GULFSTREAM GVI near Roswell, NM — 2011-04-02
- Date
- 2011-04-02
- Location
- Roswell, NM, USA
- Airport
- ROW
- Aircraft
- GULFSTREAM GVI
- Registration
- N652GD
- Category
- Airplane
- Highest injury
- Fatal
- Fatalities
- 4
Probable cause
an aerodynamic stall and subsequent uncommanded roll during a one engine-inoperative takeoff flight test, which were the result of (1) Gulfstream’s failure to properly develop and validate takeoff speeds for the flight tests and recognize and correct the takeoff safety speed (V2) error during previous G650 flight tests, (2) the G650 flight test team’s persistent and increasingly aggressive attempts to achieve V2 speeds that were erroneously low, and (3) Gulfstream’s inadequate investigation of previous G650 uncommanded roll events, which indicated that the company’s estimated stall angle of attack while the airplane was in ground effect was too high. Contributing to the accident was Gulfstream’s failure to effectively manage the G650 flight test program by pursuing an aggressive program schedule without ensuring that the roles and responsibilities of team members had been appropriately defined and implemented, engineering processes had received sufficient technical planning and oversight, potential hazards had been fully identified, and appropriate risk controls had been implemented and were functioning as intended.
Contributing factors
Contributing to the accident was Gulfstream’s failure to effectively manage the G650 flight test program by pursuing an aggressive program schedule without ensuring that the roles and responsibilities of team members had been appropriately defined and implemented, engineering processes had received sufficient technical planning and oversight, potential hazards had been fully identified, and appropriate risk controls had been implemented and were functioning as intended.
NTSB narrative
The Safety Board’s full report is available at http://www.ntsb.gov/investigations/reports_aviation.html. The Aircraft Accident Report number is NTSB/AAR-12-02. On April 2, 2011, about 0934 mountain daylight time, an experimental Gulfstream Aerospace Corporation GVI (G650), N652GD, crashed during takeoff from runway 21 at Roswell International Air Center Airport, Roswell, New Mexico. The two pilots and the two flight test engineers were fatally injured, and the airplane was substantially damaged by impact forces and a postcrash fire. The airplane was registered to and operated by Gulfstream as part of its G650 flight test program. The flight was conducted under the provisions of 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed at the time of the accident.
NTSB coding
Evidence available
- CVR
- Video
- FDR / data
- Photos
- 87 docket documents
Docket documentsshowing 50 of 87
- Survival Factors 6 - Attachment 8: Pecos Valley Regional Communication Center Dispatch Reportatc
- Cockpit Voice Recorder 12 - Factual Report of Group Chairmancvr
- Data Recorder - Attachment 1 - Tabular Data - Flight 153 - (CSV Format)fdr
- Data Recorder - Attachment 2 - FDR Tabular Data - Flight 153 - (CSV Format)fdr
- Data Recorder - Attachment 3 - Tabular Data - Flight 132 - (CSV Format)fdr
- Data Recorder - Attachment 4 - Tabular Data - Flight 088 - (CSV Format)fdr
- Aircraft Performance 13 - Aircraft Performance Study Addendum #1form
- Aircraft Performance 13 - Errata 1 to Addendum 1form
- Aircraft Performance 13 - Errata 1 to Aircraft Performance Studyform
- Aircraft Performance 13 - Errata 2 to Aircraft Performance Studyform
- Aircraft Performance 13 - Group Chairman's Aircraft Performance Studyform
- Data Recorders Factual Report Addendum 1 - Attachment 1 - Tabular Data - (CSV Format)form
- Errata Operations Group Report - Former GAC Director of Flight Test Interviewform
- G650 Field Performance Test Plan Excerptform
- Human Performance 14 - Attachment 1, Interviews with On-Board Crew Next of Kinform
- Human Performance 14 - Attachment 10, Flight Test Safety MOU Between FAA and Gulfstreamform
- Human Performance 14 - Attachment 2, Toxicological Test Results for the PICform
- Human Performance 14 - Attachment 3, Toxicological Test Results for the SICform
- Human Performance 14 - Attachment 4, Toxicological Test Results for the Lead FTEform
- Human Performance 14 - Attachment 5, Toxicological Test Results for the Second FTEform
- Human Performance 14 - Attachment 6, Emails Documenting FTE1 and SIC use of the ITFform
- Human Performance 14 - Attachment 7, Summary of Overtime for Selected G650 Flight Test Team Membersform
- Human Performance 14 - Attachment 8, Organizational Charts Reflecting the Company's Pre-Accident Structureform
- Human Performance 14 - Attachment 9, Addendum 1form
- Human Performance 14 - Attachment 9, FAA Letters to Gulfstreamform
- Human Performance 14 - Errata to the Human Performance Group Chairman's Factual Reportform
- Human Performance 14 - Factual Report of Group Chairmanform
- Human Performance 14 - Second Errata to Factual Report of Group Chairmanform
- Interview with Former Gulfstream Personnelform
- Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1form
- Survival Factors 6 - Attachment 12: ROW Triennial Drill Informationform
- Survival Factors 6 - Attachment 13: ROW After-Accident Debrief Informationform
- Survival Factors 6 - Attachment 7: G650 Crash Crew Information Bookletform
- Errata for Interview of Gulfstream Personnel (November 2011)interview
- Errata for Interviews of Gulfstream Personnel (June 2011)interview
- Errata for Interviews of Gulfstream Personnel (October 2011)interview
- Interview of Gulfstream Personnel (November 2011)interview
- Interviews of Gulfstream Personnel (June 2011)interview
- Interviews of Gulfstream Personnel (October 2011) -interview
- Interviews with FAA Atlanta ACO Personnelinterview
- On-Scene Interviews of GAC personnelinterview
- Survival Factors 6 - Attachment 2: Gulfstream G650 Personnel Door Operation Interviewsinterview
- Survival Factors 6 - Attachment 4: Airport Personnel, Emergency Response and Witness Interviewsinterview
- Written Witness Statement by Gulfstream Personnel (March 2012)interview
- Written Witness Statements by Accident Witnessesinterview
- Correspondence - NTSB Letter to Mr Flynn GAC 4-04-12other
- Correspondence - GAC Letter to Chairman Hersman NTSB 2-22-12other
- Correspondence - GAC Letter to Chairman Hersman NTSB 3-30-12other
- Excerpts of Gulfstream Presentations of Roswell I and Flight 132other
- Gulfstream Flight Operations Standard Operating Procedures (November 2009)other
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