37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 420470 |
Time | |
Date | 199811 |
Day | Fri |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | atc facility : den |
State Reference | CO |
Altitude | msl bound lower : 18100 msl bound upper : 19000 |
Environment | |
Flight Conditions | IMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | artcc : zdv |
Operator | common carrier : air carrier |
Make Model Name | Commercial Fixed Wing |
Navigation In Use | Other Other |
Flight Phase | descent other |
Route In Use | enroute airway : zdv |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : cfi pilot : atp |
Experience | flight time last 90 days : 235 flight time total : 6500 flight time type : 450 |
ASRS Report | 420470 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | altitude deviation : overshoot non adherence : clearance |
Independent Detector | other controllera |
Resolutory Action | flight crew : returned to intended course or assigned course other |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Captain's leg. We were cleared from FL230 to FL190 and to expect crossing tomsn (on the fqf 306 degree radial, D55) at 17000 ft. I acknowledged them (the controller) with a repeat back of instructions. The captain then began descent to FL190, which I set in the altitude preselector. I then became busy looking up a multitude of landing speeds (normal, residual ice, cycle ice). Without notifying me, he selected 17000 ft in the altitude preselector. I was never aware of this until I heard the controller say 'air carrier X FL190, 190' (we were descending through 18100 ft) as I was just finishing looking up the landing speeds. I then acknowledged FL190 and we immediately began a climb back up to FL190. I asked the captain what happened and he said 'that was me, I set that altitude in there.' he never did explain to me later the reason for his actions. This particular captain was the type that would accomplish a lot of the first officer's tasks without notifying him, then forget his own! This was a good example to me of how things can get out of hand when there is a lack of good crew coordination and resource management.
Original NASA ASRS Text
Title: CAPT OF A DORNIER 328 OVERSHOT ASSIGNED DSCNT ALT RESULTING IN ATC INTERVENING TO REMIND CREW OF THEIR ALT ASSIGNMENT AS THEY HAD ALREADY OVERSHOT BY ALMOST 1000 FT. THE FO RETURNED THE ACFT TO ASSIGNED AT ONCE.
Narrative: CAPT'S LEG. WE WERE CLRED FROM FL230 TO FL190 AND TO EXPECT XING TOMSN (ON THE FQF 306 DEG RADIAL, D55) AT 17000 FT. I ACKNOWLEDGED THEM (THE CTLR) WITH A REPEAT BACK OF INSTRUCTIONS. THE CAPT THEN BEGAN DSCNT TO FL190, WHICH I SET IN THE ALT PRESELECTOR. I THEN BECAME BUSY LOOKING UP A MULTITUDE OF LNDG SPDS (NORMAL, RESIDUAL ICE, CYCLE ICE). WITHOUT NOTIFYING ME, HE SELECTED 17000 FT IN THE ALT PRESELECTOR. I WAS NEVER AWARE OF THIS UNTIL I HEARD THE CTLR SAY 'ACR X FL190, 190' (WE WERE DSNDING THROUGH 18100 FT) AS I WAS JUST FINISHING LOOKING UP THE LNDG SPDS. I THEN ACKNOWLEDGED FL190 AND WE IMMEDIATELY BEGAN A CLB BACK UP TO FL190. I ASKED THE CAPT WHAT HAPPENED AND HE SAID 'THAT WAS ME, I SET THAT ALT IN THERE.' HE NEVER DID EXPLAIN TO ME LATER THE REASON FOR HIS ACTIONS. THIS PARTICULAR CAPT WAS THE TYPE THAT WOULD ACCOMPLISH A LOT OF THE FO'S TASKS WITHOUT NOTIFYING HIM, THEN FORGET HIS OWN! THIS WAS A GOOD EXAMPLE TO ME OF HOW THINGS CAN GET OUT OF HAND WHEN THERE IS A LACK OF GOOD CREW COORD AND RESOURCE MGMNT.
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.