37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 478563 |
Time | |
Date | 200007 |
Day | Sat |
Local Time Of Day | 1201 To 1800 |
Place | |
State Reference | DE |
Altitude | msl single value : 14000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zdc.artcc tower : rdu.tower |
Operator | common carrier : air carrier |
Make Model Name | B737-300 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | descent : intermediate altitude |
Route In Use | enroute : on vectors |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Experience | flight time last 90 days : 122 flight time total : 7678 flight time type : 540 |
ASRS Report | 478563 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Events | |
Anomaly | non adherence : published procedure non adherence : far |
Independent Detector | aircraft equipment : altitude alert other flight crewa |
Resolutory Action | flight crew : returned to original clearance |
Consequence | other other |
Supplementary | |
Problem Areas | Flight Crew Human Performance Aircraft |
Primary Problem | Flight Crew Human Performance |
Narrative:
We were cleared to descend to 14000 ft. Just prior to leveloff, ATC said to return to normal speed (320 KIAS) from the 250 KIAS restr. Instead of continuing to descend, the aircraft started to climb. As the PNF, I was busy doing other duties and didn't notice the climb, but saw the altitude flashing light. By the time we were approximately 14300 ft. I made a comment and after no action by the captain, I disconnected the autoplt and manually descended to 14000 ft. The captain assumed control as the PF and re-engaged the #1 autoplt. It once again started to climb. Both altimeters were verified to be set correctly. The autoplt was once again disengaged. The next attempt was successful. Whatever the mechanical/electrical problem was, the problem was a failure to monitor the situation by both pilots and to take action before the altitude deviation exceeded allowable limits. This was the last leg of a 2 day trip, returning to base, fatigue and complacency are at a high level.
Original NASA ASRS Text
Title: A B737-300 IN DSCNT AT 14000 FT THE AUTOPLT BEGAN A CLB TO 14300 FT AND WAS SWITCHED OFF, REENGAGED AND BEGAN CLB AGAIN. SWITCHED OFF AFTER ALTDEV.
Narrative: WE WERE CLRED TO DSND TO 14000 FT. JUST PRIOR TO LEVELOFF, ATC SAID TO RETURN TO NORMAL SPD (320 KIAS) FROM THE 250 KIAS RESTR. INSTEAD OF CONTINUING TO DSND, THE ACFT STARTED TO CLB. AS THE PNF, I WAS BUSY DOING OTHER DUTIES AND DIDN'T NOTICE THE CLB, BUT SAW THE ALT FLASHING LIGHT. BY THE TIME WE WERE APPROX 14300 FT. I MADE A COMMENT AND AFTER NO ACTION BY THE CAPT, I DISCONNECTED THE AUTOPLT AND MANUALLY DSNDED TO 14000 FT. THE CAPT ASSUMED CTL AS THE PF AND RE-ENGAGED THE #1 AUTOPLT. IT ONCE AGAIN STARTED TO CLB. BOTH ALTIMETERS WERE VERIFIED TO BE SET CORRECTLY. THE AUTOPLT WAS ONCE AGAIN DISENGAGED. THE NEXT ATTEMPT WAS SUCCESSFUL. WHATEVER THE MECHANICAL/ELECTRICAL PROB WAS, THE PROB WAS A FAILURE TO MONITOR THE SIT BY BOTH PLTS AND TO TAKE ACTION BEFORE THE ALTDEV EXCEEDED ALLOWABLE LIMITS. THIS WAS THE LAST LEG OF A 2 DAY TRIP, RETURNING TO BASE, FATIGUE AND COMPLACENCY ARE AT A HIGH LEVEL.
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.