Aeroflot Flight 141

Conclusions of the Czechoslovak Commission

After analyzing the circumstances of the crash, the Czechoslovak investigation commission reached the following conclusions:

The pre-flight preparation of both the aircraft and crew was conducted in accordance with established regulations. The aircraft was technically sound, and the flight proceeded along the designated route and at assigned altitudes up to the Liboc (L) locator beacon. Throughout the flight, the crew did not report any problems or difficulties.

All crew members held the required licenses and qualifications, and their health was assessed as satisfactory.

The aircraft possessed a valid airworthiness certificate and was maintained in accordance with current instructions and manuals. No design modifications had been made during its service life, and all previously identified faults had been promptly rectified.

During both takeoff and landing, the aircraft's weight and balance remained within the permissible limits.

The fuel used met the appropriate standards and specifications.

No hazardous weather conditions were forecasted or reported to the crew during the flight or during the landing approach. The flight was conducted under visual meteorological conditions before landing. However, within the surface layer—up to 100 m above ground level—the possibility of turbulence during the landing approach could not be ruled out.

All radio navigation equipment along the route and at the airport was functioning properly.

Radio communication between the aircraft and air traffic control was normal and uninterrupted.

There were no reported malfunctions in airport radio equipment during Flight 141's approach. The crew did not report any communication issues nor did they transmit squawk code 7600 (radio failure).

Both flight recorders were operational and were immediately recovered and sent for examination following the crash.

There was no structural failure of the aircraft prior to its collision with the ground. The wreckage was scattered no more than 320 m from the end of the runway.

A fire ignited immediately after the right wing struck the ground, and it quickly spread. As the aircraft overturned, fuel spilled into the fuselage, intensifying the fire both inside and outside the cabin. Rescue and firefighting operations commenced within two minutes of the crash.

The airliner was completely destroyed in the crash.

The approach lighting system for Runway 25 sustained damage as a result of the accident.

A total of 66 people perished in the crash, while 18 people were seriously injured and 16 escaped with relatively minor or no injuries. With the exception of the four deceased flight attendants, a significant portion of the crew survived.

During rescue efforts, 34 occupants were successfully evacuated from the burning wreckage. According to testimonies from surviving passengers, the design of the seatbelt buckles significantly hindered rescue and evacuation efforts.

Due to the complete destruction of the aircraft upon impact and the subsequent fire, the Czechoslovak Ministry of Transport commission was unable to determine the exact cause of the accident. However, investigators considered the possibility that during the landing approach, the Tu-154 encountered unexpected turbulence and may have been affected by wind shear.

Conclusions of the Soviet Commission

The Soviet investigation criticized the 207th Flying Squadron, whose leadership had organized preparations for the flight with serious procedural violations. These included:

The flight squadron commander, P. N. Karteriev, and the acting aviation squadron commander, K. F. Chanov, were replaced before the flight by the navigator and flight engineer. This substitution was made without justification and constituted a violation of Order No. 275-70 issued by the Ministry of Civil Aviation.

The flight assignment included two inspectors and one trainee, in violation of paragraph 4.1.12 of the GA-71 Flight Operations Manual (NPP). This led to a situation in which multiple inspectors were present in the cockpit simultaneously, complicating internal crew coordination. As a result, the crew's operations were disrupted during a critical phase of flight—the landing approach.

Investigators identified pilot error by Captain Chernetsov as a likely cause of the crash. At low altitude, the captain erroneously shifted the stabilizer from the landing position to the flight position, deviating from the procedures outlined in the Flight Operations Manual. By failing to maintain the proper landing configuration, the commander created a time-constrained situation that contributed to further control errors and ultimately led to the accident.

The design of the stabilizer control switch was also criticized, as it allowed the stabilizer angle to change imperceptibly to the crew—from −5.5° (landing position) to 0° (flight position). In the landing configuration, the stabilizer provides a nose-up pitching moment to counteract the nose-down moment generated by the aircraft’s wing and landing configuration. When the stabilizer was shifted to the flight position, the compensating nose-up force was lost, allowing the nose-down moment to dominate and cause the aircraft to descend.

The crew's attempts to recover by pulling on the control yoke were ineffective due to the limited surface area of the elevators, which could not counteract the rapid nose-down pitch.