Premium research interface

The modern interface for aviation safety intelligence.

Search investigations, review source evidence, monitor watched reports, and trace long-term patterns from one calm, data-first workspace.

63k+
Reports indexed
1940-2026
Coverage
Recent
Last data refresh
Featured Report

Loading…

Loading featured report…

Loading…
Open Report

Safety trends by operating rule

Track fatal and non-fatal accident patterns across Part 91, Part 135, and Part 121 operations.

Loading trend charts…

Browse the aviation graph

Move quickly by aircraft, airport, operator, and time with indexes built for research, not wandering.

Last Data Update

By Decade

By Month

Aircraft Manufacturer

More manufacturers

Airports

More airports

Operators

More operators

About

Aviation safety reports, made easier to study

NTSB Reports is an independent research and search tool for public aviation accident and incident records. It brings NTSB aviation reports, structured fields, docket files, extracted figures, photos, videos, and update history into one searchable interface.

The goal is practical safety education: make it faster to find relevant investigations, compare similar events, review factual records, and understand the evidence behind probable-cause and preliminary reports.

The investigative work and source records belong to the National Transportation Safety Board and the published investigation record. This site is not affiliated with or endorsed by the NTSB.

FAQs

NTSB Report

March 28, 2009 · Cessna T210L · N2445S

Madera, CA

Overview

Report Status
Final with probable cause
Event Type
Accident
Date
March 28, 2009
Injury Outcomes
2 injuries (2 serious injuries)
Location
Madera, CA
Aircraft
Cessna T210L
Tail Number
N2445S
Operator
Davis David L
Injuries
Serious
Aircraft Damage
Substantial
NTSB Number
WPR09LA170

While entering the traffic pattern at his home base after a return flight, the pilot switched to the airplane's left tank. As he continued in the pattern he asked his passenger if he would like to make a landing for currency also. When the passenger said yes, the pilot changed his planned full-stop landing to a touch-and-go. During the initial climb after the touch-and-go, the engine lost all power and the pilot executed a forced landing into a grape orchard where the vegetation was supported by closely spaced posts. The investigation confirmed that both fuel tanks were empty at the time of the forced landing. It was further determined that the fuel tank dip tube that the pilot used to determine fuel levels prior to a flight earlier that day was not specifically designed for, or calibrated to, this specific airplane model. The investigation also determined that the pilot did not check the fuel quantity of the left tank when he switched to it upon entering the pattern, and that he switched to that tank only because after a previous momentary fuel flow interruption from the right tank, the owner had made switching to the left tank in the pattern a standard procedure for this airplane regardless of the fuel quantities in each tank.

NTSB Probable Cause

A total loss of engine power during the initial climb due to fuel exhaustion as a result of the pilot's failure to properly monitor the airplane's fuel quantity and to correctly ascertain the fuel on board the airplane prior to takeoff.

Full Narrative

On March 28, 2009, about 1330 Pacific daylight time, a Cessna T210L, N2445S, impacted the terrain during a forced landing about one mile north of Madera Municipal Airport, Madera, California. The private pilot and his passenger received serious injuries, and the airplane, which was owned by the passenger, sustained substantial damage. The 14 Code of Federal Regulations Part 91 personal pleasure flight, which departed Harris Ranch Airport, Coalinga, CA, about 40 minutes prior to the accident, was being operated in visual meteorological conditions. No flight plan had been filed. According to the pilot, when he entered the traffic pattern at Madera, where he planned to make a full-stop landing, he asked his passenger if he would also like to make one landing for currency. Since the passenger replied that he would like to make a landing, the pilot changed his planned full-stop landing to a touch-and-go. During the initial climb after the touch-and-go, the airplane's engine began to sputter, and about five seconds later it lost all power while it was about 500 feet above ground level (AGL). The pilot checked to make sure the magneto switch was in the BOTH position, but because of the low altitude and the descent of the airplane, he did not make a restart attempt. Instead he decided to focus on making a power-off forced landing. He therefore turned toward a nearby open area, left the gear fully retracted, and concentrated on making a successful touchdown. After the touchdown, the airplane slid across a road and entered a grape orchard where the vegetation was supported by closely spaced posts. When a Federal Aviation Administration (FAA) Inspector responded to the scene about two hours after the accident, he found no fuel in either of the airplanes wings. He then confirmed that the fuel caps were on tight, and checked for any evidence of in-flight or on-ground fuel leakage, of which there was none. During the investigation, it was revealed that when the local fire department used a hydraulic cutting device to remove the injured occupants, they severed the fuel line that runs down the right forward door post. Because the airplane came to rest with the right wing higher than the left, this action would have allowed any remaining usable fuel from the right wing to drain out after it was cut. Therefore, the NTSB Investigator-In-Charge (IIC) contacted the on-scene commander from the Madera Fire department to determine if fuel had drained from that line. According to that individual, who confirmed that he had seen the door post being cut, and also observed the occupants being removed, no fuel drained from the line. An FAA-monitored post-accident inspection of the engine and the airframe did not reveal any evidence of malfunctions or anomalies that would have precluded the engine from producing rated horsepower, or would have allowed fuel to leak from the airplane. According to the pilot, earlier in the day, prior to the flight from Madera to Harris Ranch, he used a fuel tank dipping tube to measure the level of both fuel tanks. At that time he estimated each tank was about one-half full (about 22 gallons each), which would have provided a little over two hours flying time based upon his flight planning fuel flows. He then flew to Harris Ranch and back, for a total block-to-block time that he said could have been as much as one hour and twenty minutes. When questioned further by the IIC about his fuel measurement and fuel monitoring process, the pilot stated that the wing tank fuel dip tube was not one of the types that had been designed and marked specifically for use on the Cessna 210. He also confirmed that neither he nor the owner had put the tube through a calibrating process that would ensure its accuracy with this specific airplane. He also confirmed that although he had dipped the tanks prior to leaving Madera, he had not done so prior to the return flight from Harris Ranch. Upon further questioning, he also stated that he did not remember checking the fuel quantity in the left tank when he switched to it upon entering the pattern, nor did he check the left tank fuel level prior to asking the passenger if he would like to make a landing. When asked why he selected the left tank for landing, he said that it was standard procedure with this airplane because the owner had at some time in the past experienced a momentary interruption in fuel flow from the right tank while at altitude. Because of that event, both this pilot and the owner always switched to the left tank upon entering the pattern, regardless of which tank had the higher fuel level.

Flight

Event TypeAccident
Event Time13:30 PDT
Nearest AirportMADERA (1nm)
Runway30
Runway Length5400 ft
Runway Width100 ft
Flight Plan FiledUnknown
Flight Plan ActivatedNo
Aircraft FireNo
Aircraft ExplosionNo

Aircraft

AircraftCessna T210L
Tail NumberN2445S
Aircraft CategoryAir
DamageSubstantial
OperatorDavis David L
Operating RulePart 91
Engines1
Engine TypeReciprocating
Engine DetailsCont Motor · TSIO-520 SER · Reciprocating · 300
Seats6

People & Injuries

Injury Summary2 injuries (2 serious injuries)
Fatal0
Serious2
Minor0
Uninjured0
Total2
Crew 1Age 25 · Third Class · Serious

Conditions

ConditionsVMC
LightDaylight
WindCalm
Visibility10 sm
CeilingNone
Temperature / Dew Point0 C
Altimeter29.90 inHg
Weather SourceWIT

Appendix: Source Data