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|
Attributes | |
ACN | 113638 |
Time | |
Date | 198906 |
Day | Tue |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : sfo |
State Reference | CA |
Altitude | agl bound lower : 0 agl bound upper : 800 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tower : sfo |
Operator | common carrier : air carrier |
Make Model Name | Medium Large Transport, Low Wing, 2 Turbojet Eng |
Flight Phase | descent other landing other |
Route In Use | approach : straight in |
Flight Plan | IFR |
Aircraft 2 | |
Operator | common carrier : air carrier |
Make Model Name | Medium Transport |
Flight Phase | descent : approach descent other |
Route In Use | approach : straight in |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 220 flight time total : 16000 flight time type : 600 |
ASRS Report | 113638 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Events | |
Anomaly | conflict : airborne less severe non adherence : required legal separation |
Independent Detector | other flight crewa |
Resolutory Action | controller : issued new clearance |
Consequence | faa : reviewed incident with flight crew |
Miss Distance | horizontal : 600 vertical : 50 |
Supplementary | |
Primary Problem | ATC Human Performance |
Air Traffic Incident | Operational Error |
Narrative:
A quiet bridge approach to runway 28R was in progress. The approach frequency was rather quiet and no traffic was pointed out on the approach. Our only contact with approach was to slow to 210 KTS followed by a reduction to 180 and 160 KTS, maintain 160 KTS to the bridge contact tower at the bridge. The change to the tower frequency and the final approach checklist was all initiated bout the same time sfo tower cleared us to land 28L. The first officer repeated the landing clearance 28L and I verbally verified 28L and asked him to tune the navigation receivers for the runway. From the high span of the bridge to intercepting the 28L localizer was somewhat beyond coyote point. Just before intercepting the final course I noticed another aircraft touching down on 28R (there was no mention of that aircraft's position during the approach). My eyes went back into the cockpit for a quick check of airspeed and glide slope position and as I brought my eyes back to the runway and started my turn for alignment, I was 'shocked' to see another mdt aircraft at 12 O'clock position at approximately 500-700' in front of me. I turned back to 28R and had the first officer get us clearance to land on that runway. The first officer stated that there was another aircraft on the 28L approach in front of us and that we needed clearance to land on 28R. The tower's only response to this situation was 'cleared to land 28R'. At no time while in contact with approach or tower was any flight crew information given. Neither approach nor tower were handling but a minimum of traffic, workload was not a factor. The relative position of the mdt aircraft evidently never varied during the whole approach and was fixed perfectly still in the window when I spotted the aircraft. I'm at a loss as to why we never saw the aircraft during the approach. We were both looking out the aircraft window during most of the approach (the first officer never saw the aircraft until I made the turn away from it). In the ensuing discussion about this incident, the tower chief stated that their procedure 'require that traffic for the runways be pointed out to other arriving aircraft'. This was not done and if it had been the tower operator would have caught the mistake and this incident would not have happened. As stated before, I can't believe that neither the copilot nor myself saw the other aircraft until at that short range. I'm also dismayed that the approach and tower controller didn't follow the prescribed procedure of notifying us of the other 2 aircraft on the approach. I find it also hard to believe that the tower operator wasn't paying any attention to what was going on around him. He had no doubt given the mdt aircraft clearance to land on 28L while we were still on approach frequency. Then for whatever reason, he cleared us for landing on the same runway moments later. The tower chief stated that he was expecting my call. We discussed the incident. The tapes did confirm that he had indeed cleared us to land on the left runway by error. Hopefully he won't make this same mistake again.
Original NASA ASRS Text
Title: CLOSE PROX TWO ACR ACFT CLEARED TO LAND ON THE SAME RWY WITHOUT ADEQUATE SPACING AT SFO DURING MULTIPLE PARALLEL RWY OPERATION.
