What happened
The FAA’s narrative, in sentence case. The FAA writes it in capitals and removes private details.
(-23) Preliminary investigation results: the inspection of the tandem parachute system was delayed until September 22, 2004, due to hurricane activity in Florida where the equipment was sent for the inspection. The initial inspection of the uninsured relative workshop, inc., sigma tandem parachute system revealed that there was a main/reserve entanglement. It is not clear in what sequence the cutaway and reserve ripcord handles were pulled. The reserve was deployed manually prior to automatic activation device (aad) activation (the aad cutter did activate, but the reserve closing loop was not cut). Suspension lines were stowed in one outside line stow on the main parachute deployment bag, the canopy was completely out of the deployment bag. The reserve was still in its deployment bag and portions of the lines were still stowed. (The two) locking stows of the safety stow were still in place. The balance of the suspension lines were out of the bag. The reserve static line was still connected in its normal position on the right shoulder pad and was still connected to the right main riser. The 3-ring release had been activated. The right riser was close to its normal position on the shoulder area. The left main riser was heavily involved in the main/reserve entanglement. Tentative recovery of digital videotape imagery from a hand-cam in pending. The hand-cam was being worn on the left wrist of the tandem instructor. The instructor was a 44 year old male brazilian national, uspa tandem authorized and current, with 5,300+ jumps (3,200+tandem), holding a current third class FAA medical certificate. The passenger was a 21 year old female japanese national. The parachute system description and packing history is unavailable at this time. It is known that both parachutes were packed within the last 120 days. The investigation is ongoing and inconclusive. Parachute incident. (-23 amendment) the uninsured relative workshop, inc. sigma tandem parachute system was inspected by several industry manufacturing experts who are parachute riggers along with a FAA manufacturing inspector and was found to be free of defects. During the jump the tandem instructor was wearing a video camera called a hand-cam on his left wrist. A forensic lab reconstructed the hand-cam videotape as completely as possible in view of the damage it s ustained upon impact. Based on inspection of the equipment, hand-cam aerial video footage, ground photographs, and post incident ground video taken at the scene, observations and opinions are as follows: the tandem pair exited the aircraft and a clean drogut deployment is seen on the recovered video. The remainder of the video was severely damaged and no other information was recoverable from the tape. At some the drogue release handle was pulled. The main parachute deployment resulted in a bag-lock malfunction with one outer line stow still intact with its stow band holding it to the deployment bag. The reserve handle was pulled before cypress firing altitude