CF188798 Hornet
25 June 2003
Aalborg, Denmark
The accident aircraft, CF188798, was part of a 10-aircraft detachment, which was deployed to Aalborg, Denmark in support of Exercise CLEAN HUNTER.
On 25 June 2003 after completing a morning sortie, the accident aircraft required a recharge of the arrestor hook accumulator. The two Canadian technicians involved in the accident retrieved a nitrogen-servicing cart and with the assistance of a Danish technician proceeded to the aircraft. The senior of the two Canadian technicians connected a nitrogen hose to the aircraft and requested 3400 PSI from the Danish technician who was operating the nitrogen cart. When the requested pressure was reached, the senior technician opened the air charge valve and almost immediately thereafter the pressure accumulator of the hook actuator exploded due to a massive over-pressurization. The aircraft suffered "B" category damage. All technicians escaped without injury.
The investigation revealed that an unqualified technician attempted to conduct routine servicing on the accident aircraft. A contributing factor was the operations tempo at this Squadron that tacitly encouraged technicians to reduce the time required for maintenance actions and bypass approved maintenance procedures. This finding was confirmed by a concurrent airworthiness audit which stated that the Squadron was working at a level of risk that is normally unacceptable for a Canadian Forces maintenance organisation.
On 12 December 2003, this Squadron developed a risk mitigation plan, which addressed many of the issues raised in this report and identified in the airworthiness accreditation audit of November 2003. The risk mitigation plan incorporates 49 separate and positive procedures to strive for a safe maintenance practice.
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