Beech 1900C and Piper PA-31-350 incident near Fairbanks, Alaska, June 14, 2011
On June 14, 2011 at about 9:10 pm local time, 2 aircraft, Beech 1900C (N121WV) and Piper PA-31-350 (N4112K), were involved in the same incident near Fairbanks, Alaska. No one was hurt; 12 people were on board or involved.
The NTSB's probable cause their words, unchanged
Inadequate air traffic control actions that failed to establish and maintain required separation between the two airplanes. Contributing to the incident was inexperience on the part of the local controller, inadequate oversight by the tower controller-in-charge, and deficient facility procedures and training.
Inadequate air traffic control actions that failed to establish and maintain required separation between the two airplanes. Contributing to the incident was inexperience on the part of the local controller, inadequate oversight by the tower controller-in-charge, and deficient facility procedures and training.
Source: NTSB aviation accident database, copy made October 5, 2026. Docket and reports at the NTSB.
What the record shows
- Date
- June 14, 2011 · about 9:10 pm local time
- Place
- Fairbanks, Alaska · map
- Type
- Incident
- Injuries
- No one was hurt; 12 people were on board or involved.
- Weather
- not recorded
- Aircraft 1
- Beech 1900C · all 1900Cs on the register
- Registration
- N121WV · no longer on the register · serial UC-78
- Damage
- Not recorded
- Flight
- Flight · charter and air-taxi rules (Part 135)
- Aircraft 2
- Piper PA-31-350 · all PA-31-350s on the register
- Registration
- N4112K · registry record · serial 31-8353006
- Damage
- Not recorded
- Flight
- Flight · charter and air-taxi rules (Part 135)
The NTSB's narrative for the Beech 1900C final · quoted from the NTSB record
An air traffic control operational error and near midair collision occurred between a Raytheon Beech 1900 and a Piper Navajo about 3.5 miles west of the airport. The Beech 1900 was northeast bound toward the airport descending to enter the traffic pattern for runway 20L, while the Piper had just departed from runway 20R and was climbing on a westbound heading. Both airplanes were operating under visual flight rules at the time of the incident, and were receiving air traffic control services from a tower air traffic controller. There were no reports of injuries or damage to either airplane. The local controller, who had only been certified on the position for 5 weeks, stated that she was trying to establish vertical separation between the two airplanes by restricting the departing Navajo to remain at or below 2,000 feet. The Beech was still on the approach controller's frequency, so the local controller was not aware of what instructions had been issued to the pilot. The approach controller mistakenly believed that the Beech was in communication with the local controller. Neither the local controller nor the controller-in-charge, who was responsible for monitoring the operation and assisting the local controller, initiated any coordination with the approach controller to resolve the conflict. NTSB review of local procedures and directives found that there was a misunderstanding of required procedures and controller responsibilities for operations in Terminal Radar Service Areas, including separation standards and procedures for transfer of communications between controllers.
The complete narrative as the NTSB published it. The NTSB's docket holds the report as a PDF and any photographs, statements and other documents from the investigation.
The NTSB's narrative for the Piper PA-31-350 final · quoted from the NTSB record
An air traffic control operational error and near midair collision occurred between a Raytheon Beech 1900 and a Piper Navajo about 3.5 miles west of the airport. The Beech 1900 was northeast bound toward the airport descending to enter the traffic pattern for runway 20L, while the Piper had just departed from runway 20R and was climbing on a westbound heading. Both airplanes were operating under visual flight rules at the time of the incident, and were receiving air traffic control services from a tower air traffic controller. There were no reports of injuries or damage to either airplane. The local controller, who had only been certified on the position for 5 weeks, stated that she was trying to establish vertical separation between the two airplanes by restricting the departing Navajo to remain at or below 2,000 feet. The Beech was still on the approach controller's frequency, so the local controller was not aware of what instructions had been issued to the pilot. The approach controller mistakenly believed that the Beech was in communication with the local controller. Neither the local controller nor the controller-in-charge, who was responsible for monitoring the operation and assisting the local controller, initiated any coordination with the approach controller to resolve the conflict. NTSB review of local procedures and directives found that there was a misunderstanding of required procedures and controller responsibilities for operations in Terminal Radar Service Areas, including separation standards and procedures for transfer of communications between controllers.
The complete narrative as the NTSB published it. The NTSB's docket holds the report as a PDF and any photographs, statements and other documents from the investigation.
The factual record for the Beech 1900C from the NTSB's investigation tables, in plain English
What happened, in order
- Air traffic event during approach
- Near midair/TCAS alert/loss of separation during approach (VFR pattern downwind) defining event
The NTSB's findings
- cause Personnel issues › Task performance › (general) › (general) › ATC personnel
- factor Personnel issues › Experience/knowledge › Experience/qualifications › Total experience in position › ATC personnel
- factor Personnel issues › Experience/knowledge › Training › Type/qual of instruct/training › ATC personnel
- factor Organizational issues › Support/oversight/monitoring › Oversight › Oversight of operation › ATC
- cause Personnel issues › Action/decision › Info processing/decision › Decision making/judgment › ATC personnel
The aircraft
- Seats: 19
- Landing gear: fixed
- Engine 1: P&W Canada PT6A-60A (turboprop); 0 hours total
- Engine 2: P&W Canada PT6A-60A (turboprop); 0 hours total
- Operator: Warbelows Air Ventures INC
The flight
- Destination: Fairbanks AK
- Flight plan: VFR
- A second pilot was aboard
Weather at the time
- Temperature: 0°F (-18°C), dew point 0°F (-18°C)
Injuries
| Fatal | Serious | Minor | None | |
|---|---|---|---|---|
| Flight crew | 2 | |||
| Passengers | 5 |
The factual record for the Piper PA-31-350 from the NTSB's investigation tables, in plain English
What happened, in order
- Air traffic event during initial climb
- Near midair/TCAS alert/loss of separation during initial climb defining event
The NTSB's findings
- cause Personnel issues › Task performance › (general) › (general) › ATC personnel
- factor Personnel issues › Experience/knowledge › Experience/qualifications › Total experience in position › ATC personnel
- factor Personnel issues › Experience/knowledge › Training › Type/qual of instruct/training › ATC personnel
- factor Organizational issues › Support/oversight/monitoring › Oversight › Oversight of operation › ATC
- cause Personnel issues › Action/decision › Info processing/decision › Decision making/judgment › ATC personnel
The aircraft
- Seats: 8
- Landing gear: fixed
- Engine 1: Lycoming TIO-540 SER (piston); 0 hours total
- Engine 2: Lycoming TI0-540 SER (piston); 0 hours total
- Operator: Era Aviation INC
The flight
- Departed from: FAI Fairbanks AK
- Flight plan: VFR
Injuries
| Fatal | Serious | Minor | None | |
|---|---|---|---|---|
| Flight crew | 1 | |||
| Passengers | 4 |
Documents from the investigation the NTSB's docket: the evidence folder behind the report
The docket, the folder of records gathered during an investigation (maintenance records, photographs, witness statements, examinations), has not been read from the NTSB for this case yet; the list appears here once it has. Open the docket at the NTSB.
Everything on this page comes from the NTSB's public records. The narrative, probable cause and findings are the NTSB's own words; the coded tables behind the report are written out in plain English, with pilots' ages, home towns and medical details left out. The documents and photographs are the NTSB's docket, shown as the NTSB released them. This site's own text never names anyone involved. A preliminary report can change; the final report usually follows one to two years later, and the page is refreshed when it does.