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|
Attributes | |
ACN | 202328 |
Time | |
Date | 199202 |
Day | Tue |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : dca |
State Reference | DC |
Altitude | agl bound lower : 0 agl bound upper : 2500 |
Environment | |
Flight Conditions | IMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : dca tower : dca |
Operator | common carrier : air carrier |
Make Model Name | Medium Transport, High Wing, 2 Turboprop Eng |
Flight Phase | descent : approach descent other landing other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp pilot : cfi |
Experience | flight time last 90 days : 180 flight time total : 5500 flight time type : 2300 |
ASRS Report | 202328 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | incursion : landing without clearance non adherence : clearance |
Independent Detector | other controllera |
Resolutory Action | none taken : anomaly accepted |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation other |
Narrative:
Were flying into dca. Captain had 6 month chkride the next evening and decided to practice raw data (no flight director) ILS approachs. WX at dca was 1 mi and 300-400 ft ceiling. Approach control was vectoring us for the ILS 36, turned us on final with instruction to contact the tower at oxonn. As mentioned, captain was flying without flight director (semi- unusual) and had some problems getting established and stabilized on approach. That caused me to focus my attention on what he was doing. Between callouts, gear, flaps, checklists, etc, I got busy and simply forgot to contact the tower. It wasn't until we had taxied clear of the runway and I looked at the radio to switch frequency that I realized what had happened. Immediately told captain who asked ground to confirm with tower that there were no problems. Tower confirmed that. Contributing factors: captain and I had just come off a 3- day trip which included a min rest overnight, and we were both tired. In addition, report that morning was very early. Approach controller contributed by putting responsibility for calling tower on us at a time when our workload was at a high. In conclusion, something I would have thought impossible did happen. Callback conversation with reporter revealed the following information: reporter gave rundown on work schedule for past 2 days. Cited fatigue factor as contributing to incident. Says PIC was keeping speed up for some unknown reason and did not get the approach stabilized until well inside LOM. Says it would be better procedure for approach controller to give frequency change at time it is to be accomplished. Thinks controllers at dca get maximum traffic in and out of small airport, but in doing so they have to make too many changes. They constantly change type of approach. Runway assignment, speed assignment, heading, etc. Flight crew planning is difficult. WX was IMC and no VFR traffic to conflict with. Thinks closest aircraft was behind them about 5 mi on ILS. Says she is sure tower controller was aware of their position at all times, but did not try to get them on proper frequency. Since incident she has adopted technique of mentioning 'cleared to land' on final gear and altitude callout.
Original NASA ASRS Text
Title: COMMUTER ACFT LAND WITHOUT CLRNC. UNAUTHORIZED LNDG.
Narrative: WERE FLYING INTO DCA. CAPT HAD 6 MONTH CHKRIDE THE NEXT EVENING AND DECIDED TO PRACTICE RAW DATA (NO FLT DIRECTOR) ILS APCHS. WX AT DCA WAS 1 MI AND 300-400 FT CEILING. APCH CTL WAS VECTORING US FOR THE ILS 36, TURNED US ON FINAL WITH INSTRUCTION TO CONTACT THE TWR AT OXONN. AS MENTIONED, CAPT WAS FLYING WITHOUT FLT DIRECTOR (SEMI- UNUSUAL) AND HAD SOME PROBLEMS GETTING ESTABLISHED AND STABILIZED ON APCH. THAT CAUSED ME TO FOCUS MY ATTN ON WHAT HE WAS DOING. BTWN CALLOUTS, GEAR, FLAPS, CHKLISTS, ETC, I GOT BUSY AND SIMPLY FORGOT TO CONTACT THE TWR. IT WASN'T UNTIL WE HAD TAXIED CLR OF THE RWY AND I LOOKED AT THE RADIO TO SWITCH FREQ THAT I REALIZED WHAT HAD HAPPENED. IMMEDIATELY TOLD CAPT WHO ASKED GND TO CONFIRM WITH TWR THAT THERE WERE NO PROBLEMS. TWR CONFIRMED THAT. CONTRIBUTING FACTORS: CAPT AND I HAD JUST COME OFF A 3- DAY TRIP WHICH INCLUDED A MIN REST OVERNIGHT, AND WE WERE BOTH TIRED. IN ADDITION, RPT THAT MORNING WAS VERY EARLY. APCH CTLR CONTRIBUTED BY PUTTING RESPONSIBILITY FOR CALLING TWR ON US AT A TIME WHEN OUR WORKLOAD WAS AT A HIGH. IN CONCLUSION, SOMETHING I WOULD HAVE THOUGHT IMPOSSIBLE DID HAPPEN. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: RPTR GAVE RUNDOWN ON WORK SCHEDULE FOR PAST 2 DAYS. CITED FATIGUE FACTOR AS CONTRIBUTING TO INCIDENT. SAYS PIC WAS KEEPING SPD UP FOR SOME UNKNOWN REASON AND DID NOT GET THE APCH STABILIZED UNTIL WELL INSIDE LOM. SAYS IT WOULD BE BETTER PROC FOR APCH CTLR TO GIVE FREQ CHANGE AT TIME IT IS TO BE ACCOMPLISHED. THINKS CTLRS AT DCA GET MAX TFC IN AND OUT OF SMALL ARPT, BUT IN DOING SO THEY HAVE TO MAKE TOO MANY CHANGES. THEY CONSTANTLY CHANGE TYPE OF APCH. RWY ASSIGNMENT, SPD ASSIGNMENT, HDG, ETC. FLC PLANNING IS DIFFICULT. WX WAS IMC AND NO VFR TFC TO CONFLICT WITH. THINKS CLOSEST ACFT WAS BEHIND THEM ABOUT 5 MI ON ILS. SAYS SHE IS SURE TWR CTLR WAS AWARE OF THEIR POS AT ALL TIMES, BUT DID NOT TRY TO GET THEM ON PROPER FREQ. SINCE INCIDENT SHE HAS ADOPTED TECHNIQUE OF MENTIONING 'CLRED TO LAND' ON FINAL GEAR AND ALT CALLOUT.
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.