1967 USS Forrestal Fire - Investigation

Investigation

Although investigators could not identify the exact chain of events behind the carnage, they revealed potential maintenance issues including concerns in circuitry (stray voltage) associated with LAU-10 rocket launchers and Zunis, as well as the age of the 1,000 lb (450 kg) "fat bombs" loaded for the strike, shards from one of which dated it originally to the Korean War in 1953.

Safety regulations should have prevented the Zuni rocket from firing. A triple ejector rack (TER) electrical safety pin prevented any electrical signal from reaching the rockets but it was known that high winds could sometimes catch the attached tags and blow them free. The backup was the “pigtail” connection of the electrical wiring to the rockets pod. Regulations required they be connected only when the aircraft was attached to the catapult ready to launch. The Navy investigation found that four weeks before the fire, Forrestal's Weapons Coordination Board had a meeting to discuss the possible problem of a faulty pigtail delaying a mission while the aircraft was removed from the launcher. The board ruled that in the future the crew could ignore protocol and connect the pigtails while the aircraft were still queued. Though never made official, the crew immediately acted on the ruling. The inquiry found that the TER pin was likely blown free while the pigtail was connected and that the missile fired due to a power surge when the pilot transferred his systems from external to internal power. This incident also led the U.S. Navy to implement safety reviews for weapons systems going on board ships (whether for use or for shipping). Today, this evaluation still exists as the Weapon System Explosives Safety Review Board.