The Transportation Safety Board of Canada (TSB) has finished an investigation into a fatal incident that occurred on May 6, 2023 at the Smithers Airport.
It involved an Airbus AS 350 B3 operated by Mustang Helicopters.
According to the board, the helicopter underwent maintenance that day which required its rotor system to run at nearly full RPM.
It added the helicopter started an uncommanded rotation during a ground maintenance run, prompting the pilot to kill fuel to the engine and apply the rotor brake.
The board said the helicopter rotated about 540 degrees before coming to a stop.
Two maintenance staff members were standing near the helicopter’s left cargo door both being struck where one was seriously and the other fatally injured.
TSB said the pilot shortened the operator’s checklist to expedite operations after the first maintenance ground run, leading to important steps not being completed.
It added skipping the steps left pressure in the hydraulic system and the right anti-torque pedal in a fully forward position, both undetected before the third ground maintenance run.
The board said the pilot’s attention was split between the maintenance operations and his cellphone, connected to an earpiece, as the type of maintenance was viewed as routine and repetitive.
According to TSB, no regulations in Canada prohibit the use of cellphones in the cockpit, and is well understood that electronic devices can divert attention from activities necessary for safe operations.
The board added the operator has strengthened safety practices with updated maintenance procedures following the occurrence, including a new distraction policy.
The full report can be found here.
