CEN13LA500

NTSB accident investigation · Cessna 206 · Brooklyn, IA · August 16, 2013

Accident · FatalLimited investigationFinal report
Date
August 16, 2013, 17:30 local (22:30 UTC)
Place
Brooklyn, IA
Injuries
1 fatal, 1 uninjured
Damage
Minor damage
Phase of flight
Enroute
Aircraft
N2070KCessna 206
Defining event
Enroute-climb to cruise: Miscellaneous/other
Weather
Visual (VMC) · Day
Status
Completed · report August 7, 2014
Report
Approved by Office Director
NTSB office
Central Region
Parties
FAA Flight Standards District Office
FAA report
20130816018009A
Case key
87837

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

The improper routing of the seatbelt, which resulted in the inadvertent deployment of the reserve parachute, and the open jump door, which allowed the passenger to be pulled from the airplane.

Findings · 3

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Use of equip/info: use of equip/systemPersonnel issues › Task performance · PassengerCessna 206: 2 casesAll aircraft: 1,391 casesProbable cause
Equipment/furnishings: passenger compartment equipAircraft › Aircraft systems · Incorrect use/operationCessna 206: 1 caseAll aircraft: 24 casesProbable cause
Use of equip/info: use of equip/systemPersonnel issues › Task performance · PilotCessna 206: 2 casesAll aircraft: 1,391 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

Before departure for the positioning flight, the pilot was told that an observer/passenger would be joining him for the flight. The airplane, which was typically used in skydiving operations, had its right cabin door removed, and a fabric roll-up jump door had been installed; it was not closed during the flight. The pilot reported that the passenger sat behind him on the right side of the airplane and that he heard him attach his seatbelt. During the flight, the passenger moved forward in the cabin, which resulted in the passenger's reserve parachute inadvertently deploying and the passenger being pulled through the open jump door. The passenger hit the doorframe, and the parachute became entangled with the empennage, which resulted in a loss of airplane control and a subsequent aerodynamic stall. The parachute eventually separated from the empennage, and the pilot was able to regain control of the airplane and land it without further incident. A postaccident examination revealed that the passenger had inadvertently attached his seatbelt to the handle that released the reserve parachute. Therefore, the reserve parachute deployed when the passenger moved. The pilot did not conduct a safety briefing before the flight; however, the improper routing of the seatbelt may not have been identified even if he had conducted a safety briefing. Additionally, if the jump door had been closed, it is likely that the passenger would not have been pulled out of the airplane.

Factual narrative

On August 16, 2013, about 1730 central daylight time, a Cessna 206 airplane, N2070K, was damaged inflight near Brooklyn, Iowa. The commercial pilot was not injured; however, the passenger was fatally injured. The airplane was registered to Brooklyn Air Inc., and operated by Skydive Iowa Inc., under the provisions of 14 Code of Federal Regulations Part 91 as positioning flight. Visual meteorological conditions prevailed for the flight, which operated without a flight plan. The flight originated from Skydive Iowa Airport (09IA), Brooklyn, Iowa, and was en route to Grinnell Regional Airport (KGGI), Grinnell, Iowa. According to the pilot, the purpose of the flight was to position the airplane to Grinnell, Iowa, so that maintenance could be conducted. After starting the airplane engine and preparing to taxi, the pilot was notified by the company tandem master that a passenger would be joining him for the flight to Grinnell as an observer. Both the pilot and passenger were wearing parachutes, as required by the company policy. The airplane was used in skydive operations and the right-side, cabin door had been removed. The pilot reported that the passenger boarded the airplane, took a seat on the right side of the airplane, behind the pilot, and fastened his seatbelt. He stated that he did not inspect the seatbelt and had heard the "click" of the seatbelt as it was latched. No passenger briefing was provided by the pilot. Shortly after departure, the passenger elected to move from his position behind the pilot to a position in the front of the airplane, beside the pilot. As the passenger was moving, the reserve parachute, in the passenger's parachute-pack, deployed and the passenger was pulled from the airplane. The pilot stated that as the passenger exited the airplane, he heard a loud "bang". At the same time, the parachute became entangled in the empennage. The airplane pitched up approximately 50 degrees, banked 80 degrees to the right, and stalled. Eventually, the parachute separated from the empennage and the pilot was able to recover the airplane between 600 and 700 feet above ground level (agl). The pilot observed the parachute open, and about 100 feet agl, the parachute made a sharp right turn. The pilot assumed that the passenger was controlling the parachute. According to one witness on the ground, he observed the canopy of the parachute circle several times before the parachute seemed to go straight down. Another witness commented that the parachute was very low and very fast. A witness responded to the location where the parachute came down and found the passenger unconscious and without a pulse. According to the Iowa Department of Public Health, who conducted the autopsy, the passenger died from multiple blunt force injuries. The pilot continued to KGGI and landed without further incident. A post-accident examination of the airplane revealed minor damage to the fuselage at the door frame and skin damage to the horizontal stabilizer. Bloodwas found on the door frame of the airplane where the passenger egressed. Further examination revealed that the "D" ring, or handle that released the reserve parachute, was buckled into the seatbelt. A review of the airplane operating limitations, "Limitations for the Operation of an Aircraft with a Door Removed" – stated that "when operations other than intentional parachute jumping and skydiving are conducted, a suitable guardrail or equivalent safety device must be provided for the doorway." The pilot reported that a "roll-up door" was installed on the airplane but was not in use at the time of the accident flight because of the warm temperatures and because one of the devices used to fasten the corner of the door to the airframe was broken, preventing them from properly securing the door. Despite multiple attempts, the pilot refused to provide the required Pilot Operator Aircraft Accident/Incident Report, National Transportation Safety Board Form 6120.1/2.

Aircraft

Registration
N2070K
Reported as
Cessna 206
Category
Airplane
Serial number
206-0196
Built
1964
Engine
Cont Motor IO-520, 285 horsepower, reciprocating
Damage
Minor damage
Flight
Positioning · Part 91
Operator
Sky Dive Iowa Inc
Registered owner
Brooklyn Air Inc.
Airworthiness certificate
Standard, Normal
Last inspection
Annual · August 1, 2013
Departed
09IA · Brooklyn, IA
Destination
KGGI · Grinnell, IA

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
27
Injuries
None
Certificate
Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Seat
Left
Restraint
3-point
Flight hours
320 total · 1 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
130° at 3 knots
Visibility
10 statute miles
Lowest ceiling
8,000 ft broken
Temperature
77 °F, dew point 50 °F
Altimeter
30.18 inHg
Observed at
KGGI, 15 nm away

Docket · 4

The files NTSB released with the investigation on April 2, 2014, on NTSB’s docket system: statements, records, photos and specialists’ reports. 1.3 MB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.

Other investigations on N2070K · 1

Matched to the same aircraft by N-number and date.