37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 137132 |
Time | |
Date | 199002 |
Day | Thu |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : mdw |
State Reference | IL |
Altitude | msl bound lower : 3000 msl bound upper : 6000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : ord tower : prc |
Operator | common carrier : air carrier |
Make Model Name | Light Transport, Low Wing, 2 Turboprop Eng |
Flight Phase | climbout : intermediate altitude cruise other |
Route In Use | departure sid : sid |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 280 flight time total : 4800 flight time type : 1400 |
ASRS Report | 137132 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : commercial pilot : instrument pilot : atp |
Experience | flight time last 90 days : 250 flight time total : 4200 flight time type : 1200 |
ASRS Report | 137133 |
Events | |
Anomaly | altitude deviation : overshoot non adherence : clearance other anomaly other other anomaly other |
Independent Detector | other controllera other flight crewa |
Resolutory Action | controller : issued new clearance |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Departed runway 22L at mdw. Local controller advised us to contact departure. We were unable to contact them as we had the wrong frequency. In standby. Radio found proper frequency, advised departure we were passing 4000' for 6000'. Departure asked what was our assigned altitude, then he asked what code we were squawking. We realized that we were mistakenly flying a clearance from a previous leg. Sometime between the time the clearance was copied and the taxi check was performed the notepaper which is usually displayed on the center pedestal got flipped displaying a previous clearance. We set wrong squawk, wrong departure frequency and wrong initial altitude in altitude alerter. This crew did not catch the problem until after we had busted our 3000' assigned altitude. Human performance considerations are, we were tired. We had been working combinations of long days with minimum rest. If you get tired enough sooner or later you'll do something incredibly stupid, there are limitless opportunities. Supplemental information from acn 137133. Captain got clearance while I went to get WX and release.
Original NASA ASRS Text
Title: COMMUTER LTT ALT DEV OVERSHOT PLUS WRONG MODE 'C' CODE SET IN TRANSPONDER.
Narrative: DEPARTED RWY 22L AT MDW. LCL CTLR ADVISED US TO CONTACT DEP. WE WERE UNABLE TO CONTACT THEM AS WE HAD THE WRONG FREQ. IN STANDBY. RADIO FOUND PROPER FREQ, ADVISED DEP WE WERE PASSING 4000' FOR 6000'. DEP ASKED WHAT WAS OUR ASSIGNED ALT, THEN HE ASKED WHAT CODE WE WERE SQUAWKING. WE REALIZED THAT WE WERE MISTAKENLY FLYING A CLRNC FROM A PREVIOUS LEG. SOMETIME BTWN THE TIME THE CLRNC WAS COPIED AND THE TAXI CHK WAS PERFORMED THE NOTEPAPER WHICH IS USUALLY DISPLAYED ON THE CENTER PEDESTAL GOT FLIPPED DISPLAYING A PREVIOUS CLRNC. WE SET WRONG SQUAWK, WRONG DEP FREQ AND WRONG INITIAL ALT IN ALT ALERTER. THIS CREW DID NOT CATCH THE PROB UNTIL AFTER WE HAD BUSTED OUR 3000' ASSIGNED ALT. HUMAN PERFORMANCE CONSIDERATIONS ARE, WE WERE TIRED. WE HAD BEEN WORKING COMBINATIONS OF LONG DAYS WITH MINIMUM REST. IF YOU GET TIRED ENOUGH SOONER OR LATER YOU'LL DO SOMETHING INCREDIBLY STUPID, THERE ARE LIMITLESS OPPORTUNITIES. SUPPLEMENTAL INFO FROM ACN 137133. CAPT GOT CLRNC WHILE I WENT TO GET WX AND RELEASE.
Data retrieved from NASA's ASRS site as of July 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.