Narrative: A QUIET BRIDGE APCH TO RWY 28R WAS IN PROGRESS. THE APCH FREQ WAS RATHER QUIET AND NO TFC WAS POINTED OUT ON THE APCH. OUR ONLY CONTACT WITH APCH WAS TO SLOW TO 210 KTS FOLLOWED BY A REDUCTION TO 180 AND 160 KTS, MAINTAIN 160 KTS TO THE BRIDGE CONTACT TWR AT THE BRIDGE. THE CHANGE TO THE TWR FREQ AND THE FINAL APCH CHECKLIST WAS ALL INITIATED BOUT THE SAME TIME SFO TWR CLRED US TO LAND 28L. THE F/O REPEATED THE LNDG CLRNC 28L AND I VERBALLY VERIFIED 28L AND ASKED HIM TO TUNE THE NAV RECEIVERS FOR THE RWY. FROM THE HIGH SPAN OF THE BRIDGE TO INTERCEPTING THE 28L LOC WAS SOMEWHAT BEYOND COYOTE POINT. JUST BEFORE INTERCEPTING THE FINAL COURSE I NOTICED ANOTHER ACFT TOUCHING DOWN ON 28R (THERE WAS NO MENTION OF THAT ACFT'S POSITION DURING THE APCH). MY EYES WENT BACK INTO THE COCKPIT FOR A QUICK CHECK OF AIRSPEED AND GLIDE SLOPE POSITION AND AS I BROUGHT MY EYES BACK TO THE RWY AND STARTED MY TURN FOR ALIGNMENT, I WAS 'SHOCKED' TO SEE ANOTHER MDT ACFT AT 12 O'CLOCK POSITION AT APPROX 500-700' IN FRONT OF ME. I TURNED BACK TO 28R AND HAD THE F/O GET US CLRNC TO LAND ON THAT RWY. THE F/O STATED THAT THERE WAS ANOTHER ACFT ON THE 28L APCH IN FRONT OF US AND THAT WE NEEDED CLRNC TO LAND ON 28R. THE TWR'S ONLY RESPONSE TO THIS SITUATION WAS 'CLRED TO LAND 28R'. AT NO TIME WHILE IN CONTACT WITH APCH OR TWR WAS ANY FLT CREW INFO GIVEN. NEITHER APCH NOR TWR WERE HANDLING BUT A MINIMUM OF TFC, WORKLOAD WAS NOT A FACTOR. THE RELATIVE POSITION OF THE MDT ACFT EVIDENTLY NEVER VARIED DURING THE WHOLE APCH AND WAS FIXED PERFECTLY STILL IN THE WINDOW WHEN I SPOTTED THE ACFT. I'M AT A LOSS AS TO WHY WE NEVER SAW THE ACFT DURING THE APCH. WE WERE BOTH LOOKING OUT THE ACFT WINDOW DURING MOST OF THE APCH (THE F/O NEVER SAW THE ACFT UNTIL I MADE THE TURN AWAY FROM IT). IN THE ENSUING DISCUSSION ABOUT THIS INCIDENT, THE TWR CHIEF STATED THAT THEIR PROC 'REQUIRE THAT TFC FOR THE RWYS BE POINTED OUT TO OTHER ARRIVING ACFT'. THIS WAS NOT DONE AND IF IT HAD BEEN THE TWR OPERATOR WOULD HAVE CAUGHT THE MISTAKE AND THIS INCIDENT WOULD NOT HAVE HAPPENED. AS STATED BEFORE, I CAN'T BELIEVE THAT NEITHER THE COPLT NOR MYSELF SAW THE OTHER ACFT UNTIL AT THAT SHORT RANGE. I'M ALSO DISMAYED THAT THE APCH AND TWR CTLR DIDN'T FOLLOW THE PRESCRIBED PROC OF NOTIFYING US OF THE OTHER 2 ACFT ON THE APCH. I FIND IT ALSO HARD TO BELIEVE THAT THE TWR OPERATOR WASN'T PAYING ANY ATTN TO WHAT WAS GOING ON AROUND HIM. HE HAD NO DOUBT GIVEN THE MDT ACFT CLRNC TO LAND ON 28L WHILE WE WERE STILL ON APCH FREQ. THEN FOR WHATEVER REASON, HE CLRED US FOR LNDG ON THE SAME RWY MOMENTS LATER. THE TWR CHIEF STATED THAT HE WAS EXPECTING MY CALL. WE DISCUSSED THE INCIDENT. THE TAPES DID CONFIRM THAT HE HAD INDEED CLRED US TO LAND ON THE LEFT RWY BY ERROR. HOPEFULLY HE WON'T MAKE THIS SAME MISTAKE AGAIN.
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.