What happened
On September 23, an Alta Flights Cessna 414A, registration C-GVZE, departed Cranbrook, British Columbia, for a scheduled cargo flight to Calgary, Alberta. Although the flight had arrived in Cranbrook earlier that day under instrument flight rules, the pilot filed a visual flight rules (VFR) flight plan for the return leg. The aircraft departed at 1911 MDT, climbing toward an intended altitude of 11,500 feet.
Radar tracking began at 1931, showing the aircraft over the Continental Divide. At 1933, the aircraft began a steady descent. By 1936, the aircraft disappeared from radar at 9,000 feet while traversing the Highwood Range. The wreckage was located approximately 40 hours later on a mountain ridge at 8,900 feet. The impact resulted in a total breakup of the Cessna 414A and the fatal injury of the pilot.
The investigation
The investigation examined the flight path, weather conditions, and the aircraft's equipment. Radar data indicated the aircraft maintained a stable descent rate and wings-level attitude until impact. Investigators noted that while the flight was conducted under VFR, the Highwood Range mountains were obscured by cloud cover. It was determined that the pilot likely misidentified the terrain, potentially mistaking the mountainous area for the lower-altitude eastern slopes near Calgary.
Findings
- The pilot likely lost situational awareness, believing the aircraft was over lower terrain.
- The aircraft was likely flown into clouds, which prevented the pilot from seeing the rising terrain.
- The pilot flew into cloud cover while operating under VFR, leading to controlled flight into terrain (CFIT).
- The aircraft lacked terrain avoidance instrumentation, such as GPWS or TAWS, which could have provided a final warning.
- The flight was a single-pilot operation in mountainous terrain.
- A premature closure of the flight plan by NAV CANADA delayed search and rescue efforts by two hours.
Safety action
- Alta Flights updated its Operations Manual to mandate higher and further clearances from obstacles during all VFR flights, both day and night.
- The company implemented additional training focused on CFIT awareness and terrain clearance.
- NAV CANADA improved the ability of air traffic controllers in Calgary and Edmonton to search computer records for aircraft arrival and departure information to reduce reliance on memory.