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|
Attributes | |
ACN | 228696 |
Time | |
Date | 199212 |
Day | Mon |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | airport : roc |
State Reference | NY |
Altitude | agl bound lower : 1500 agl bound upper : 1500 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | tracon : roc tracon : ord |
Operator | common carrier : air carrier |
Make Model Name | Medium Large Transport, Low Wing, 2 Turbojet Eng |
Navigation In Use | Other Other |
Flight Phase | descent : approach landing : go around |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : instrument pilot : commercial pilot : atp |
Experience | flight time last 90 days : 210 flight time total : 12000 flight time type : 800 |
ASRS Report | 228696 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | non adherence : clearance non adherence : far non adherence : published procedure other anomaly other |
Independent Detector | other flight crewa |
Resolutory Action | other |
Consequence | other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
This incident was caused by what I believe was a gross breakdown in effective crew management and synergy. I will attempt to illustrate as follows. The trip started with the usual introduction and a very formal crew briefing. I thought obviously the captain takes CRM seriously. This is good! However as he talked he pointed out that certain company procedures are bs and that we would do it this way(south). He made it clear that the PF was to program the FMC and it was not necessary for the PNF to follow along the route with vors. The computer will know where it is going. Also discussed was his recent sim chkride and the mentality behind some of the standard procedures which are bs and were derived from the old 'air carrier X' and 'air carrier Y' mindset. He said that his evaluator was an ex 'air carrier Y' check airman and that they have forced a lot of worthless procedures on us and that he ardently disagreed with some of them to his evaluator. Once we got going I realized the start of a negative trend when additional non standard actions were directed on the pressurization and bleed panel, flight director commands and mode control panel functions after takeoff. En route I followed the flight plan VOR data as a backup to the computer. At some impulse the captain reaches over to my selector switch and disengages me from VOR navigation in an effort to discourage my usage of this non technologically advanced procedure. The PNF's FMC is also within his reach and is constantly being changed by him from one data page to another. The captain is starting to take over the whole cockpit including navaids, communication radios, both HSI switches, both FMC's etc, and this is only the first leg. Landing procedures were normal but the parking/securing checklist involved change to the placement of hydraulic pump switches. This was explained as an old 'air carrier X' mentality oversight. I became aware that when I was allowed to do my job that even the most routine of tasks was closely scrutinized. I thought back to his crew briefings as a preface to CRM and realized that the briefing was more harmful than none at all because his words and actions were totally divergent. This already had broken down an important element of synergy and complicated matters by the resultant confusion. Next leg dca-roc. I was the PF. Upon liftoff and before indicating a positive rate of climb on the vsi he reaches over to the gear handle states 'positive rate' and raises the landing gear. Next on the list he prematurely and uncommanded by the PF activates the VNAV climb mode on the MCP. The next problem arises approximately 90 mi sse of roc and leads into the incident. ATIS is received and roc is VFR landing runway 22 with 3 KTS of wind. Captain tells me he will be asking for a visual to runway 4. He sets up the LNAV for runway 4 and makes the request to approach control. Controller momentarily comes back and gives a left turn to a heading for vectors to visual runway 4. Captain immediately looks at the LNAV to assess the controllers heading. The initial heading is not suitable to him and he promptly requests in an overbearing tone a heading closer to the OM. Controller states unable at which time the captain states 'runway in sight.' controller clears us for visual to runway 4 and captain then asks me if I have it. My answer is 'I think it's on the other side of that dark spot.' he then tells me to look at the LNAV and says we are too high. I begin descent and shortly thereafter he says 5/6 mi out on the FMC. I cannot make a positive identify and realize I must have wrongly idented the position of the airport. He doesn't see it either and never did in the first place. Captain says 'you do have it don't you?' I state 'not now but I will not go below 1500 ft until aligned.' a few seconds later I see the airport but it's about 1 mi off our left wing at which time I initiate an uneventful go around to a landing on runway 22. Callback conversation with reporter revealed the following information. He indeed did turn a copy of report into the professional standards group with his air carrier. Reporter told of problems with captain and indicated that he (captain) had several personnel problems that appeared to nag on him as well as operating procedures in the aircraft. The captain was defined as very intelligent and aggressive in the cockpit but unpredictable. Looks like the captain is the sort that knows all and wants to do all and has to be 'doing something' even if it is nonproductive. It is interesting to note that both pilots are 'mergered' pilots, brought in from different carriers to this air carrier. One agrees with current policies and one obviously doesn't.
