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|
Attributes | |
ACN | 261814 |
Time | |
Date | 199401 |
Day | Sun |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | atc facility : crg |
State Reference | FL |
Altitude | msl bound lower : 12000 msl bound upper : 18000 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | artcc : zjx tower : hpn |
Operator | common carrier : air carrier |
Make Model Name | B767 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Navigation In Use | Other Other |
Flight Phase | cruise other descent other |
Route In Use | enroute : on vectors enroute airway : j45 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : flight engineer pilot : commercial pilot : atp pilot : instrument |
Experience | flight time last 90 days : 150 flight time total : 4800 flight time type : 1700 |
ASRS Report | 261814 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | altitude deviation : crossing restriction not met non adherence : clearance |
Independent Detector | other controllera other flight crewa |
Resolutory Action | none taken : insufficient time |
Consequence | faa : reviewed incident with flight crew |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Flight from altitude to jax, captain was flying. At approximately 17 NM northwest of alma int on J45 at FL280, we were given 2 crossing restrictions. One was to cross alma intersection at or below FL240 and cross 55 NM out of crg at 12000 ft. The captain programmed the FMS for the restriction at alma of FL240 and then put in the 12000 ft restriction which he mistakenly believed to be 35 NM out of crg. Shortly after crossing alma at FL240, we were given a vector heading of 140 degrees. Abeam the FMS computed top of descent point, we started our descent from FL240. At approximately FL210, we were told to slow to 250 KTS and cleared directly to crg. As the captain slowed to 250 KTS I reprogrammed the FMS to direct crg and offered to put in the crossing restriction. As I was putting in the 55 NM at 12000, I noticed we were only 58 NM out and descending through 18000 ft. After questioning the captain about the restriction, he said he thought it was 35 NM out at 12000 ft. As we were about to confirm the restriction with ZJX, they called and asked our altitude and if we had copied the crossing restriction. We replied we had but thought it no longer applied due to the changes in routing we had been given, but were still trying to comply. We were then handed off to jax approach. I believe there were several items which contributed to this error. One was that both the captain and I have over 2 1/2 yrs on the 767 and this was the third rotation of the month together so I relaxed more than I should have and did not check his programming of the FMS after he put in the restr. Second, the FMS programming restrs make it difficult to detect this type of error, since there were 2 intxns between crg and 55 NM out the FMS will not take crg/-55, you must compute the distance off the intersection closest to 55 NM from crg. Third, the FMS system is so reliable that we have become complacent to the point that we did not back it up with raw data by tuning in crg VOR and checking the DME. No matter how good the FMS is, if it's programmed wrong the output is no good. No matter how experienced you or your crew is, we still can make mistakes. When you feel comfortable it is time to double check everything you do.
Original NASA ASRS Text
Title: WDB FLC MISSES CLRNC. MISS XING RESTR.
Narrative: FLT FROM ALT TO JAX, CAPT WAS FLYING. AT APPROX 17 NM NW OF ALMA INT ON J45 AT FL280, WE WERE GIVEN 2 XING RESTRICTIONS. ONE WAS TO CROSS ALMA INTXN AT OR BELOW FL240 AND CROSS 55 NM OUT OF CRG AT 12000 FT. THE CAPT PROGRAMMED THE FMS FOR THE RESTRICTION AT ALMA OF FL240 AND THEN PUT IN THE 12000 FT RESTRICTION WHICH HE MISTAKENLY BELIEVED TO BE 35 NM OUT OF CRG. SHORTLY AFTER XING ALMA AT FL240, WE WERE GIVEN A VECTOR HDG OF 140 DEGS. ABEAM THE FMS COMPUTED TOP OF DSCNT POINT, WE STARTED OUR DSCNT FROM FL240. AT APPROX FL210, WE WERE TOLD TO SLOW TO 250 KTS AND CLRED DIRECTLY TO CRG. AS THE CAPT SLOWED TO 250 KTS I REPROGRAMMED THE FMS TO DIRECT CRG AND OFFERED TO PUT IN THE XING RESTRICTION. AS I WAS PUTTING IN THE 55 NM AT 12000, I NOTICED WE WERE ONLY 58 NM OUT AND DSNDING THROUGH 18000 FT. AFTER QUESTIONING THE CAPT ABOUT THE RESTRICTION, HE SAID HE THOUGHT IT WAS 35 NM OUT AT 12000 FT. AS WE WERE ABOUT TO CONFIRM THE RESTRICTION WITH ZJX, THEY CALLED AND ASKED OUR ALT AND IF WE HAD COPIED THE XING RESTRICTION. WE REPLIED WE HAD BUT THOUGHT IT NO LONGER APPLIED DUE TO THE CHANGES IN ROUTING WE HAD BEEN GIVEN, BUT WERE STILL TRYING TO COMPLY. WE WERE THEN HANDED OFF TO JAX APCH. I BELIEVE THERE WERE SEVERAL ITEMS WHICH CONTRIBUTED TO THIS ERROR. ONE WAS THAT BOTH THE CAPT AND I HAVE OVER 2 1/2 YRS ON THE 767 AND THIS WAS THE THIRD ROTATION OF THE MONTH TOGETHER SO I RELAXED MORE THAN I SHOULD HAVE AND DID NOT CHK HIS PROGRAMMING OF THE FMS AFTER HE PUT IN THE RESTR. SECOND, THE FMS PROGRAMMING RESTRS MAKE IT DIFFICULT TO DETECT THIS TYPE OF ERROR, SINCE THERE WERE 2 INTXNS BTWN CRG AND 55 NM OUT THE FMS WILL NOT TAKE CRG/-55, YOU MUST COMPUTE THE DISTANCE OFF THE INTXN CLOSEST TO 55 NM FROM CRG. THIRD, THE FMS SYS IS SO RELIABLE THAT WE HAVE BECOME COMPLACENT TO THE POINT THAT WE DID NOT BACK IT UP WITH RAW DATA BY TUNING IN CRG VOR AND CHKING THE DME. NO MATTER HOW GOOD THE FMS IS, IF IT'S PROGRAMMED WRONG THE OUTPUT IS NO GOOD. NO MATTER HOW EXPERIENCED YOU OR YOUR CREW IS, WE STILL CAN MAKE MISTAKES. WHEN YOU FEEL COMFORTABLE IT IS TIME TO DOUBLE CHK EVERYTHING YOU DO.
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.