# NTSB WPR11LA487: Piper J3C-65, N3453K, Fortuna, CA, August 17, 2011 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: August 17, 2011, 15:00 local (22:00 UTC) - Place: Fortuna, CA - Coordinates: 40.553611, -124.132499 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=40.5536&lon=-124.1325&mi=10 - Phase of flight: [Standing](https://openairdocs.org/ntsb-phases/150) (OpenAirDocs' grouping) - Defining event: [Standing-engine(s) start-up: AC/prop/rotor contact w person](https://openairdocs.org/ntsb-events/081) - Highest injury: Serious injuries - Injuries: 1 serious, 2 uninjured; on the ground: 1 serious - Status: Completed, report April 20, 2012 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: Federal Aviation Administration - NTSB case key (mKey): 82985 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR11LA487 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/82985/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=82985 - Page: https://openairdocs.org/ntsb/WPR11LA487 ## Probable cause The unexpected engine start during hand propping, which resulted in a serious injury. Contributing to the accident was the lack of communication between the pilot and the individual hand propping the engine. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Other (probable cause); cases with it: [Piper J3C-65, 5 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=7100510), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) - [Communication (personnel): lack of communication](https://openairdocs.org/ntsb-findings/02063510): Personnel issues › Task performance · Not specified (probable cause); cases with it: [Piper J3C-65, 1 case](https://openairdocs.org/ntsb-findings/02063510/cases.md?model=7100510), [All aircraft, 84 cases](https://openairdocs.org/ntsb-findings/02063510/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Standing-engine(s) start-up: AC/prop/rotor contact w person](https://openairdocs.org/ntsb-events/081) (defining event); cases with it: [Piper J3C-65, 1 case](https://openairdocs.org/ntsb-events/081/sequence.md?model=7100510), [All aircraft, 61 cases](https://openairdocs.org/ntsb-events/081/sequence.md) ## Analysis The individual attempting to start the engine by turning the propeller (hand prop) reported that, during the first attempt to start the engine, verbal callouts were used. He further reported that the pilot then told him to pull the propeller through three times. The individual said that he then motioned, without a verbal callout to the pilot, that he would pull the propeller through per the pilot's request. The pilot reported that the individual hand-propping the engine pulled the propeller through a second time before he could secure the airplane by turning off the magnetos. As the individual rotated the propeller and reached to grab the other propeller blade, the engine unexpectedly started, which resulted in the propeller striking the individual in the right arm, causing a fracture. ## Factual narrative On August 17, 2011, about 1500 Pacific daylight time, a two seat tandem seating configuration Piper J3C-65, N3453K, was not damaged during an engine start at the Rohnerville Airport (FOT), Fortuna, California. The airplane was registered to and operated by the commercial pilot under the provisions of Title 14 Code of Federal Regulations Part 91. The commercial pilot and his passenger were not injured and one person assisting in starting the airplane sustained serious injuries. Visual meteorological conditions prevailed and no flight plan was filed for the personal flight. The flight had not departed at the time of the accident and had an intended destination of Garberville, California. In a written statement to the National Transportation Safety Board (NTSB) investigator-in-charge (IIC), the pilot reported that as he was briefing his wife, a non-pilot rated passenger, that he would hand prop the engine while she operated the throttle and brakes, the father of one of his previous students approached him and told him to get inside the airplane and that he would "do the propping." The pilot stated that he was unsure of the individual's experience, but noted that the person's daughter, who he had previously instructed in the airplane, was present. The daughter of the individual hand propping the engine communicated to the pilot "…brakes, throttle cracked, stick back, and mags on,” both followed by her father pulling the propeller through. The pilot stated that the engine start was unsuccessful and that before he could turn the magnetos off, the individual motioned towards the propeller and pulled it through despite him yelling "it's hot." The engine subsequently started and the individual was struck on the forearm. The pilot questioned the individual if he was ok and was assured he was and that it was just a glancing blow. In a statement submitted to the IIC, the non-pilot rated individual, who hand propped the airplane reported that after taking a photo of his daughter, the pilot and the pilot's wife in front of the airplane, the pilot's wife got into the front seat and the pilot climbed into the rear seat. After taking the picture the individual then moved to the propeller, with his daughter positioned outside and on the right side of the airplane. The individual stated that the pilot called out something similar to “let's give it a try” as he relayed to the pilot “brakes on, mags off, clear” prior to pulling the propeller through. The engine did not start and the pilot called out to the individual's daughter to prime the airplane's engine. The individual's daughter then reached into the cockpit area, primed the engine, and moved back away from the airplane. The individual further stated that the pilot told him to "...go ahead and turn it over three times." The individual said that he complied with the pilot's instructions without calling out “brakes on, mags off, clear.” The individual said that he pulled the propeller through with his left armand that while reaching out to grab the other propeller blade with his right arm, the engine started and struck him in his right forearm. The individual added that at no time while he was pulling the propeller through following the initial attempt to start the engine did the pilot communicate with him. Several weeks after the accident, the IIC was notified that the individual who was performing the hand propping eventually got an x-ray of his forearm, and it was determined that the bone was broken. ## Aircraft - Registration: [N3453K](https://openairdocs.org/deregistered/N3453K-2023-03-08), registration cancelled 2023-03-08, S/N 22144, built 1946 (OpenAirDocs) - Reported make and model: PIPER J3C-65 - Registry model: [Piper J3C-65](https://openairdocs.org/model/piper-j3c-65) (registry code 7100510) (OpenAirDocs) - Registry engine: [Continental A&C65 series](https://openairdocs.org/engine/continental-a-c65-series) (registry code 17003, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 22144 - Airframe hours: 1034 - Engines: CONT MOTOR A&C65 SERIES 65 horsepower reciprocating - Damage: No damage - Flight: Personal, Part 91 - Operator: Baron Fred N - Registered owner: Baron Fred N - Airworthiness certificate: Standard, Normal - Last inspection: Annual, February 16, 2011, 98 hours before - Departed: FOT, Fortuna, CA - Destination: Garberville, CA - Airport: FOT, Rohnerville Airport ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 75; injuries: none; commercial, flight instructor; airplane ratings: single-engine land; medical: class 3, with waivers/limitations; last flight review July 19, 2010; seat: right; flight hours: 5,000 total, 400 in this make and model, 4,900 as pilot in command, 25 in the last 90 days, 10 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 75 °F - Altimeter: 29.92 inHg ## Other investigations on N3453K (1) 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. - [NTSB WPR22LA008](https://openairdocs.org/ntsb/WPR22LA008), Oct 4, 2021: Piper J3C-65 (N3453K), Garberville, CA, substantial damage. Probable cause: The pilot's failure to maintain directional control during the landing roll, which resulted in a runway excursion and subsequent collision with an unoccupied parked airplane. ## Docket (2 files) The files NTSB released with the investigation on March 15, 2012, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=82985. 1.9 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 552 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40363822&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Individual Performing Hand Propping Statement (item 2, .PDF, 1.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40363823&FileExtension=.PDF&FileName=Individual%20Performing%20Hand%20Propping%20Statement-Redacted.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.