37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 273341 |
Time | |
Date | 199406 |
Day | Sat |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : sbp |
State Reference | CA |
Altitude | msl bound lower : 6000 msl bound upper : 6400 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | Jetstream 31 |
Operating Under FAR Part | Part 135 |
Flight Phase | climbout : intermediate altitude |
Route In Use | enroute airway : zla |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : cfi pilot : atp |
Experience | flight time last 90 days : 200 flight time total : 7000 flight time type : 3000 |
ASRS Report | 273341 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : cfi pilot : atp |
Experience | flight time last 90 days : 206 flight time total : 5000 flight time type : 2500 |
ASRS Report | 273597 |
Events | |
Anomaly | aircraft equipment problem : less severe altitude deviation : overshoot non adherence : clearance non adherence other other anomaly other |
Independent Detector | other controllera other flight crewa |
Resolutory Action | controller : issued new clearance flight crew : became reoriented none taken : detected after the fact |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Flight, fourth leg of the day. Duty start AM00 local. Departed sbp with IFR plan to sfo with initial climb to 9000 ft. In contact with ZLA, instructions were to fly heading 320 degrees and maintain 6000 ft. Airplane was not equipped with altitude alerter. Airplane also had cockpit flow deferred. In the climb, both me and copilot were looking out for the terrain and traffic in the area. I was flying and out of 5000 ft, first officer failed to call 1000 ft to go (tired, distracted?) at about 5500 ft, I really started getting uncomfortable with the cockpit temperature too hot. We had been unable to cool it due to deferred flow and I asked first officer if he thought that, by opening cockpit door, we might be able to get a breath of fresh air. Then I scanned outside and back to altimeter when I noted 6400 ft and climbing. At that same time, center called us asking to state altitude. I eased back on power and slowly pitched down. Center called again asking for altitude and also saying to now climb to 16000 ft. First officer answered back with altitude leaving and climbing to. Factors: poor crew coordination, outside distraction, fatigue. Supplemental information from acn 273597: a deferred air flow system (1 of only 2) led to stuffy cockpit, which I was attempting to regularly adjust in flight. In my judgement, certain psychological factors were the very factors which led to my failure to back up the flying pilot properly. Fatigue seemed, in retrospect, to be more acute. I am also no convinced that this level of fatigue was a direct result to the unusually bad episode of labor relations my company elected to get into when it had announced that it was simply no longer going to fill certain new potential captain vacancies with the seniority system with which it agreed to in a legally binding contract with the pilot group. The result has been that many of us have suffered lower quality sleep, lower morale, increased family tension, etc, etc., which shows up on the flight line despite our attempts to hold it at bay. I regularly work 190 hours per month as a fully qualified airline pilot, based and live in san francisco bay area. After 5 yrs of full time employment with my airline, my gross annual income is 'up to' 20000 dollars per yr.
Original NASA ASRS Text
Title: ALT BUST.
Narrative: FLT, FOURTH LEG OF THE DAY. DUTY START AM00 LCL. DEPARTED SBP WITH IFR PLAN TO SFO WITH INITIAL CLB TO 9000 FT. IN CONTACT WITH ZLA, INSTRUCTIONS WERE TO FLY HDG 320 DEGS AND MAINTAIN 6000 FT. AIRPLANE WAS NOT EQUIPPED WITH ALT ALERTER. AIRPLANE ALSO HAD COCKPIT FLOW DEFERRED. IN THE CLB, BOTH ME AND COPLT WERE LOOKING OUT FOR THE TERRAIN AND TFC IN THE AREA. I WAS FLYING AND OUT OF 5000 FT, FO FAILED TO CALL 1000 FT TO GO (TIRED, DISTRACTED?) AT ABOUT 5500 FT, I REALLY STARTED GETTING UNCOMFORTABLE WITH THE COCKPIT TEMP TOO HOT. WE HAD BEEN UNABLE TO COOL IT DUE TO DEFERRED FLOW AND I ASKED FO IF HE THOUGHT THAT, BY OPENING COCKPIT DOOR, WE MIGHT BE ABLE TO GET A BREATH OF FRESH AIR. THEN I SCANNED OUTSIDE AND BACK TO ALTIMETER WHEN I NOTED 6400 FT AND CLBING. AT THAT SAME TIME, CTR CALLED US ASKING TO STATE ALT. I EASED BACK ON PWR AND SLOWLY PITCHED DOWN. CTR CALLED AGAIN ASKING FOR ALT AND ALSO SAYING TO NOW CLB TO 16000 FT. FO ANSWERED BACK WITH ALT LEAVING AND CLBING TO. FACTORS: POOR CREW COORD, OUTSIDE DISTR, FATIGUE. SUPPLEMENTAL INFO FROM ACN 273597: A DEFERRED AIR FLOW SYS (1 OF ONLY 2) LED TO STUFFY COCKPIT, WHICH I WAS ATTEMPTING TO REGULARLY ADJUST IN FLT. IN MY JUDGEMENT, CERTAIN PSYCHOLOGICAL FACTORS WERE THE VERY FACTORS WHICH LED TO MY FAILURE TO BACK UP THE FLYING PLT PROPERLY. FATIGUE SEEMED, IN RETROSPECT, TO BE MORE ACUTE. I AM ALSO NO CONVINCED THAT THIS LEVEL OF FATIGUE WAS A DIRECT RESULT TO THE UNUSUALLY BAD EPISODE OF LABOR RELATIONS MY COMPANY ELECTED TO GET INTO WHEN IT HAD ANNOUNCED THAT IT WAS SIMPLY NO LONGER GOING TO FILL CERTAIN NEW POTENTIAL CAPT VACANCIES WITH THE SENIORITY SYS WITH WHICH IT AGREED TO IN A LEGALLY BINDING CONTRACT WITH THE PLT GROUP. THE RESULT HAS BEEN THAT MANY OF US HAVE SUFFERED LOWER QUALITY SLEEP, LOWER MORALE, INCREASED FAMILY TENSION, ETC, ETC., WHICH SHOWS UP ON THE FLT LINE DESPITE OUR ATTEMPTS TO HOLD IT AT BAY. I REGULARLY WORK 190 HRS PER MONTH AS A FULLY QUALIFIED AIRLINE PLT, BASED AND LIVE IN SAN FRANCISCO BAY AREA. AFTER 5 YRS OF FULL TIME EMPLOYMENT WITH MY AIRLINE, MY GROSS ANNUAL INCOME IS 'UP TO' 20000 DOLLARS PER YR.
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.