Interim report on the accident on 1st June 2009 to the Airbus A330-203

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Interim report
f-cp090601ae
on the accident on 1st June 2009
to the Airbus A330-203
registered F-GZCP
operated by Air France
flight AF 447 Rio de Janeiro – Paris
F-GZCP - 1st June 2009
1
This document has been prepared on the basis of the initial information
gathered during the investigation, without any analysis and - given the
continuing absence of wreckage, the flight recorders, radar tracks and
direct testimony - without any description of the circumstances of the
accident. Some of the points covered may evolve with time. Nothing in the
presentation of this interim report or in the points that are raised therein
should be interpreted as an indication of the orientation or conclusions of
the investigation.
In accordance with Annex 13 to the Convention on International Civil
Aviation, with EC directive 94/56 and with the French Civil Aviation Code,
the investigation is not conducted in such a way as to apportion blame
or to assess individual or collective responsibility. The sole objective is
to draw lessons from this occurrence which may help to prevent future
accidents or incidents
SPECIAL FOREWORD TO ENGLISH EDITION
This interim report has been translated and published by the BEA to
make its reading easier for English-speaking people. As accurate as the
translation may be, the original text in French should be considered as the
work of reference.
Foreword

F-GZCP - 1st June 2009
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Table of Contents
FOREWORD 1
GLOSSARY 5
SYNOPSIS 9
ORGANISATION OF THE INVESTIGATION 11
1. FACTUAL INFORMATION 13
1.1 History of Flight 13
1.2 Killed and Injured 14
1.3 Damage to Aircraft 14
1.4 Other Damage 14
1.5 Personnel Information 14
1.5.1 Flight crew 14
1.5.2 Cabin crew 17
1.6 Aircraft Information 19
1.6.1 Airframe 19
1.6.2 Engines 20
1.6.3 Weight and balance 20
1.6.4 Condition of the aircraft before departure 20
1.6.5 Maintenance operations follow-up 21
1.6.6 Information on the airspeed measuring system 21
1.6.7 Checks and maintenance of the Pitot probes 23
1.6.8 ACARS communication system 24
1.6.9 Centralised Maintenance System 25
1.6.10 Radio communications system 28
1.7 Meteorological Conditions 28
1.7.1 Meteorological Situation 28
1.7.2 Comments on the information available 29
1.8 Aids to Navigation 33
1.9 Communications 33
1.9.1 Communications between the control centres 34
1.9.2 Coordination between the control centres 35
1.10 Aerodrome Information 37
F-GZCP - 1st June 2009
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1.11 Flight Recorders 37
1.12 Wreckage and Impact Information 37
1.12.1 Localisation of the bodies and aircraft parts 37
1.12.2 Identification of the items recovered 38
1.12.3 Visual inspection 38
1.12.4 Summary of visual examination 40
1.13 Medical and Pathological Information 40
1.14 Fire 41
1.15 Survival Aspects 41
1.16 Tests and Research 45
1.16.1 Sea Searches 45
1.16.2 ACARS messages 48
1.17 Information on Organisations and Management 57
1.17.1 Preparation of flights within Air France 57
1.17.2 Work cycles and flight crew rest 61
1.17.3 Instruction for use of the on-board weather radar 63
1.17.4 Letters of agreement between air traffic control
organisations 64
1.17.5 Experimental implementation of the ADS-C system
at Dakar 66
1.18 Additional information 66
1.18.1 Events associated with erroneous air speed indications 66
1.18.2 Brief history of the Pitot probes on Airbus A330 / A340 67
1.18.3 Testimony of crews in flight in the vicinity of the accident
zone 67
1.18.4 Procedures to be applied in case an unreliable speed
indication is detected 69
2. INITIAL FINDINGS 70
LIST OF APPENDICES 73
F-GZCP - 1st June 2009
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Glossary
AAIB Air Accident Investigation Branch
ACARS Aircraft Communications Addressing and Reporting System
ACP Audio Control Panel
ADIRU Air Data and Inertial Reference Unit
ADM Air Data Module
ADR Air Data Reference
ADS-C Automatic Dependent Surveillance-Contract
AFS Automatic Flight System
AIC Aeronautical Information Circular
AMU Audio Management Panel
AOC Airline Operational Control
ASECNA Air Traffic Safety Agency for Africa and Madagascar
ATA Air Transport Association of America
ATC Air Traffic Control
ATPL Airline Transport Pilot License
ATSU Air Traffic Service Unit
BFU German accident investigation board (Bundesstelle für
Flugunfalluntersuchung)
BITE Built-In Test Equipment
SB Service Bulletin
CAS Calibrated Airspeed
CAT Clear Air Turbulence
OCC Operations Coordination Centre
ECC En-route Control Centre
RCC Rescue Coordination Centre
CDL Configuration Deviation List
CECLANT Atlantic Command
CENIPA Brazilian accident investigation board (CENtro de Investigação
e Prevenção de Acidentes aeronãuticos)
CFR Current Flight Report
CG Centre of Gravity
CMC Central Maintenance Computer
CMS Central Maintenance System
CNOA French national operations centre
CPDLC Controller-Pilot DataLink Communications
CPL Commercial Pilot’s Licence
DGAC French civil aviation directorate (Direction Générale de
l'Aviation Civile)
DMC Display Management Computer
F-GZCP - 1st June 2009
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ECAM Electronic Centralized Aircraft Monitoring
EFCS Electronic Flight Control System
ETOPS Extended-range Twin-engine OPerationS
EWD Engine Warning Display
FADEC Full Authority Digital Engine Control
FCDC Flight Control Data Concentrator
FCL Flight Crew Licensing
FCMS Fuel Control Monitoring System
FCOM Flight Crew Operating Manual
FCPC Flight Control Primary Computer
FCSC Flight Control Secondary Computer
FCTM Flight Crew Training Manual
FD Flight Director
FIR Flight Information Region
FL Flight Level
FM Flight Management
FMGEC Flight Management Guidance and Envelope Computer
FMS Flight Management System
FPV Flight Path Vector
FWS Flight Warning System
GNSS Global Navigation Satellite System
GPS Global Positioning System
GPWS Ground Proximity Warning System
HF High Frequency
IATA International Air Transport Association
IFPS Initial Flight plan Processing System
IR Inertial Reference
IRME Multi Engine Instrument Rating
ISIS Integrated Standby Instrument System
kHz kilo Hertz
kt knot
LMC Last Minute Change
MAC Mean Aerodynamic Chord
MEL Minimum Equipment List
METAR METeorological Airport Report
MHz Mega Hertz
MRCC Maritime Rescue Coordination Centre
MTOW Maximum Takeoff Weight
ND Navigation Display
NM Nautical Mile
NOTAM NOTice to AirMen
F-GZCP - 1st June 2009
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NTSB National Transportation Safety Board (USA)
ICAO International Civil Aviation Organisation
PF Pilot Flying
PFD Primary Flight Display
PFR Post Flight Report
RCC Rescue Coordination Centre
RMP Radio Management Panel
ROV Remotely Operated Vehicle
SAR Search and Rescue
SD System Display
SELCAL SELective CALling system
SIGMET SIGnificant METeorological information
TAF Terminal Area Forecast
TCAS Traffic alert and Collision Avoidance System
TEMSI Significant weather chart
TPL Towed Pinger Locator
ULB Underwater Locator Beacon
USCG US Coast Guard
UTC Universal Time Coordinated
VHF Very High Frequency
ITCZ Inter-Tropical Convergence Zone