- 31 pages vanished from the maintenance log of the Lion Air Boeing 737 Max before it crashed, killing everyone on board, investigators said in their final report into the tragedy.
- The report from Indonesian investigators, released on Friday, said the pages were missing from October 2018 — the same month as the crash that killed all 189 people on board.
- The report zeroed in on flaws in Boeing’s design of the 737 Max, but also noted errors from Lion Air and the crew on board.
- It said that Lion Air should have investigated similar errors with the same plane the day before it crashed. Instead, information about how to recover the plane never made it to the doomed crew.
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31 pages are missing from the maintenance log of the Lion Air Boeing 737 Max plane from the month that it crashed into the sea and killed everyone on board, investigators said in their final report.
The report from Indonesian investigators was released on Friday, and pointed to Boeing’s faulty design of the plane as well as compounding missteps from the airline and the pilots and crew on board the fatal flight, The Seattle Times reported.
The plane crashed into the Java Sea 13 minutes after taking off from Jakarta, Indonesia, killing all 189 people on board.
The report zeroed in on the design of Boeing’s plane, noting flaws in its software system that continually pushed the plane’s nose down, as well as how Boeing did not tell pilots about the system, did not notice that an alert in the plane was not working, and made the system more powerful without telling regulators.
But it also noted flaws in Lion Air’s handling of the plane, including noting that 31 pages from the plane’s maintenance logs for October 2018 — the month of the fatal crash — were missing. It is not known what happened to those pages.
The report pointed to the plane’s previous flight, where passengers said that the plane climbed and dropped so much that it was “like a rollercoaster,” causing people to throw up.
It said that both flights displayed similar issues, and that Lion Air should have investigated after the problems on the fight flight.
It said that flight “experienced multiple malfunctions was classified as a serious incident and should have been investigated.”
Instead, that information did not make it to the pilots of the second crash. Both crews were battling with the plane’s nose repeatedly pointing down.
Lion Air declined to comment to Reuters about the report.
A Bloomberg report in March, which cited unnamed investigative sources, said that an off-duty pilot riding in the cockpit diagnosed the problem and told the crew how to fix it, citing a checklist.
But the investigators said that the first officer on the second flight was not familiar with the checklist that he was supposed to run through, and had performed poorly in some training exercises with the airline.
A voice recording that was recovered from the plane wreckage shows that the pilots were desperately reading the flight manual for a solution before the crash.
It also said that investigators could not prove that the airline had inspected a newly installed critical sensor, which turned out to be faulty during the flight.
It said that maintenance records do not show any evidence that the maintenance engineer who installed the sensor — an angle of attack sensor, which measures the plane’s angle in the sky — tested it, though the engineer said that it had been.
The report said that “the investigation could not determine with any certainty” that the installation was “successful.”