Original NASA ASRS Text
Title: FLC BEHAVIOR UNPROFESSIONAL ATTITUDE BY CAPT IN OP OF ACR FLT.
Narrative: THIS INCIDENT WAS CAUSED BY WHAT I BELIEVE WAS A GROSS BREAKDOWN IN EFFECTIVE CREW MGMNT AND SYNERGY. I WILL ATTEMPT TO ILLUSTRATE AS FOLLOWS. THE TRIP STARTED WITH THE USUAL INTRODUCTION AND A VERY FORMAL CREW BRIEFING. I THOUGHT OBVIOUSLY THE CAPT TAKES CRM SERIOUSLY. THIS IS GOOD! HOWEVER AS HE TALKED HE POINTED OUT THAT CERTAIN COMPANY PROCS ARE BS AND THAT WE WOULD DO IT THIS WAY(S). HE MADE IT CLR THAT THE PF WAS TO PROGRAM THE FMC AND IT WAS NOT NECESSARY FOR THE PNF TO FOLLOW ALONG THE RTE WITH VORS. THE COMPUTER WILL KNOW WHERE IT IS GOING. ALSO DISCUSSED WAS HIS RECENT SIM CHKRIDE AND THE MENTALITY BEHIND SOME OF THE STANDARD PROCS WHICH ARE BS AND WERE DERIVED FROM THE OLD 'ACR X' AND 'ACR Y' MINDSET. HE SAID THAT HIS EVALUATOR WAS AN EX 'ACR Y' CHK AIRMAN AND THAT THEY HAVE FORCED A LOT OF WORTHLESS PROCS ON US AND THAT HE ARDENTLY DISAGREED WITH SOME OF THEM TO HIS EVALUATOR. ONCE WE GOT GOING I REALIZED THE START OF A NEGATIVE TREND WHEN ADDITIONAL NON STANDARD ACTIONS WERE DIRECTED ON THE PRESSURIZATION AND BLEED PANEL, FLT DIRECTOR COMMANDS AND MODE CTL PANEL FUNCTIONS AFTER TKOF. ENRTE I FOLLOWED THE FLT PLAN VOR DATA AS A BACKUP TO THE COMPUTER. AT SOME IMPULSE THE CAPT REACHES OVER TO MY SELECTOR SWITCH AND DISENGAGES ME FROM VOR NAV IN AN EFFORT TO DISCOURAGE MY USAGE OF THIS NON TECHNOLOGICALLY ADVANCED PROC. THE PNF'S FMC IS ALSO WITHIN HIS REACH AND IS CONSTANTLY BEING CHANGED BY HIM FROM ONE DATA PAGE TO ANOTHER. THE CAPT IS STARTING TO TAKE OVER THE WHOLE COCKPIT INCLUDING NAVAIDS, COM RADIOS, BOTH HSI SWITCHES, BOTH FMC'S ETC, AND THIS IS ONLY THE FIRST LEG. LNDG PROCS WERE NORMAL BUT THE PARKING/SECURING CHKLIST INVOLVED CHANGE TO THE PLACEMENT OF HYDRAULIC PUMP SWITCHES. THIS WAS EXPLAINED AS AN OLD 'ACR X' MENTALITY OVERSIGHT. I BECAME AWARE THAT WHEN I WAS ALLOWED TO DO MY JOB THAT EVEN THE MOST ROUTINE OF TASKS WAS CLOSELY SCRUTINIZED. I THOUGHT BACK TO HIS CREW BRIEFINGS AS A PREFACE TO CRM AND REALIZED THAT THE BRIEFING WAS MORE HARMFUL THAN NONE AT ALL BECAUSE HIS WORDS AND ACTIONS WERE TOTALLY DIVERGENT. THIS ALREADY HAD BROKEN DOWN AN IMPORTANT ELEMENT OF SYNERGY AND COMPLICATED MATTERS BY THE