New Report: Misplaced Flashlight Sucked into F-35 Engine Caused
$4 Million in Damage
Jan. 18, 2024
| By Greg Hadley
A handheld flashlight left inside an engine
inlet of an F-35 fighter was sucked into the engine during a maintenance ground
run at Luke Air Force Base, Ariz., in March 2023, causing nearly $4 million
worth of damage, according to a new accident investigation report.
The investigation, released Jan. 18, faulted
the maintainer for failing to follow Air Force and joint directives as the
leading cause of the mishap, which damaged the $14 million engine badly enough
that it could not be repaired locally.
However, investigators also cited problems with
the F-35’s Autonomic Logistics Information System as a substantially contributing
factor. ALIS is intended to integrate operations, maintenance, prognostics,
supply chain, customer support services, training and technical data, but the system has struggled with a lack of real-time
connectivity, clumsy interfaces, and more.
As a result, the report stated, “the
substantial number of checklists and difficulty in accessing the correct ones
causes complacency when users reference the required maintenance
procedures.”
The mishap in question took place March 15,
when a three-person maintenance team was completing a Time Compliance Technical
Directive on the F-35 to “install a metering plug into an engine fuel line and
conduct a leak check on the new metering plug while the engine was running,”
according to the report.
After the plug was installed, one maintainer
conducted a tool inventory check, before another maintainer conducted a “Before
Operations Servicing” inspection of the engine. To do so, the maintainer used a
flashlight to inspect the engine inlet and left it on the lip of the
intake.
The maintainer who performed the engine
inspection then conducted an engine run for five minutes to check for any fuel
leaks. During that time, the cockpit showed no indication of foreign object
damage to the engine, but as the engine shut down, the team reported hearing
abnormal noises. The maintainer who conducted the engine run performed another
inspection and identified the damage, while the maintainer who completed the
first tool inventory check performed another and noted a missing
flashlight.
Ultimately, the engine sustained damage to
its second stage rotor, third stage rotor, fifth stage rotor, sixth stage
rotor, fuel nozzle, bypass duct, high pressure compressor (HPC), high pressure
turbine (HPT), and fan inlet variable vane—valued at $3,933,106.
Investigators found the maintainer who
conducted the inspection before the engine run failed to follow Joint Technical
Data warnings to remove all loose items before entering the aircraft inlet and
to make sure that all engine inlets and exhausts are free of foreign and loose
objects. The Airman also failed to follow Department of the Air Force
instructions to “perform a visual inventory” of the tool kit after completing
each task.
Finally, the report also found that the local
practice within the 62nd Aircraft Maintenance Unit did not wholly follow DAF
instructions, which require the individual who signed out the tool kit to
conduct visual inventory checks. Instead, the unit’s practice was to have the
individual performing the engine run conduct the inventory check. As a result,
both Airmen involved in the mishap thought the flashlight was accounted
for.
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