# NTSB CEN23LA423: Beech A36, N9379Q, Broken Bow, OK, September 29, 2023 - Type: NTSB accident investigation - Classification: Accident · Fatal · Class 3 · Limited · Final report - Date: September 29, 2023, 14:15 local (19:15 UTC) - Place: Broken Bow, OK - Coordinates: 34.013167, -94.758333 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=34.0132&lon=-94.7583&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing-flare/touchdown: Loss of control on ground](https://openairdocs.org/ntsb-events/230) - Highest injury: Fatal - Injuries: 1 fatal, 1 uninjured; on the ground: 1 fatal - Status: Completed, report September 30, 2025 - Report: Approved by Office Director - Investigation class: Class 3 - NTSB office: Central Region - Parties: FAA - NTSB case key (mKey): 193162 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN23LA423 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/193162/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=193162 - Page: https://openairdocs.org/ntsb/CEN23LA423 ## Probable cause The pilot’s failure to maintain the runway centerline during landing and subsequent failure to maintain clearance from the airport grounds worker during the landing roll. Contributing to the accident was the absence of a NOTAM for mowing operations at the time of the accident. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Info processing/decision: identification/recognition](https://openairdocs.org/ntsb-findings/02041510): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Beech A36, 2 cases](https://openairdocs.org/ntsb-findings/02041510/cases.md?model=1151604), [All aircraft, 559 cases](https://openairdocs.org/ntsb-findings/02041510/cases.md) - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Beech A36, 43 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=1151604), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Airport facilities/design: airport communication](https://openairdocs.org/ntsb-findings/03017050): Environmental issues › Operating environment · Availability of related info (probable cause); cases with it: [Beech A36, 1 case](https://openairdocs.org/ntsb-findings/03017050/cases.md?model=1151604), [All aircraft, 2 cases](https://openairdocs.org/ntsb-findings/03017050/cases.md) - [Performance/control parameters: directional control](https://openairdocs.org/ntsb-findings/01062020): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Beech A36, 7 cases](https://openairdocs.org/ntsb-findings/01062020/cases.md?model=1151604), [All aircraft, 3,958 cases](https://openairdocs.org/ntsb-findings/01062020/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing-flare/touchdown: Abrupt maneuver](https://openairdocs.org/ntsb-events/270); cases with it: [Beech A36, 2 cases](https://openairdocs.org/ntsb-events/270/sequence.md?model=1151604), [All aircraft, 346 cases](https://openairdocs.org/ntsb-events/270/sequence.md) - [Landing-flare/touchdown: Loss of control on ground](https://openairdocs.org/ntsb-events/230) (defining event); cases with it: [Beech A36, 10 cases](https://openairdocs.org/ntsb-events/230/sequence.md?model=1151604), [All aircraft, 4,585 cases](https://openairdocs.org/ntsb-events/230/sequence.md) - [Landing: Abnormal runway contact](https://openairdocs.org/ntsb-events/090); cases with it: [Beech A36, 7 cases](https://openairdocs.org/ntsb-events/090/sequence.md?model=1151604), [All aircraft, 1,506 cases](https://openairdocs.org/ntsb-events/090/sequence.md) - [Landing-landing roll: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Beech A36, 78 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=1151604), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis While on approach to land, the pilot watched for tractors that were bailing hay. During the landing flare, the pilot saw an airport grounds worker mowing the grass next to the right side of the runway. He attempted to avoid the worker by pulling back on the control yoke. The airplane drifted to the right, touched down, and the right wing struck the worker, who was fatally injured. The airplane sustained substantial damage to the right wing. The worker was mowing along the edge of runway, which was 50 ft. wide. The wingspan of the airplane was 33 ft 6 inches; therefore, the centerline of the airplane would have to have been at least 8 ft 3 inches to the right of the runway centerline to place the right wingtip directly over the runway edge. The pilot did not adequately compensate for the crosswind during landing, and the airplane was not aligned with the runway centerline during landing and landing roll, which resulted in the airplane striking the grounds worker. According to the airport manager, the worker was not scheduled to be mowing at the airport on the day of the accident, and he was unaware that she elected to begin mowing at the airport. He was also unaware that Notices to Airmen (NOTAM) should be issued, and no NOTAM had been issued for the mowing or hay bailing operations being conducted at the airport. ## Factual narrative On September 29, 2023, about 1425 central daylight time, a Beech A36 airplane, N9379Q, was involved in an accident while landing at Broken Bow Airport (90F), near Broken Bow, Oklahoma. The pilot was not injured. An airport grounds worker was fatally injured. The airplane received substantial damage. