ;:59? 5> 8 !:?1 I%171A-9?J 59 ?45> /:9?1C? 81-9> ?4-? ;-=? :2 ?41 =@9B-D @>10 0@=593 ?41 4534 >;110 ;4->1 :2 ?41 7-90593 0:B9 ?: - >;110 :2 -;;=:C58-?17D 69:?>

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227

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

228

229

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT )) ' "1 1-+ - +(& ,. &",,"(' & 2 -! ) + -(+ -( -! "+ -2 (&&"-- ( -! (&&",,"(' ' 1-+ - +(& ) + -"(' % -- + (6 D8AA

230

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231

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

FINAL REPORT

232

10 February 2011

@ ! MKA 1-+ - +(& ) + -"(' % -- + (6 D8AA ; ' %",! + ',% -"('<

233

Air Accident Investigation Unit Report 2014-001

Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

234

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Fairchild SA 227-BC Metro III EC-ITP

Cork Airport

10 February 2011

FINAL REPORT

236

! !"' !; !'& !'& !*& " " * " " "# "& # # & # # ! # !& # # # # # #! #' '' $! % % & % %# %# %)% %)& %*+ & ! & & & & ! & %#& & & # & & & &"# ' ' *& '%'" (& (&

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237

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Cork Airport

10 February 2011

FINAL REPORT

238

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731=5- 731=5- 731=5- (95?10 5930:8 (95?10 5930:8 (95?10 5930:8 (95?10 5930:8 (95?10 5930:8 =17-90 =17-90 =17-90 =17-90 =17-90 198-=6 &;-59 &;-59 &;-59 &;-59

NOTES

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In accordance with Annex 13 to the Convention on International Civil Aviation, Regulation (EU) No 996/2010, and Statutory Instrument No. 460 of 2009, Air Navigation (Notification and Investigation of Accidents, Serious Incidents and Incidents) Regulations 2009, the sole purpose of this investigation is to prevent aviation accidents and serious incidents. It is not the purpose of any such investigation and the associated investigation report to apportion blame or liability. A safety recommendation shall in no case create a presumption of blame or liability for an occurrence.

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A.A.I.U., Department of Transport Tourism and Sport, 2nd Floor, Leeson Lane, Dublin 2, Ireland. Tel (24x7): +353 1 604 1293 or +353 1 241 1777 Fax: +353 1 604 1514 Email: info@aaiu.ie Web: www.aaiu.ie