37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 430795 |
Time | |
Date | 199903 |
Day | Tue |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : lax.airport |
State Reference | CA |
Altitude | agl single value : 0 |
Environment | |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B747-100 |
Operating Under FAR Part | Part 121 |
Flight Plan | IFR |
Aircraft 2 | |
Flight Phase | ground : parked |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : commercial pilot : instrument pilot : flight engineer pilot : multi engine pilot : atp |
Experience | flight time last 90 days : 189 flight time total : 19000 flight time type : 4000 |
ASRS Report | 430795 |
Person 2 | |
Affiliation | company : air carrier |
Function | observation : company check pilot |
Qualification | pilot : multi engine pilot : instrument pilot : flight engineer pilot : atp pilot : commercial |
Experience | flight time last 90 days : 300 flight time total : 10000 flight time type : 500 |
ASRS Report | 430800 |
Events | |
Anomaly | non adherence : published procedure non adherence : company policies non adherence : far |
Independent Detector | other flight crewa |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Narrative:
On mar/xa/99 I was presented with a notification to PIC for the flight I was responsible for. Unfortunately, the presentation of the notification to PIC took place at a very awkward time, and at a location that was extremely busy with the activities of other ground personnel attempting to fulfill their duties relevant to the departure of the flight. I signed the notification to PIC and took my copy deciding to review it at a later time prior to departure. I then proceeded to the cockpit and placed the notification to PIC on the center radio pedestal, and went about getting a cup of coffee and my flight kit. Somehow, during the time I spent getting the coffee and my flight kit, the notification to PIC ended up in a concealed slot behind my seat. Regrettably, I forgot about its existence until about 2 hours from our destination. It was then that I discovered the dangerous goods loaded on board the aircraft at departure exceeded the legal limits allowed. Contributing factors: corporate goal of on time performance, which brings about a myriad of frenzied activity within the last few mins prior to closing the aircraft door for departure. Time consuming activities of coordinating the elements of an international departure from lax. (Meeting allocated 'off' time slot performance.) so was getting a line check. Common concept of ground personnel that departing in an aircraft from lax to nrt is not much more labor intensive for the operating crew than getting into an automobile and going for a drive. Corrective action: thorough face-to-face briefing between the crew and a ground agent specifically trained in all facets of dangerous goods shipment aboard commercial aircraft whenever a notification to PIC is required. Included in this briefing should be a review of loading limitations of the specific dangerous goods on board.
Original NASA ASRS Text
Title: AN ACR M747-200 FLC DISCOVERED ENRTE THAT THEY HAD DEPARTED WITH TOO MUCH HAZMAT IN THE AFT CARGO COMPARTMENT.
Narrative: ON MAR/XA/99 I WAS PRESENTED WITH A NOTIFICATION TO PIC FOR THE FLT I WAS RESPONSIBLE FOR. UNFORTUNATELY, THE PRESENTATION OF THE NOTIFICATION TO PIC TOOK PLACE AT A VERY AWKWARD TIME, AND AT A LOCATION THAT WAS EXTREMELY BUSY WITH THE ACTIVITIES OF OTHER GND PERSONNEL ATTEMPTING TO FULFILL THEIR DUTIES RELEVANT TO THE DEP OF THE FLT. I SIGNED THE NOTIFICATION TO PIC AND TOOK MY COPY DECIDING TO REVIEW IT AT A LATER TIME PRIOR TO DEP. I THEN PROCEEDED TO THE COCKPIT AND PLACED THE NOTIFICATION TO PIC ON THE CTR RADIO PEDESTAL, AND WENT ABOUT GETTING A CUP OF COFFEE AND MY FLT KIT. SOMEHOW, DURING THE TIME I SPENT GETTING THE COFFEE AND MY FLT KIT, THE NOTIFICATION TO PIC ENDED UP IN A CONCEALED SLOT BEHIND MY SEAT. REGRETTABLY, I FORGOT ABOUT ITS EXISTENCE UNTIL ABOUT 2 HRS FROM OUR DEST. IT WAS THEN THAT I DISCOVERED THE DANGEROUS GOODS LOADED ON BOARD THE ACFT AT DEP EXCEEDED THE LEGAL LIMITS ALLOWED. CONTRIBUTING FACTORS: CORPORATE GOAL OF ON TIME PERFORMANCE, WHICH BRINGS ABOUT A MYRIAD OF FRENZIED ACTIVITY WITHIN THE LAST FEW MINS PRIOR TO CLOSING THE ACFT DOOR FOR DEP. TIME CONSUMING ACTIVITIES OF COORDINATING THE ELEMENTS OF AN INTL DEP FROM LAX. (MEETING ALLOCATED 'OFF' TIME SLOT PERFORMANCE.) SO WAS GETTING A LINE CHK. COMMON CONCEPT OF GND PERSONNEL THAT DEPARTING IN AN ACFT FROM LAX TO NRT IS NOT MUCH MORE LABOR INTENSIVE FOR THE OPERATING CREW THAN GETTING INTO AN AUTOMOBILE AND GOING FOR A DRIVE. CORRECTIVE ACTION: THOROUGH FACE-TO-FACE BRIEFING BTWN THE CREW AND A GND AGENT SPECIFICALLY TRAINED IN ALL FACETS OF DANGEROUS GOODS SHIPMENT ABOARD COMMERCIAL ACFT WHENEVER A NOTIFICATION TO PIC IS REQUIRED. INCLUDED IN THIS BRIEFING SHOULD BE A REVIEW OF LOADING LIMITATIONS OF THE SPECIFIC DANGEROUS GOODS ON BOARD.
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.