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N168SH accident description

Utah map... Utah list
Crash location 40.630834°N, 112.056667°W
Nearest city West Valley City, UT
40.691613°N, 112.001050°W
5.1 miles away
Tail number N168SH
Accident date 08 Jan 2009
Aircraft type Robinson Helicopter Company R44 Ii
Additional details: None

NTSB Factual Report

HISTORY OF FLIGHT

On January 8, 2009, approximately 2052 mountain standard time, a Robinson Helicopter Company R44 II, N168SH, impacted terrain following a loss of control in cruise flight near West Valley City, Utah. The flight instructor and the commercial pilot receiving instruction were seriously injured. The helicopter sustained substantial damage. The helicopter was registered to Majestic Helicopters LLC, Eagle Mountain, Utah, and operated by the pilot under the provisions of 14 Code of Federal Regulations Part 91. A flight plan was not filed and night visual meteorological conditions prevailed for the helicopter’s departure from Tooele, Utah, about 2037, with an intended destination of Bountiful, Utah. Instrument meteorological conditions (IMC) prevailed in the vicinity of the accident site at the time of the accident.

Both the pilot and the instructor reported that the flight began as an instrument flight rules (IFR) cross-country training flight. They departed from Bountiful about 1650, and flew to Provo, Utah, where they stopped to refuel the helicopter. The pilot filed an IFR flight plan from Provo to Wendover, Utah. After departure from Provo, the pilot put on foggles (a view limiting device) and flew to Staco intersection, where he removed the foggles and continued towards Wendover. After encountering turbulence and head winds, they elected to terminate the IFR flight plan about 10 miles from Wendover, reverse course, and return to Bountiful under visual flight rules (VFR).

The instructor reported that on the return trip from Wendover, he was not instructing the pilot and that he was "just a passenger." They landed at Tooele, refueled the helicopter and departed VFR for Bountiful. According to the instructor, the weather conditions at Tooele were winds light and variable, visibility 4 miles, and ceiling about 2,000 feet above ground level (6,321 feet mean sea level [msl]). The planned flight path was from Tooele northeast to Garfield Stack, then south along Highway 111 to circle south around the Salt Lake City Class B airspace, then north to Bountiful. The helicopter was heading south along Highway 111 at about 6,100 feet msl when the "cloud ceiling dropped causing helicopter to enter a cloud, visual of ground was lost." The pilot "became quickly disoriented losing positive control of the aircraft." The flight instructor took the controls and attempted to regain control of the helicopter, but was unable to do so before the helicopter impacted the ground.

The pilot reported that he was flying the final leg of the flight back to Bountiful when the weather conditions began to deteriorate. The helicopter entered the clouds and "began to rotate almost immediately." He turned on the emergency locator transmitter (ELT) switch and the helicopter impacted the ground.

PERSONNEL INFORMATION

The pilot, age 24, held a commercial pilot certificate with a helicopter rating. The pilot’s most recent second-class medical certificate was issued on January 9, 2008, with no limitations. He reported that he had about 209 hours of flight experience of which 144 hours were in the same make and model as the accident helicopter. The pilot had 44 hours of night flight experience and 39 hours of simulated instrument experience.

The instructor, age 23, held a commercial pilot certificate with helicopter and instrument helicopter ratings. Additionally, he held a flight instructor certificate with helicopter and helicopter instrument ratings. The instructor’s most recent third-class medical certificate was issued on April 25, 2008, with the limitation, must wear corrective lenses. The instructor completed an NTSB Pilot/Operator Aircraft Accident Report Form, but did not provide any record of his flight experience. Total flight time data extracted from the instructor's medical certificate application dated April 25, 2008, indicated that the pilot reported a total flight time of 294 hours at that time.

AIRCRAFT INFORMATION

The 2007 model Robinson R44 II helicopter, S/N 11658, was powered by one 245-horsepower Lycoming IO-540-AE1A5 reciprocating engine, S/N L-31782-48A. The helicopter was approved for day and night VFR operations. At the time of the accident, the airframe and engine had accumulated 445.4 hours total time. The last annual inspection was completed on November 24, 2008, at an airframe and engine total time of 416.4 hours.

The most recent maintenance documented on the helicopter was the removal and reinstallation following repair of the artificial horizon on November 29, 2008, at an airframe total time of 418.9 hours. The repair order form for the artificial horizon stated that the work performed included installing a new inclinometer bubble, replacing the roll gimbal bearings, and function testing and recalibrating the unit in accordance with the manufacturer’s specifications.

METEOROLOGICAL INFORMATION

At 2053, the reported weather conditions at Salt Lake City International Airport (elevation 4,227 feet), located approximately 11 nautical miles north of the accident site, were wind from 310 degrees at 7 knots; visibility 6 miles in light rain and mist; ceiling overcast 1,500 feet; temperature 2 degrees Celsius; dew point -1 degree Celsius; and altimeter setting 30.03 inches of Mercury.

WRECKAGE AND IMPACT INFORMATION

The helicopter came to rest on its left side oriented on a southwesterly heading near the crest of a snow covered hill just east of 6600 South Highway 111. Rising terrain was observed to the south and west of the accident site. A large impact crater was observed immediately in front (to the southwest) of the main wreckage. The crater measured about 15 feet in length and 6 feet in width and was 8 to 12 inches deep. Separated portions of the landing skids were located within the impact crater. No additional ground scars were located at the accident site.

The rotor head and mast remained attached to the transmission. Both main rotor blades exhibited extensive impact damage. The tail boom remained attached to the fuselage and was bent downward. The tail rotor gearbox and tail rotor assembly remained attached to the tail boom, however, they had sustained impact damage. The tail rotor blades were mostly separated. The horizontal and vertical stabilizers were separated and found adjacent to the main wreckage.

The bottom of the fuselage exhibited severe upward deformation. The left and right landing skids were separated. The forward landing skid mounts were impact damaged and compressed upwards and outboard of the fuselage. The aft landing skid mounts were separated. The engine remained attached to the fuselage. The engine firewall appeared to be impact damaged.

ADDITIONAL INFORMATION

Robinson Helicopter Company Safety Notice SN-18, revised June 1994, titled "LOSS OF VISIBILITY CAN BE FATAL," states in part: Flying a helicopter in obscured visibility due to fog, snow, low ceiling, or even a dark night can be fatal. Helicopters have less inherent stability and much faster roll and pitch rates than airplanes. Loss of the pilot’s outside visual references, even for a moment, can result in disorientation, wrong control inputs, and an uncontrolled crash.

Robinson Helicopter Company Safety Notice SN-26, revised June 1994, titled "NIGHT FLIGHT PLUS BAD WEATHER CAN BE DEADLY," states in part: When it is dark, the pilot cannot see wires or the bottom of the clouds, nor low hanging scud or fog. Even when he does see it, he is unable to judge its altitude because there is no horizon for reference. He doesn't realize it is there until he has actually flown into it and suddenly loses his outside visual references and his ability to control the attitude of the helicopter.

Both the pilot and the instructor reported that the artificial horizon required repeated adjustments during the flight. With the helicopter in level flight, the horizon indicator would gradually creep up to 2 to 4 degrees of climb, and the pilot would readjust it to level flight. The pilot and the instructor both stated that they did not think this problem had anything to do with the accident and that although the helicopter was equipped for IFR training, it was not certified for flight in IMC.

NTSB Probable Cause

The pilot’s inadvertent VFR flight into IMC conditions, which resulted in his spatial disorientation and loss of control of the helicopter. Also causal was the flight instructor’s delay in taking remedial action.

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