Regardless of the type of maintenance performed on aircraft, instructions are to be used to provide the aviation technicians completing the maintenance activities with guidance on, and an outline of, the maintenance items to be performed and completed. However, the use of instructions does not guarantee the correct and proper completion of the maintenance activities as the instructions may be erroneous and/or maintenance personnel can misunderstand, misinterpret, or improperly follow the procedures outlined. Resulting maintenance errors can potentially result in aircraft accidents, as illustrated by Air Midwest Flight 5481. With the purpose of understanding how human factors associated with written maintenance instructions have contributed to aircraft accidents, the researchers qualitatively analyzed, using the people (P), environment (E), actions (A), resources (R) –PEAR –framework, 12 aircraft accidents that occurred from January 1, 2003,through December 31, 2017,under Part 121 or Part 135 operations in the United States that had maintenance instruction-related errors as contributing or causal factors. The detailed accident information, including causal factors, were retrieved from the aircraft accident reports provided by the National Transportation Safety Board (NTSB). The findings indicated that maintenance activities, specifically in terms of the adequacy and proper use of maintenance instructions, are largely impacted by human factor elements, such as the overall organizational environment and the resources available.