L2012-01 Risk of Runway Collision Between Two Airliners at Helsinki-Vantaa Aerodrome on 29 December 2011

A serious incident occurred at Helsinki-Vantaa aerodrome on Thursday, 29 December 2011 at 14:40 Finnish time. A Saab 340 aircraft operated by RAF-AVIA Airlines, call sign NEF025, was preparing to take off for a cargo flight and entered the runway. Simultaneously, a Golden Air ATR 72 aircraft, call sign BLF218, which had already been cleared to land, was approaching the runway. NEF025 had two crew members. BLF218 had 67 passengers and 4 aircrew members.

In accordance with the instructions of the air traffic control, NEF025 was taxiing to holding point RWY 22R. Since NEF025 had not contacted Aerodrome Control Tower West (TWR-W), responsible for traffic on RWY 22R, the controller switched on the red stop bar so that NEF025 would not taxi onto the runway in front of the landing aircraft. A moment after this NEF025 called TWR-W. At this time the controller informed NEF025 of the landing aircraft. NEF025 continued to taxi onto the runway past the illuminated stop bar.

BLF218 was approaching RWY 22R and received a landing clearance from the TWR controller. During the final stage of the approach the pilots of BLF218 noticed that the runway was occupied and aborted the approach. Simultaneously, also the TWR controller noticed that NEF025 had entered the runway and cleared BLF218 for a go-around.

The serious incident occurred because the flight crew of NEF025 misinterpreted the traffic information, crossed the illuminated stop bar and entered the active runway 22R without an air traffic control clearance. Inadequate multi-crew cooperation between the pilots of NEF025 was a contributing factor.

In the spring of 2012 the Latvian Civil Aviation Agency (LV CAA) organised two flight safety meetings with RAF-AVIA and audited the company’s operations. As a result of the meetings and the audit LV CAA issued several recommendations for the purpose of correcting the observed anomalies. RAF-AVIA agreed to the recommendations of LV CAA.

Safety Investigation Authority, Finland (SIAF) issued five safety recommendations: two of them were directed at the Latvian Civil Aviation Agency and three at Finavia Corporation (henceforth: Finavia).

SIAF recommend that LV CAA ensure that the pilots of RAF-AVIA are familiar with the procedures related to stop bars. Furthermore, SIAF also recommended that LV CAA make certain that RAF-AVIA pilots possess sufficient multi-crew cooperation skills.

SIAF recommend that Finavia emphasise the importance of disciplined radiotelephony communications in air traffic control operations and that Finavia focus particular attention on correct read-backs. Secondly, SIAF recommended that Finavia make certain that air traffic controllers include the pertinent air traffic control clearance, as applicable, when they complement the standard radiotelephony phraseology with traffic information. SIAF also recommended that Finavia study the possibilities of introducing a runway incursion alerting system.

L2012-01 Report (pdf, 1.17 Mt)