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Air transportation safety investigation A19O0103

The TSB has completed this investigation. The report was published on 2 April 2020.

Table of contents

Wheels-down water landing

Privately registered
Cessna A185E (on amphibious floats), C-GBUI
Upper Raft Lake, Ontario

View final report

The occurrence

On , a privately registered Cessna 185 E aircraft, equipped with amphibious floats, departed the runway at Orillia Ramara Regional Airport, Ontario, destined to Upper Raft Lake, located approximately 48 nm to the north of the Orillia/Lake St. John Water Aerodrome, with 7 people on board.

During the landing, when the aircraft touched down on the surface of the water, it flipped over and came to rest in an inverted position. The aircraft sustained substantial damage; it was submerged in the water but held afloat by the aircraft floats. The landing gear, which is normally up for a water landing, was observed to be in the down position.

The 6 passengers egressed the aircraft and sustained minor injuries, while the pilot was fatally injured. The aircraft was equipped with an emergency locater transmitter (ELT); however, no signal was received at the time of the occurrence by alerting services.


Media materials

News release

2020-04-02

Investigation report: August 2019 fatal wheels-down water landing in Upper Raft Lake, Ontario
Read the news release


Investigation information

Map showing the location of the occurrence




Investigator-in-charge

Photo of Beverley Harvey

Senior Investigator Beverley Harvey works in the International Operations and Major Investigations division of the Air Investigations Branch. Ms. Harvey, who started her career as a pilot in New Zealand, has over 40 years’ civil aviation experience. She was a flight instructor at the Rockcliffe Flying Club in Ottawa before flying single-engine aircraft for Earlton Airways and Wanapitei Airways in Ontario. She subsequently flew the Cessna 402 and Beechcraft 99 aircraft for Austin Airways. At Air Ontario Ms. Harvey flew the de Havilland DHC-8 100 and 300 series aircraft.

Ms. Harvey joined Transport Canada in 2000 and worked as an inspector before joining the TSB in 2008. She is a certified aircraft accident investigator, and completed her training at the University of Southern California. She holds a valid Airline Transport Pilot Licence.


  Download high-resolution photos from the TSB Flickr page.

Class of investigation

This is a class 4 investigation. These investigations are limited in scope, and while the final reports may contain limited analysis, they do not contain findings or recommendations. Class 4 investigations are generally completed within 220 days. For more information, see the Policy on Occurrence Classification.

TSB investigation process

There are 3 phases to a TSB investigation

  1. Field phase: a team of investigators examines the occurrence site and wreckage, interviews witnesses and collects pertinent information.
  2. Examination and analysis phase: the TSB reviews pertinent records, tests components of the wreckage in the lab, determines the sequence of events and identifies safety deficiencies. When safety deficiencies are suspected or confirmed, the TSB advises the appropriate authority without waiting until publication of the final report.
  3. Report phase: a confidential draft report is approved by the Board and sent to persons and corporations who are directly concerned by the report. They then have the opportunity to dispute or correct information they believe to be incorrect. The Board considers all representations before approving the final report, which is subsequently released to the public.

For more information, see our Investigation process page.

The TSB is an independent agency that investigates air, marine, pipeline, and rail transportation occurrences. Its sole aim is the advancement of transportation safety. It is not the function of the Board to assign fault or determine civil or criminal liability.