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|
Attributes | |
ACN | 291050 |
Time | |
Date | 199412 |
Day | Fri |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | atc facility : mco |
State Reference | FL |
Altitude | msl bound lower : 3000 msl bound upper : 3000 |
Environment | |
Flight Conditions | IMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : mco artcc : zan |
Operator | common carrier : air carrier |
Make Model Name | Any Unknown or Unlisted Aircraft Manufacturer |
Operating Under FAR Part | Part 121 |
Flight Phase | cruise other |
Route In Use | enroute : on vectors |
Flight Plan | IFR |
Aircraft 2 | |
Operator | common carrier : air carrier |
Make Model Name | Any Unknown or Unlisted Aircraft Manufacturer |
Operating Under FAR Part | Part 121 |
Flight Phase | cruise other descent : approach |
Route In Use | enroute : on vectors |
Flight Plan | IFR |
Person 1 | |
Affiliation | government : faa |
Function | controller : approach |
Qualification | controller : radar |
Experience | controller radar : 20 |
ASRS Report | 291050 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | conflict : airborne less severe non adherence : published procedure non adherence : required legal separation other anomaly other |
Independent Detector | other other : unspecified atc other other : unspecified |
Resolutory Action | other |
Consequence | faa : investigated |
Miss Distance | horizontal : 7800 vertical : 500 |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation Operational Error |
Narrative:
Safety on the radio -- a shared responsibility. Another readback error. I was working the final approach sector for the orl airport on dec/fri/94. I had air carrier X on the east downwind expecting runway 17. I had air carrier Y on the west downwind also expecting runway 17. I turned air carrier X to a 270 degree heading and air carrier Y to a 090 degree heading. Air carrier Y was about 4.5 mi north of air carrier X, and was being vectored to follow air carrier X. I turned air carrier X (by accident) right heading 150 degrees and cleared them for the ILS approach. Air carrier Y read back the clearance and at the end of his readback he said Y. I did not catch the pilot say Y. Air carrier Y was probably expecting that transmission and thought it was for him. I was semi-busy at the time and was planning my next move. I made 2 missions to 2 different aircraft and then told air carrier Y to 'fly heading 120 degrees' in an effort to get him behind air carrier X whom I thought was turning on the approach. During my transmission to air carrier Y, I decided not to turn him and told him to 'continue eastbound.' the frequency was too congested for air carrier X to question the instruction and since I did not question air carrier Y, air carrier X assumed he heard wrong and continued wbound. A supervisor behind me noticed that air carrier Y was not eastbound and I took evasive action with both aircraft to avoid a collision. The aircraft passed approximately 1.3 mi and 500 ft from each other. Although it is the responsibility of the controller to catch a wrong readback, it must be the responsibility of the pilot to listen very carefully to the radio. I feel this error is 50 percent air carrier Y's fault. I was decertified and retrained on the position because I missed the readback and lost separation. I admit, not catching the wrong readback was my mistake, but it was also the pilot's mistake taking someone else's instructions. If this did not happen air carrier X would have questioned his clearance and the whole incident would not have happened.
Original NASA ASRS Text
Title: PLTDEV OPERROR.
Narrative: SAFETY ON THE RADIO -- A SHARED RESPONSIBILITY. ANOTHER READBACK ERROR. I WAS WORKING THE FINAL APCH SECTOR FOR THE ORL ARPT ON DEC/FRI/94. I HAD ACR X ON THE E DOWNWIND EXPECTING RWY 17. I HAD ACR Y ON THE W DOWNWIND ALSO EXPECTING RWY 17. I TURNED ACR X TO A 270 DEG HDG AND ACR Y TO A 090 DEG HDG. ACR Y WAS ABOUT 4.5 MI N OF ACR X, AND WAS BEING VECTORED TO FOLLOW ACR X. I TURNED ACR X (BY ACCIDENT) R HDG 150 DEGS AND CLRED THEM FOR THE ILS APCH. ACR Y READ BACK THE CLRNC AND AT THE END OF HIS READBACK HE SAID Y. I DID NOT CATCH THE PLT SAY Y. ACR Y WAS PROBABLY EXPECTING THAT XMISSION AND THOUGHT IT WAS FOR HIM. I WAS SEMI-BUSY AT THE TIME AND WAS PLANNING MY NEXT MOVE. I MADE 2 MISSIONS TO 2 DIFFERENT ACFT AND THEN TOLD ACR Y TO 'FLY HDG 120 DEGS' IN AN EFFORT TO GET HIM BEHIND ACR X WHOM I THOUGHT WAS TURNING ON THE APCH. DURING MY XMISSION TO ACR Y, I DECIDED NOT TO TURN HIM AND TOLD HIM TO 'CONTINUE EBOUND.' THE FREQ WAS TOO CONGESTED FOR ACR X TO QUESTION THE INSTRUCTION AND SINCE I DID NOT QUESTION ACR Y, ACR X ASSUMED HE HEARD WRONG AND CONTINUED WBOUND. A SUPVR BEHIND ME NOTICED THAT ACR Y WAS NOT EBOUND AND I TOOK EVASIVE ACTION WITH BOTH ACFT TO AVOID A COLLISION. THE ACFT PASSED APPROX 1.3 MI AND 500 FT FROM EACH OTHER. ALTHOUGH IT IS THE RESPONSIBILITY OF THE CTLR TO CATCH A WRONG READBACK, IT MUST BE THE RESPONSIBILITY OF THE PLT TO LISTEN VERY CAREFULLY TO THE RADIO. I FEEL THIS ERROR IS 50 PERCENT ACR Y'S FAULT. I WAS DECERTIFIED AND RETRAINED ON THE POS BECAUSE I MISSED THE READBACK AND LOST SEPARATION. I ADMIT, NOT CATCHING THE WRONG READBACK WAS MY MISTAKE, BUT IT WAS ALSO THE PLT'S MISTAKE TAKING SOMEONE ELSE'S INSTRUCTIONS. IF THIS DID NOT HAPPEN ACR X WOULD HAVE QUESTIONED HIS CLRNC AND THE WHOLE INCIDENT WOULD NOT HAVE HAPPENED.
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.