and before the 3-ring risers had released. The reserve static line was still connected in its normal position on the right shoulder pad and was still connected to the right main riser. Evidence indicates that the cutaway handle was pulled after reserve deployment; the 3-ring release had been activated. The reserve deployed into the trailing malfunction and the reserve freebag wedged into the main suspension lines. There was severe twisting of the main and reserve suspension lines above and below the reserve deployment bag. The right riser of was close to its normal position on the shoulder area. The left main riser was heavily involved in the main/reserve entanglement. At some point the main canopy came out of its deployment bag however the single outer line stow never released and there were too many twists for the main to deploy. The tandem instructor was a 44 year old male brazilian national, uspa tandem authorized and current, with 5,300+ jumps (3,200+ tandem), holding a current FAA third class medical certificate. The passenger was a 21 year old female japanese national. Parachute system information: harness and container model: sigma tandem parachute system serial: 37772 date of mfg: 07/01 jumps on system: 2617 main parachute make: new zealand aerosports model: icarus 330 serial: 8644 date of mfg: 7/2002 pack date: 08/10/04 (packed by the tandem instructor) jumps on canopy: 1376 last relined at: 1244 jumps reserve parachute make: vector 2R model: 360 serial: 4366 date of mfg: 05-2001 pack date: 05/18/04 (packed by an appropriately rated parachute rigger) previous deployments: none
As the FAA filed it
(-23) PRELIMINARY INVESTIGATION RESULTS: THE INSPECTION OF THE TANDEM PARACHUTE SYSTEM WAS DELAYED UNTIL SEPTEMBER 22, 2004, DUE TO HURRICANE ACTIVITY IN FLORIDA WHERE THE EQUIPMENT WAS SENT FOR THE INSPECTION. THE INITIAL INSPECTION OF THE UNINSURED RELATIVE WORKSHOP, INC., SIGMA TANDEM PARACHUTE SYSTEM REVEALED THAT THERE WAS A MAIN/RESERVE ENTANGLEMENT. IT IS NOT CLEAR IN WHAT SEQUENCE THE CUTAWAY AND RESERVE RIPCORD HANDLES WERE PULLED. THE RESERVE WAS DEPLOYED MANUALLY PRIOR TO AUTOMATIC ACTIVATION DEVICE (AAD) ACTIVATION (THE AAD CUTTER DID ACTIVATE, BUT THE RESERVE CLOSING LOOP WAS NOT CUT). SUSPENSION LINES WERE STOWED IN ONE OUTSIDE LINE STOW ON THE MAIN PARACHUTE DEPLOYMENT BAG, THE CANOPY WAS COMPLETELY OUT OF THE DEPLOYMENT BAG. THE RESERVE WAS STILL IN ITS DEPLOYMENT BAG AND PORTIONS OF THE LINES WERE STILL STOWED. (THE TWO) LOCKING STOWS OF THE SAFETY STOW WERE STILL IN PLACE. THE BALANCE OF THE SUSPENSION LINES WERE OUT OF THE BAG. THE RESERVE STATIC LINE WAS STILL CONNECTED IN ITS NORMAL POSITION ON THE RIGHT SHOULDER PAD AND WAS STILL CONNECTED TO THE RIGHT MAIN RISER. THE 3-RING RELEASE HAD BEEN ACTIVATED. THE RIGHT RISER WAS CLOSE TO ITS NORMAL POSITION ON THE SHOULDER AREA. THE LEFT MAIN RISER WAS HEAVILY INVOLVED IN THE MAIN/RESERVE ENTANGLEMENT. TENTATIVE RECOVERY OF DIGITAL VIDEOTAPE IMAGERY FROM A HAND-CAM IN PENDING. THE HAND-CAM WAS BEING WORN ON THE LEFT WRIST OF THE TANDEM INSTRUCTOR. THE INSTRUCTOR WAS A 44 YEAR OLD MALE BRAZILIAN NATIONAL, USPA