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|
Attributes | |
ACN | 112323 |
Time | |
Date | 198905 |
Day | Wed |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | atc facility : row |
State Reference | NM |
Altitude | msl bound lower : 31000 msl bound upper : 31000 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | artcc : zab tracon : bdl |
Operator | common carrier : air carrier |
Make Model Name | Large Transport, Low Wing, 2 Turbojet Eng |
Navigation In Use | Other Other |
Flight Phase | cruise other |
Route In Use | enroute : direct |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp pilot : flight engineer |
Experience | flight time last 90 days : 120 flight time total : 7500 flight time type : 625 |
ASRS Report | 112323 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp pilot : cfi pilot : flight engineer |
Experience | flight time last 90 days : 200 flight time total : 4500 flight time type : 300 |
ASRS Report | 112070 |
Events | |
Anomaly | non adherence : clearance other spatial deviation |
Independent Detector | other controllera other flight crewa |
Resolutory Action | none taken : anomaly accepted other |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
We were cleared direct to row VOR. The copilot, who was flying, turned on the engine sync but got an EFIS switch instead which caused his CRT displays to echo my side. The EFIS transfer switch and sync switch are close together and virtually identical, extremely bad design! I had my VOR tuned to another VOR, while the copilot previously had row on his side. He then began navigating to the VOR that I had selected instead of row since that's what was then presented on his side. The controller finally asked where we were going and we discovered the error. The annunciator light that tells when the EFIS transfer switch has been moved is a steady light that is very dim and easily overlooked, another extremely bad design.
Original NASA ASRS Text
Title: FLT CLEARED DIRECT DEVIATED FROM COURSE BECAUSE OF MISREADING NAVIGATION INSTRUMENTATION.
Narrative: WE WERE CLRED DIRECT TO ROW VOR. THE COPLT, WHO WAS FLYING, TURNED ON THE ENGINE SYNC BUT GOT AN EFIS SWITCH INSTEAD WHICH CAUSED HIS CRT DISPLAYS TO ECHO MY SIDE. THE EFIS TRANSFER SWITCH AND SYNC SWITCH ARE CLOSE TOGETHER AND VIRTUALLY IDENTICAL, EXTREMELY BAD DESIGN! I HAD MY VOR TUNED TO ANOTHER VOR, WHILE THE COPLT PREVIOUSLY HAD ROW ON HIS SIDE. HE THEN BEGAN NAVIGATING TO THE VOR THAT I HAD SELECTED INSTEAD OF ROW SINCE THAT'S WHAT WAS THEN PRESENTED ON HIS SIDE. THE CTLR FINALLY ASKED WHERE WE WERE GOING AND WE DISCOVERED THE ERROR. THE ANNUNCIATOR LIGHT THAT TELLS WHEN THE EFIS TRANSFER SWITCH HAS BEEN MOVED IS A STEADY LIGHT THAT IS VERY DIM AND EASILY OVERLOOKED, ANOTHER EXTREMELY BAD DESIGN.
Data retrieved from NASA's ASRS site as of August 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.