37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 306963 |
Time | |
Date | 199506 |
Day | Wed |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | airport : sfo |
State Reference | CA |
Altitude | agl bound lower : 0 agl bound upper : 0 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | Commercial Fixed Wing |
Operating Under FAR Part | Part 135 |
Flight Phase | ground other : taxi |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 250 flight time total : 6597 flight time type : 250 |
ASRS Report | 306963 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : cfi pilot : commercial pilot : instrument |
Experience | flight time last 90 days : 100 flight time total : 6600 flight time type : 800 |
ASRS Report | 307088 |
Events | |
Anomaly | incursion : runway |
Independent Detector | other controllera |
Resolutory Action | controller : issued new clearance other |
Consequence | faa : reviewed incident with flight crew |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
We taxied into sfo about 17 mins late. Our next departure was flight to sjc scheduled quick departure time of XA40. As we shut down first officer left the cockpit to do his duties, I stayed inside and picked up the departure ATIS (which had been calling for runway 28 departures for that day) and then called for clearance to sjc. We were given the (sfo gap #2) departure which calls for tracking the 281 degree radial off of sfo when departing the runways 28. I look up the departure procedure on my approach plate and set the #1 navigation to that departure. On taxi out, the first officer called for taxi. Instruction from ground control was to taxi to runway 1 left via inner foxtrot outer, which the first officer read back correctly. However I myself misunderstood the clearance and only remember hearing (inner foxtrot outer) which is also a normal route when taxing to the runways 28. At this point we began to taxi and I did not confirm with the first officer what runway we were taxing to. I just assumed I was headed for runways 28 (this has now set a trap for the events to come). As we began to taxi I looked off to my right. In the distance I remember seeing a cargo 727 taxiing out for takeoff. As we are performing the taxi checklist, we come to the passenger briefing portion at which the first officer briefs the people and I monitor the radios. We are now on the inner taxiway and approaching intersection foxtrot. I still assume to be taxiing for the runways 28. As I approach and transition to the outer taxiway at foxtrot, I look south to the departure end of runways 1 to see if the runways are clear as I prepare to cross them at foxtrot. At this point, I notice that runway 1L clear and that there are no aircraft on that runway. I am now also aware that the 727 that I had seen earlier is on a taxiway, heading over to runway 1R and also that there is a 737 in position on runway 1R. At this point I begin to question if we are cleared to cross the runways 1. As the first officer finishes the passenger brief and comes back on, I ask him to confirm with ground control if we are cleared to cross the runways 1. Looking puzzled he asks if we are cleared to cross the runways 1, he may have believed that we were given a runway change to runway 28 while he was briefing. There was a little radio congestion and we got no response from ground control on our request. Because runway 1L was clear of aircraft, I decided to cross it and not disrupt any flow of traffic that might be coming up behind us. After passing over runway 1L, I came to a complete stop because of the 737 that was sitting on runway 1R and we had not yet heard back from ground control. At this point we are sitting between runways 1L and 1R on intersection foxtrot. The ground controller now calls us and asks us where we are going, I respond, to the runways 28. Her response is we are using the runways 1. She then clears us to cross runway 1R to taxiway lima and down to the departure end of the runways 1 for takeoff. I feel that there are a few factors that may have prevented this situation. First of all on the beginning of taxi, if there is any doubt or misunderstanding, reconfirm with each other or ask ground control again. If we had been further along in our checklist, to the (crew brief) phase -- this error probably would have been discovered, because we discuss departure procedures headings and altitude. Radio congestion, if we had gotten a response back from ground control on our initial request we may have been corrected prior to crossing. One last thing is never assume to be helping out by not disrupting the flow on workload of others, for if conflict arises you will be responsible. Supplemental information from acn 307088: because of prior leg captain thought sfo was still using the runways 28. I try to make a habit of reading back the taxi clearance to both the ground controller and again to the captain. This is not yet reflexive and I may not have repeated it a second time to the captain.
Original NASA ASRS Text
Title: COMMUTER ACFT CROSSES RWY WITHOUT CLRNC.