TANDEM AUTHORIZED AND CURRENT, WITH 5,300+ JUMPS (3,200+TANDEM), HOLDING A CURRENT THIRD CLASS FAA MEDICAL CERTIFICATE. THE PASSENGER WAS A 21 YEAR OLD FEMALE JAPANESE NATIONAL. THE PARACHUTE SYSTEM DESCRIPTION AND PACKING HISTORY IS UNAVAILABLE AT THIS TIME. IT IS KNOWN THAT BOTH PARACHUTES WERE PACKED WITHIN THE LAST 120 DAYS. THE INVESTIGATION IS ONGOING AND INCONCLUSIVE. PARACHUTE INCIDENT. (-23 AMENDMENT) THE UNINSURED RELATIVE WORKSHOP, INC. SIGMA TANDEM PARACHUTE SYSTEM WAS INSPECTED BY SEVERAL INDUSTRY MANUFACTURING EXPERTS WHO ARE PARACHUTE RIGGERS ALONG WITH A FAA MANUFACTURING INSPECTOR AND WAS FOUND TO BE FREE OF DEFECTS. DURING THE JUMP THE TANDEM INSTRUCTOR WAS WEARING A VIDEO CAMERA CALLED A HAND-CAM ON HIS LEFT WRIST. A FORENSIC LAB RECONSTRUCTED THE HAND-CAM VIDEOTAPE AS COMPLETELY AS POSSIBLE IN VIEW OF THE DAMAGE IT S USTAINED UPON IMPACT. BASED ON INSPECTION OF THE EQUIPMENT, HAND-CAM AERIAL VIDEO FOOTAGE, GROUND PHOTOGRAPHS, AND POST INCIDENT GROUND VIDEO TAKEN AT THE SCENE, OBSERVATIONS AND OPINIONS ARE AS FOLLOWS: THE TANDEM PAIR EXITED THE AIRCRAFT AND A CLEAN DROGUT DEPLOYMENT IS SEEN ON THE RECOVERED VIDEO. THE REMAINDER OF THE VIDEO WAS SEVERELY DAMAGED AND NO OTHER INFORMATION WAS RECOVERABLE FROM THE TAPE. AT SOME THE DROGUE RELEASE HANDLE WAS PULLED. THE MAIN PARACHUTE DEPLOYMENT RESULTED IN A BAG-LOCK MALFUNCTION WITH ONE OUTER LINE STOW STILL INTACT WITH ITS STOW BAND HOLDING IT TO THE DEPLOYMENT BAG. THE RESERVE HANDLE WAS PULLED BEFORE CYPRESS FIRING ALTITUDE AND BEFORE THE 3-RING RISERS HAD RELEASED. THE RESERVE STATIC LINE WAS STILL CONNECTED IN ITS NORMAL POSITION ON THE RIGHT SHOULDER PAD AND WAS STILL CONNECTED TO THE RIGHT MAIN RISER. EVIDENCE INDICATES THAT THE CUTAWAY HANDLE WAS PULLED AFTER RESERVE DEPLOYMENT; THE 3-RING RELEASE HAD BEEN ACTIVATED. THE RESERVE DEPLOYED INTO THE TRAILING MALFUNCTION AND THE RESERVE FREEBAG WEDGED INTO THE MAIN SUSPENSION LINES. THERE WAS SEVERE TWISTING OF THE MAIN AND RESERVE SUSPENSION LINES ABOVE AND BELOW THE RESERVE DEPLOYMENT BAG. THE RIGHT RISER OF WAS CLOSE TO ITS NORMAL POSITION ON THE SHOULDER AREA. THE LEFT MAIN RISER WAS HEAVILY INVOLVED IN THE MAIN/RESERVE ENTANGLEMENT. AT SOME POINT THE MAIN CANOPY CAME OUT OF ITS DEPLOYMENT BAG HOWEVER THE SINGLE OUTER LINE STOW NEVER RELEASED AND THERE WERE TOO MANY TWISTS FOR THE MAIN TO DEPLOY. THE TANDEM INSTRUCTOR WAS A 44 YEAR OLD MALE BRAZILIAN NATIONAL, USPA TANDEM AUTHORIZED AND CURRENT, WITH 5,300+ JUMPS (3,200+ TANDEM), HOLDING A CURRENT FAA THIRD CLASS MEDICAL CERTIFICATE. THE PASSENGER WAS A 21 YEAR OLD FEMALE JAPANESE NATIONAL. PARACHUTE SYSTEM INFORMATION: HARNESS AND CONTAINER MODEL: SIGMA TANDEM PARACHUTE SYSTEM SERIAL: 37772 DATE OF MFG: 07/01 JUMPS ON SYSTEM: 2617 MAIN PARACHUTE MAKE: NEW ZEALAND AEROSPORTS MODEL: ICARUS 330 SERIAL: 8644 DATE OF MFG: 7/2002 PACK DATE: 08/10/04 (PACKED BY THE TANDEM INSTRUCTOR) JUMPS ON CANOPY: 1376 LAST RELINED AT: 1244 JUMPS RESERVE PARACHUTE MAKE: VECTOR 2R MODEL: 360 SERIAL: 4366 DATE OF MFG: 05-2001 PACK DATE: 05/18/04 (PACKED BY AN APPROPRIATELY RATED PARACHUTE RIGGER) PREVIOUS DEPLOYMENTS: NONE