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|
Attributes | |
ACN | 177294 |
Time | |
Date | 199104 |
Day | Tue |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : pbi |
State Reference | FL |
Altitude | agl bound lower : 0 agl bound upper : 0 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | Medium Transport, High Wing, 2 Turboprop Eng |
Flight Phase | climbout : takeoff other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Experience | flight time last 90 days : 225 flight time total : 5900 flight time type : 920 |
ASRS Report | 177294 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | aircraft equipment problem : less severe |
Independent Detector | aircraft equipment other aircraft equipment : unspecified |
Resolutory Action | flight crew : overcame equipment problem |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
As first officer and PF, I completed the runway checks while positioning in place on runway 13 at pbi. The PIC gave me control of the aircraft and I slowly advanced the power levers. At the designated power lever position, we heard the takeoff items incomplete warning horn. I immediately aborted the takeoff and notified the tower of our preliminary intention to return to the #south to reinitiate the takeoff. The PIC quickly idented a mispositioned engine electronic control unit (ecu) switch which he, as PNF, had overlooked setting during the previous leg 'silent' descent checks. He surmised that he had become distracted with a frequency change and traffic call as he was verifying by checklist his flow of aircraft preparatory switch selections and pressurization requirements and only thought he had activated the ecu switch and seat belt sign on the checklist when actually he had actuated the seat belt sign and a landing light switch which had been deleted from that checklist some 4 weeks before as a function of a company initiated, FAA approved checklist upgrade. The PIC noted no other takeoff confign errors, consulted the weight tables to ensure sufficient runway was available at the adjacent approved intersection, reviewed the runway checks, received clearance for takeoff and subsequently departed west/O further incident on a scheduled revenue flight to tpa. Avoiding this oversight depends on not depending on a flow to substitute for the positive use of a checklist item by item. Adding the ecu to the before start checklist would complete/reverify the coverage of all takeoff confign warning sensitive items prior to taking the runway and substantially reduce the incidence of this error.
Original NASA ASRS Text
Title: COMMUTER MDT TKOF ABORT WHEN TKOF WARNING HORN DETECTED ENGINE ELECTRONIC CTL UNIT NOT PROPERLY SET FOR TKOF.
Narrative: AS F/O AND PF, I COMPLETED THE RWY CHKS WHILE POSITIONING IN PLACE ON RWY 13 AT PBI. THE PIC GAVE ME CTL OF THE ACFT AND I SLOWLY ADVANCED THE PWR LEVERS. AT THE DESIGNATED PWR LEVER POS, WE HEARD THE TKOF ITEMS INCOMPLETE WARNING HORN. I IMMEDIATELY ABORTED THE TKOF AND NOTIFIED THE TWR OF OUR PRELIMINARY INTENTION TO RETURN TO THE #S TO REINITIATE THE TKOF. THE PIC QUICKLY IDENTED A MISPOSITIONED ENG ELECTRONIC CTL UNIT (ECU) SWITCH WHICH HE, AS PNF, HAD OVERLOOKED SETTING DURING THE PREVIOUS LEG 'SILENT' DSNT CHKS. HE SURMISED THAT HE HAD BECOME DISTRACTED WITH A FREQ CHANGE AND TFC CALL AS HE WAS VERIFYING BY CHKLIST HIS FLOW OF ACFT PREPARATORY SWITCH SELECTIONS AND PRESSURIZATION REQUIREMENTS AND ONLY THOUGHT HE HAD ACTIVATED THE ECU SWITCH AND SEAT BELT SIGN ON THE CHKLIST WHEN ACTUALLY HE HAD ACTUATED THE SEAT BELT SIGN AND A LNDG LIGHT SWITCH WHICH HAD BEEN DELETED FROM THAT CHKLIST SOME 4 WKS BEFORE AS A FUNCTION OF A COMPANY INITIATED, FAA APPROVED CHKLIST UPGRADE. THE PIC NOTED NO OTHER TKOF CONFIGN ERRORS, CONSULTED THE WT TABLES TO ENSURE SUFFICIENT RWY WAS AVAILABLE AT THE ADJACENT APPROVED INTXN, REVIEWED THE RWY CHKS, RECEIVED CLRNC FOR TKOF AND SUBSEQUENTLY DEPARTED W/O FURTHER INCIDENT ON A SCHEDULED REVENUE FLT TO TPA. AVOIDING THIS OVERSIGHT DEPENDS ON NOT DEPENDING ON A FLOW TO SUBSTITUTE FOR THE POSITIVE USE OF A CHKLIST ITEM BY ITEM. ADDING THE ECU TO THE BEFORE START CHKLIST WOULD COMPLETE/REVERIFY THE COVERAGE OF ALL TKOF CONFIGN WARNING SENSITIVE ITEMS PRIOR TO TAKING THE RWY AND SUBSTANTIALLY REDUCE THE INCIDENCE OF THIS ERROR.
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.