37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 356763 |
Time | |
Date | 199612 |
Day | Mon |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | atc facility : ftz airport : stl |
State Reference | MO |
Altitude | msl bound lower : 13300 msl bound upper : 15000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zkc |
Operator | common carrier : air carrier |
Make Model Name | B737-300 |
Operating Under FAR Part | Part 121 |
Navigation In Use | Other Other |
Flight Phase | descent other |
Route In Use | arrival star : star |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : cfi pilot : atp pilot : flight engineer |
Experience | flight time last 90 days : 210 flight time total : 7500 flight time type : 4600 |
ASRS Report | 356763 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : commercial pilot : instrument pilot : atp |
Experience | flight time last 90 days : 180 flight time total : 5600 flight time type : 1600 |
ASRS Report | 356560 |
Events | |
Anomaly | altitude deviation : crossing restriction not met altitude deviation : overshoot non adherence : clearance non adherence : published procedure |
Independent Detector | other controllera |
Resolutory Action | controller : issued new clearance |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Our flight was cruising at FL240 inbound to stl from mci. Stl was experiencing bad WX and we were being vectored many times, descended and slowed down. There was a lot of radio traffic, with the unusual increase in workload in the cockpit, as well as in ATC. We next received a final vector to intercept the trake 7 STAR with a multiple descent clearance to cross an 11 NM DME fix (the same spot as the depicted intersecting kayla). The clearance was to descend to FL200 with a pilot's discretion to cross 11 DME at 15000 ft. I was the PF, my first officer was working the radios and read back the clearance the way he heard it. Unfortunately, my first officer set the wrong altitude (20000 ft) in the MCP altitude alerter, then went off frequency to get the new ATIS. When the alerter sounded I discovered FL200 set in the altitude window of the alerter. I then confirmed with him if we had 'been cleared on down,' as I thought we had been, and he replied yes. I looked at the STAR intersection altitude and reset the MCP altitude alerter to 11000 ft and continued the descent. At approximately 13300 ft the controller asked us our altitude, we answered and were told what he had wanted was 15000 ft. But before we could reply or even climb back to 15000 ft, the controller told us to just stay at 13000 ft. He then said it was no problem and to call approach on the next frequency. There was no traffic close to us and the rest of the flight was uneventful. To me the problem was caused by a deviation from our sops and poor crew communication. Had the MCP altitude alerter been set properly the first time or I caught the deviation in setting the alerter, this problem would not have arose. Proper phraseology would have helped also.
Original NASA ASRS Text
Title: B737-300 IS CLRED TO CROSS KAYLA AT 15000 FT BUT PF THOUGHT IT WAS 11000 FT. THE WRONG ALT HAD BEEN ENTERED IN THE ALT ALERT. ATC RECLRED THEM TO 13000 FT.
Narrative: OUR FLT WAS CRUISING AT FL240 INBOUND TO STL FROM MCI. STL WAS EXPERIENCING BAD WX AND WE WERE BEING VECTORED MANY TIMES, DSNDED AND SLOWED DOWN. THERE WAS A LOT OF RADIO TFC, WITH THE UNUSUAL INCREASE IN WORKLOAD IN THE COCKPIT, AS WELL AS IN ATC. WE NEXT RECEIVED A FINAL VECTOR TO INTERCEPT THE TRAKE 7 STAR WITH A MULTIPLE DSCNT CLRNC TO CROSS AN 11 NM DME FIX (THE SAME SPOT AS THE DEPICTED INTERSECTING KAYLA). THE CLRNC WAS TO DSND TO FL200 WITH A PLT'S DISCRETION TO CROSS 11 DME AT 15000 FT. I WAS THE PF, MY FO WAS WORKING THE RADIOS AND READ BACK THE CLRNC THE WAY HE HEARD IT. UNFORTUNATELY, MY FO SET THE WRONG ALT (20000 FT) IN THE MCP ALT ALERTER, THEN WENT OFF FREQ TO GET THE NEW ATIS. WHEN THE ALERTER SOUNDED I DISCOVERED FL200 SET IN THE ALT WINDOW OF THE ALERTER. I THEN CONFIRMED WITH HIM IF WE HAD 'BEEN CLRED ON DOWN,' AS I THOUGHT WE HAD BEEN, AND HE REPLIED YES. I LOOKED AT THE STAR INTXN ALT AND RESET THE MCP ALT ALERTER TO 11000 FT AND CONTINUED THE DSCNT. AT APPROX 13300 FT THE CTLR ASKED US OUR ALT, WE ANSWERED AND WERE TOLD WHAT HE HAD WANTED WAS 15000 FT. BUT BEFORE WE COULD REPLY OR EVEN CLB BACK TO 15000 FT, THE CTLR TOLD US TO JUST STAY AT 13000 FT. HE THEN SAID IT WAS NO PROB AND TO CALL APCH ON THE NEXT FREQ. THERE WAS NO TFC CLOSE TO US AND THE REST OF THE FLT WAS UNEVENTFUL. TO ME THE PROB WAS CAUSED BY A DEV FROM OUR SOPS AND POOR CREW COM. HAD THE MCP ALT ALERTER BEEN SET PROPERLY THE FIRST TIME OR I CAUGHT THE DEV IN SETTING THE ALERTER, THIS PROB WOULD NOT HAVE AROSE. PROPER PHRASEOLOGY WOULD HAVE HELPED ALSO.
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.