Narrative: WE TAXIED INTO SFO ABOUT 17 MINS LATE. OUR NEXT DEP WAS FLT TO SJC SCHEDULED QUICK DEP TIME OF XA40. AS WE SHUT DOWN FO LEFT THE COCKPIT TO DO HIS DUTIES, I STAYED INSIDE AND PICKED UP THE DEP ATIS (WHICH HAD BEEN CALLING FOR RWY 28 DEPS FOR THAT DAY) AND THEN CALLED FOR CLRNC TO SJC. WE WERE GIVEN THE (SFO GAP #2) DEP WHICH CALLS FOR TRACKING THE 281 DEG RADIAL OFF OF SFO WHEN DEPARTING THE RWYS 28. I LOOK UP THE DEP PROC ON MY APCH PLATE AND SET THE #1 NAV TO THAT DEP. ON TAXI OUT, THE FO CALLED FOR TAXI. INSTRUCTION FROM GND CTL WAS TO TAXI TO RWY 1 L VIA INNER FOXTROT OUTER, WHICH THE FO READ BACK CORRECTLY. HOWEVER I MYSELF MISUNDERSTOOD THE CLRNC AND ONLY REMEMBER HEARING (INNER FOXTROT OUTER) WHICH IS ALSO A NORMAL RTE WHEN TAXING TO THE RWYS 28. AT THIS POINT WE BEGAN TO TAXI AND I DID NOT CONFIRM WITH THE FO WHAT RWY WE WERE TAXING TO. I JUST ASSUMED I WAS HEADED FOR RWYS 28 (THIS HAS NOW SET A TRAP FOR THE EVENTS TO COME). AS WE BEGAN TO TAXI I LOOKED OFF TO MY R. IN THE DISTANCE I REMEMBER SEEING A CARGO 727 TAXIING OUT FOR TKOF. AS WE ARE PERFORMING THE TAXI CHKLIST, WE COME TO THE PAX BRIEFING PORTION AT WHICH THE FO BRIEFS THE PEOPLE AND I MONITOR THE RADIOS. WE ARE NOW ON THE INNER TXWY AND APCHING INTXN FOXTROT. I STILL ASSUME TO BE TAXIING FOR THE RWYS 28. AS I APCH AND TRANSITION TO THE OUTER TXWY AT FOXTROT, I LOOK S TO THE DEP END OF RWYS 1 TO SEE IF THE RWYS ARE CLR AS I PREPARE TO CROSS THEM AT FOXTROT. AT THIS POINT, I NOTICE THAT RWY 1L CLR AND THAT THERE ARE NO ACFT ON THAT RWY. I AM NOW ALSO AWARE THAT THE 727 THAT I HAD SEEN EARLIER IS ON A TXWY, HDG OVER TO RWY 1R AND ALSO THAT THERE IS A 737 IN POS ON RWY 1R. AT THIS POINT I BEGIN TO QUESTION IF WE ARE CLRED TO CROSS THE RWYS 1. AS THE FO FINISHES THE PAX BRIEF AND COMES BACK ON, I ASK HIM TO CONFIRM WITH GND CTL IF WE ARE CLRED TO CROSS THE RWYS 1. LOOKING PUZZLED HE ASKS IF WE ARE CLRED TO CROSS THE RWYS 1, HE MAY HAVE BELIEVED THAT WE WERE GIVEN A RWY CHANGE TO RWY 28 WHILE HE WAS BRIEFING. THERE WAS A LITTLE RADIO CONGESTION AND WE GOT NO RESPONSE FROM GND CTL ON OUR REQUEST. BECAUSE RWY 1L WAS CLR OF ACFT, I DECIDED TO CROSS IT AND NOT DISRUPT ANY FLOW OF TFC THAT MIGHT BE COMING UP BEHIND US. AFTER PASSING OVER RWY 1L, I CAME TO A COMPLETE STOP BECAUSE OF THE 737 THAT WAS SITTING ON RWY 1R AND WE HAD NOT YET HEARD BACK FROM GND CTL. AT THIS POINT WE ARE SITTING BTWN RWYS 1L AND 1R ON INTXN FOXTROT. THE GND CTLR NOW CALLS US AND ASKS US WHERE WE ARE GOING, I RESPOND, TO THE RWYS 28. HER RESPONSE IS WE ARE USING THE RWYS 1. SHE THEN CLRS US TO CROSS RWY 1R TO TXWY LIMA AND DOWN TO THE DEP END OF THE RWYS 1 FOR TKOF. I FEEL THAT THERE ARE A FEW FACTORS THAT MAY HAVE PREVENTED THIS SIT. FIRST OF ALL ON THE BEGINNING OF TAXI, IF THERE IS ANY DOUBT OR MISUNDERSTANDING, RECONFIRM WITH EACH OTHER OR ASK GND CTL AGAIN. IF WE HAD BEEN FURTHER ALONG IN OUR CHKLIST, TO THE (CREW BRIEF) PHASE -- THIS ERROR PROBABLY WOULD HAVE BEEN DISCOVERED, BECAUSE WE DISCUSS DEP PROCS HDGS AND ALT. RADIO CONGESTION, IF WE HAD GOTTEN A RESPONSE BACK FROM GND CTL ON OUR INITIAL REQUEST WE MAY HAVE BEEN CORRECTED PRIOR TO XING. ONE LAST THING IS NEVER ASSUME TO BE HELPING OUT BY NOT DISRUPTING THE FLOW ON WORKLOAD OF OTHERS, FOR IF CONFLICT ARISES YOU WILL BE RESPONSIBLE. SUPPLEMENTAL INFO FROM ACN 307088: BECAUSE OF PRIOR LEG CAPT THOUGHT SFO WAS STILL USING THE RWYS 28. I TRY TO MAKE A HABIT OF READING BACK THE TAXI CLRNC TO BOTH THE GND CTLR AND AGAIN TO THE CAPT. THIS IS NOT YET REFLEXIVE AND I MAY NOT HAVE REPEATED IT A SECOND TIME TO THE CAPT.
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.