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|
Attributes | |
ACN | 153488 |
Time | |
Date | 199007 |
Day | Sat |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : cvg |
State Reference | OH |
Altitude | msl bound lower : 1500 msl bound upper : 1500 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : cvg |
Operator | common carrier : air carrier |
Make Model Name | Medium Large Transport, Low Wing, 2 Turbojet Eng |
Flight Phase | climbout : intermediate altitude |
Route In Use | departure other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : instrument pilot : flight engineer pilot : commercial pilot : cfi pilot : atp |
Experience | flight time last 90 days : 200 flight time total : 15000 flight time type : 300 |
ASRS Report | 153488 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : instrument pilot : commercial |
Events | |
Anomaly | non adherence : clearance non adherence : published procedure other spatial deviation |
Independent Detector | other controllera |
Resolutory Action | controller : issued new clearance other |
Consequence | faa : reviewed incident with flight crew Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Acting as captain of flight. Our departure briefing included a reading of the gaill 4 departure by my first officer as we taxied onto the runway (27L) at cvg. He read aloud only the pertinent information: time (1 min), direction of turn (right), and heading (090 degrees). I glanced down at my open flight operations book to verify what he said on the pictorial view. I saw what he read, large, uncluttered in the middle of the page, the pictorial view of the gaill 4 departure. After takeoff this procedure was followed until the controller asked for our heading (about 350 degrees) and gave us a 360 degree heading to fly. According to a supervisor on the radar vacuum at cvg, this lost communication procedure has never been flown due to actual lost communications. The pictorial view (lost communication) needs to be completely erased from the chart to avoid being misread during critical phases of flight (takeoff) during normal gaill 4 departures. The pictorial view of the lost communication procedure is an eye catcher for quick reference because of its middle of the page position and clear view position.
Original NASA ASRS Text
Title: FLT CREW OF MLG DEPARTING CVG FLEW WRONG DEP PATTERN.
Narrative: ACTING AS CAPT OF FLT. OUR DEP BRIEFING INCLUDED A READING OF THE GAILL 4 DEP BY MY F/O AS WE TAXIED ONTO THE RWY (27L) AT CVG. HE READ ALOUD ONLY THE PERTINENT INFO: TIME (1 MIN), DIRECTION OF TURN (RIGHT), AND HDG (090 DEGS). I GLANCED DOWN AT MY OPEN FLT OPS BOOK TO VERIFY WHAT HE SAID ON THE PICTORIAL VIEW. I SAW WHAT HE READ, LARGE, UNCLUTTERED IN THE MIDDLE OF THE PAGE, THE PICTORIAL VIEW OF THE GAILL 4 DEP. AFTER TKOF THIS PROC WAS FOLLOWED UNTIL THE CTLR ASKED FOR OUR HDG (ABOUT 350 DEGS) AND GAVE US A 360 DEG HDG TO FLY. ACCORDING TO A SUPVR ON THE RADAR VACUUM AT CVG, THIS LOST COM PROC HAS NEVER BEEN FLOWN DUE TO ACTUAL LOST COMS. THE PICTORIAL VIEW (LOST COM) NEEDS TO BE COMPLETELY ERASED FROM THE CHART TO AVOID BEING MISREAD DURING CRITICAL PHASES OF FLT (TKOF) DURING NORMAL GAILL 4 DEPS. THE PICTORIAL VIEW OF THE LOST COM PROC IS AN EYE CATCHER FOR QUICK REF BECAUSE OF ITS MIDDLE OF THE PAGE POS AND CLR VIEW POS.
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.