The risky mid-air manoeuvre that led to a fatal collision between two ex-fighter jets was not discussed beforehand, a damning ATSB report has revealed.
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Investigators also said the operator of the two SIAI Marchetti S-211s did not hold the certificate required for the flight, the S-211s were not permitted to be used for the filming flight, and the pilot of the surviving plane had medical restrictions that were not being fully followed.
VH-DZJ crashed in Port Phillip Bay on 19 November 2023 after colliding with another S-211, VH-DQJ, during an aerobatic formation filming flight. In its preliminary report in January, the Australian Transport Safety Bureau (ATSB) said the manoeuvre that led to the collision was performed because of a “good filming opportunity”.
The two jets, formerly owned by the Republic of Singapore Air Force and used for jet training, were being operated by Jetworks Aviation, the flying school owned by Stephen Gale. Gale, who was piloting VH-DZJ at the time, was killed in the crash along with cameraman James Rose, while VH-DQJ was able to return safely to Essendon Airport.
According to the ATSB, the manoeuvre “involved the formation lead aircraft [VH-DQJ], callsign ‘Viper 1’, rolling inverted before the second jet [VH-DZJ], ‘Viper 2’ passed directly beneath it”.
“This manoeuvre had not been specifically briefed before the flight and was conducted without the prior knowledge of the crew of Viper 1, the ATSB investigation of the accident found,” the ATSB said.
This was followed by a radio discussion between the two pilots on repeating the manoeuvre, which, according to ATSB chief commissioner Angus Mitchell, “did not allow the pilots to fully consider the risks associated with the manoeuvre before it was attempted for a second time”.
“Pre-briefing of in-flight manoeuvres is critical to safe formation flying to mitigate the risks of increased pilot workload and distraction,” said Mitchell.
“Minimising the risk of these flights requires pilots to prioritise operational safety, in particular through in-depth briefings, pre-flight planning of manoeuvres, and strict adherence to procedures and the agreed plan.
“This ensures everyone has a similar understanding of the intended manoeuvres and can fully consider the associated risks.”
Mitchell added that other factors, including medical restrictions and a lack of the required operating certificate, increased the risk of something going wrong.
“While these factors did not directly contribute to the aircraft handling or decision making that led to the collision, regulatory limitations exist to mitigate known risks associated with this type of operation,” he said.
“Operating outside of these limitations removes in-built safety defences and organisational structures designed to identify and mitigate these risks.”