RESULTANT CONFUSION. NEXT LEG DCA-ROC. I WAS THE PF. UPON LIFTOFF AND BEFORE INDICATING A POSITIVE RATE OF CLB ON THE VSI HE REACHES OVER TO THE GEAR HANDLE STATES 'POSITIVE RATE' AND RAISES THE LNDG GEAR. NEXT ON THE LIST HE PREMATURELY AND UNCOMMANDED BY THE PF ACTIVATES THE VNAV CLB MODE ON THE MCP. THE NEXT PROBLEM ARISES APPROX 90 MI SSE OF ROC AND LEADS INTO THE INCIDENT. ATIS IS RECEIVED AND ROC IS VFR LNDG RWY 22 WITH 3 KTS OF WIND. CAPT TELLS ME HE WILL BE ASKING FOR A VISUAL TO RWY 4. HE SETS UP THE LNAV FOR RWY 4 AND MAKES THE REQUEST TO APCH CTL. CTLR MOMENTARILY COMES BACK AND GIVES A L TURN TO A HDG FOR VECTORS TO VISUAL RWY 4. CAPT IMMEDIATELY LOOKS AT THE LNAV TO ASSESS THE CTLRS HDG. THE INITIAL HDG IS NOT SUITABLE TO HIM AND HE PROMPTLY REQUESTS IN AN OVERBEARING TONE A HDG CLOSER TO THE OM. CTLR STATES UNABLE AT WHICH TIME THE CAPT STATES 'RWY IN SIGHT.' CTLR CLRS US FOR VISUAL TO RWY 4 AND CAPT THEN ASKS ME IF I HAVE IT. MY ANSWER IS 'I THINK IT'S ON THE OTHER SIDE OF THAT DARK SPOT.' HE THEN TELLS ME TO LOOK AT THE LNAV AND SAYS WE ARE TOO HIGH. I BEGIN DSCNT AND SHORTLY THEREAFTER HE SAYS 5/6 MI OUT ON THE FMC. I CANNOT MAKE A POSITIVE IDENT AND REALIZE I MUST HAVE WRONGLY IDENTED THE POS OF THE ARPT. HE DOESN'T SEE IT EITHER AND NEVER DID IN THE FIRST PLACE. CAPT SAYS 'YOU DO HAVE IT DON'T YOU?' I STATE 'NOT NOW BUT I WILL NOT GO BELOW 1500 FT UNTIL ALIGNED.' A FEW SECONDS LATER I SEE THE ARPT BUT IT'S ABOUT 1 MI OFF OUR L WING AT WHICH TIME I INITIATE AN UNEVENTFUL GAR TO A LNDG ON RWY 22. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO. HE INDEED DID TURN A COPY OF RPT INTO THE PROFESSIONAL STANDARDS GROUP WITH HIS ACR. RPTR TOLD OF PROBLEMS WITH CAPT AND INDICATED THAT HE (CAPT) HAD SEVERAL PERSONNEL PROBLEMS THAT APPEARED TO NAG ON HIM AS WELL AS OPERATING PROCS IN THE ACFT. THE CAPT WAS DEFINED AS VERY INTELLIGENT AND AGGRESSIVE IN THE COCKPIT BUT UNPREDICTABLE. LOOKS LIKE THE CAPT IS THE SORT THAT KNOWS ALL AND WANTS TO DO ALL AND HAS TO BE 'DOING SOMETHING' EVEN IF IT IS NONPRODUCTIVE. IT IS INTERESTING TO NOTE THAT BOTH PLTS ARE 'MERGERED' PLTS, BROUGHT IN FROM DIFFERENT CARRIERS TO THIS ACR. ONE AGREES WITH CURRENT POLICIES AND ONE OBVIOUSLY DOESN'T.
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.