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. A worker was mowing the grass along the west side of runway 17 at 90F and was traveling toward the south. The airplane landed on runway 17 and was rolling out when the right wing struck the worker, resulting in fatal injuries. At the time of the accident there was also a work crew bailing hay about 1,000 ft south of the worker on the opposite side of the runway. There were no Notices to Airmen (NOTAM) active for the mowing or hay bailing operations being conducted at the airport. According to the pilot, while on approach to land, the pilot watched for tractors that were bailing hay. He set up for a straight-in approach for runway 17 and made several position reports on the Universal Communications frequency. While on final approach, he identified that the runway environment was clear and continued. During the landing flare, he saw a small black riding lawnmower on the right side of the runway. The pilot pulled back on the control yoke, and the airplane drifted to the right of runway centerline due to a crosswind. The main landing gear touched down and he pulled back on the control yoke again to avoid the mower; however, the right wing struck the grounds worker. The pilot reported that the right wing received substantial damage due to the impact. According to a local law enforcement report of the accident, the grounds worker was mowing on the edge of the runway when she was struck by the airplane. According to Federal Aviation Administration chart supplements, the runway width was 50 ft. According to the Airplane Flight Manual, the Beech A36 airplane has a wingspan of 33 ft 6 inches. The airport manager was contacted through legal representatives and reported that the grounds worker had been instructed to mow in the cemetery across the street and that after she completed mowing that area, she voluntarily and without direction, moved to the airport and began mowing. It was confirmed that a NOTAM was not issued to advise pilots that mowing would be in progress because the airport manager was not aware that the worker would be mowing at the airport. The airport manager was also not aware that NOTAMs needed to be issued since the airport did not receive any federal funding. After the accident, a Federal Aviation Administration Inspector provided counseling to the airport manager regarding best practices including NOTAM issuance, use of high visibility devices for the workers and vehicles, and communication radio usage. All the suggested improvements were implemented by the city following the accident. ## Aircraft - Registration: [N9379Q](https://openairdocs.org/aircraft/N9379Q), registered now, S/N E-305, built 1972 (OpenAirDocs) - Reported make and model: BEECH A36 - Registry model: [Beech A36](https://openairdocs.org/model/beech-a36) (registry code 1151604) (OpenAirDocs) - Registry engine: [Continental IO-520 series](https://openairdocs.org/engine/continental-io-520-series) (registry code 17032, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: E-305 - Year built: 1972 - Airframe hours: 3380 - Engines: Continental IO-520-BA 285 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Utility - Last inspection: Annual, June 25, 2023 - Departed: TKI, McKinney, TX - Destination: 90F, Broken Bow, OK - Flight plan: VFR - Airport: 90F, Broken Bow Municipal Airport, runway 17, 3,200 × 50 ft, asphalt - Equipment: Electronic flight bag or handheld device, Auto-pilot, ADS-B, Stall warning system, Onboard weather, Electronic primary flight display, Electronic multifunction display ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 70; injuries: none; private; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review March 7, 2022; seat: left; flight hours: 1,430 total, 820 in this make and model, 1,430 as pilot in command, 12 in the last 90 days, 3 in the last 30 days, 0 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 90 °F, dew point 66 °F - Altimeter: 30.00 inHg - Observed at: K4O4, 8 nm away - METAR: K4O4 291915Z AUTO VRB06G12KT 10SM CLR 32/19 A3000 RMK AO2 ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20230929019449A](https://openairdocs.org/incident/20230929019449A), Sep 29, 2023: Beech A36, Broken Bow, OK, Substantial damage, 1 fatal. On September 29, 2023, at about 1417 local time, the aircraft landed on runway 17 at jewel b. callaham municipal airport at Broken Bow, OK. And, while doing… ## Docket (3 files) The files NTSB released with the investigation on September 30, 2025, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=193162. 1.6 MB in all. - Pilot/operator aircraft accident report, NTSB form 6120.1 (item 1, PDF, 9 pages, 1.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=18376218&FileExtension=pdf&FileName=NTSB%20Form%206120_Redacted-Rel.pdf - 90F NOTAM (item 2, PDF, 1 page, 51 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=18705168&FileExtension=pdf&FileName=90F%20NOTAM-Rel.pdf - Questions directed to airport manager (item 3, PDF, 2 pages, 88 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=19303190&FileExtension=pdf&FileName=Airport%20Manager%20responses%20from%20attorney-Rel.pdf From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.