37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 335858 |
Time | |
Date | 199605 |
Day | Mon |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | atc facility : djb |
State Reference | OH |
Altitude | msl bound lower : 33000 msl bound upper : 33000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zob |
Operator | common carrier : air carrier |
Make Model Name | Commercial Fixed Wing |
Operating Under FAR Part | Part 121 |
Flight Phase | cruise other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : flight engineer pilot : atp |
Experience | flight time last 90 days : 190 flight time total : 8650 flight time type : 550 |
ASRS Report | 335858 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | non adherence : clearance other spatial deviation |
Independent Detector | other flight crewa |
Resolutory Action | flight crew : returned to intended course or assigned course |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
En route from ord to bwi at FL330 inbound to djb VOR center cleared us 'after djb VOR djb direct mgw' (rather than our flight plan route of V162 which would have taken us via air en route to mgw). Approaching djb VOR I allowed myself to become distracted in assisting the captain with sending an engine trend monitoring report via the ACARS. When I next looked back at my flight instruments we were 25 DME beyond djb VOR still on our heading that had taken us to djb having missed making the turn direct to mgw over djb VOR. Course correction was initiated. I believe the primary cause of this event was complacency inspired by the 'comfort' of being in the cruise segment of the flight. Secondary causes where a short layover/'minimum rest' the night before and the poor location of the ACARS control display unit which in this particular airplane is in the far aft part of the center control pedestal, considerably outside the pilot's normal forward scan area. The chance of this or similar event occurring in the future could be reduced by an increased vigilance against complacency, improved preflight rest, and possibly the relocation of the ACARS control unit. (Thank you for the opportunity to provide NASA, the FAA, and the aviation community with this information in a non-punitive environment.)
Original NASA ASRS Text
Title: FLC OF AN MLG FAILED TO CHANGE COURSE AS ASSIGNED DURING HIGH ALT CRUISE UNTIL NOTICING THE ERROR 25 MI PAST THE VOR FIX.
Narrative: ENRTE FROM ORD TO BWI AT FL330 INBOUND TO DJB VOR CTR CLRED US 'AFTER DJB VOR DJB DIRECT MGW' (RATHER THAN OUR FLT PLAN RTE OF V162 WHICH WOULD HAVE TAKEN US VIA AIR ENRTE TO MGW). APCHING DJB VOR I ALLOWED MYSELF TO BECOME DISTRACTED IN ASSISTING THE CAPT WITH SENDING AN ENG TREND MONITORING RPT VIA THE ACARS. WHEN I NEXT LOOKED BACK AT MY FLT INSTS WE WERE 25 DME BEYOND DJB VOR STILL ON OUR HDG THAT HAD TAKEN US TO DJB HAVING MISSED MAKING THE TURN DIRECT TO MGW OVER DJB VOR. COURSE CORRECTION WAS INITIATED. I BELIEVE THE PRIMARY CAUSE OF THIS EVENT WAS COMPLACENCY INSPIRED BY THE 'COMFORT' OF BEING IN THE CRUISE SEGMENT OF THE FLT. SECONDARY CAUSES WHERE A SHORT LAYOVER/'MINIMUM REST' THE NIGHT BEFORE AND THE POOR LOCATION OF THE ACARS CTL DISPLAY UNIT WHICH IN THIS PARTICULAR AIRPLANE IS IN THE FAR AFT PART OF THE CTR CTL PEDESTAL, CONSIDERABLY OUTSIDE THE PLT'S NORMAL FORWARD SCAN AREA. THE CHANCE OF THIS OR SIMILAR EVENT OCCURRING IN THE FUTURE COULD BE REDUCED BY AN INCREASED VIGILANCE AGAINST COMPLACENCY, IMPROVED PREFLT REST, AND POSSIBLY THE RELOCATION OF THE ACARS CTL UNIT. (THANK YOU FOR THE OPPORTUNITY TO PROVIDE NASA, THE FAA, AND THE AVIATION COMMUNITY WITH THIS INFO IN A NON-PUNITIVE ENVIRONMENT.)
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.