What happened
On 25 August 2017, a Hercules C-130J (registration ZH873) was conducting a routine resupply mission as part of the Hercules Detachment of 903 Expeditionary Air Wing. While performing a Military Operating Standard (MOS) approach to a semi-prepared Temporary Landing Zone (TLZ) at night using Night Vision Goggles, the aircraft impacted upward sloping terrain short of the runway.
Following the impact with the ground, the crew initiated a go-around and successfully recovered the aircraft, diverting it to another airfield. There were no reported fatalities or injuries during the incident.
The investigation
The Service Inquiry examined several operational and regulatory factors surrounding the flight. Investigators reviewed the training, currency, and experience levels of the crew, noting that while both pilots were highly experienced, there was a significant disparity in their recent operational recency regarding MOS approaches and heavy aircraft operations.
The inquiry also scrutinized the authorization process for the sortie, the adequacy of Crew Resource Management (CRM) within the cockpit, and the consistency of handling instructions provided to the Hercules Force. Additionally, the investigation looked into the safety management practices of the Operating Duty Holder regarding the use of Operational Emergency Clearances.
Findings
- The pilot flying chose an aiming point at the front of the touchdown box to avoid a potential float; however, this incorrect aiming point made the accident more likely as it led to the aircraft impacting terrain short of the prepared surface.
- There was a lack of assertive behavior and a flat cockpit gradient, which hindered effective Crew Resource and Resource Management (CRM).
- The authorization process failed to properly identify risks related to the crew composition, specifically regarding the pilot flying's recent experience levels.
- Inconsistencies were found in the handling advice provided across different manuals and training materials, which could lead to varied perceptions of how MOS approaches should be executed.
- Shortfalls were identified in the safety management governance, including non-compliance with regulations regarding the maintenance of Safety Statements and the recording of Operational Emergency Clearances.