37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 484472 |
Time | |
Date | 200009 |
Day | Thu |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | navaid : atl.vortac |
State Reference | GA |
Altitude | msl single value : 21000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : ztl.artcc |
Operator | common carrier : air carrier |
Make Model Name | B727 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Navigation In Use | other vortac |
Flight Phase | descent : holding |
Route In Use | arrival : holding pattern |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : second officer |
Qualification | pilot : multi engine pilot : flight engineer pilot : cfi pilot : atp |
Experience | flight time last 90 days : 180 flight time total : 4800 flight time type : 1200 |
ASRS Report | 484472 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp pilot : flight engineer |
Experience | flight time last 90 days : 160 flight time total : 5500 flight time type : 1500 |
ASRS Report | 484471 |
Events | |
Anomaly | altitude deviation : excursion from assigned altitude non adherence : published procedure non adherence : company policies non adherence : clearance other anomaly other other spatial deviation |
Independent Detector | other controllera other flight crewa other flight crewb |
Resolutory Action | controller : issued alert flight crew : became reoriented flight crew : returned to intended or assigned course none taken : detected after the fact |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
After a parallel entry was made into a published holding pattern (entry was a left turn), the next subsequent turn at the fix was a published right turn. First officer was flying and upon reaching the fix made a left turn instead of a right turn. The flight engineer noticed the mistake after about 30 degree of turn and called it to the crew's attention. The first officer promptly corrected the turn back to the right. ATC queried our turn and was notified of the mistake. The left turn to make a parallel entry was probably a contributing factor to the left turn at the fix. Also, fatigue could have been a factor because our crew rest was shortened the night prior to 8 hours because of delays and our duty day was in excess of 13 hours to be more clear we had a 13+ hour duty day, 8 hours of rest and then the mistake on the next early morning flight. Supplemental information from acn 484471: about 70 degrees into the turn and still descending to FL210, the so queried my turn and I began a standard rate (or better) turn back to the right. The center controller queried our actions and captain told him of our correcting maneuver. No loss of separation that we were aware of. Autoplt was not cooperating to my satisfaction so I disconnected it and completed turn and leveloff manually. Leveloff was rough, +/-200 ft. No interaction with controller after initial query and captain's response. First officer completed nice parallel entry and got a left hand mindset. So vigilance saved the day (hopefully). Fatigue a possible factor due to 13 hour duty day the previous day and minimum 8 hour rest period.
Original NASA ASRS Text
Title: B727 CREW TURNED THE WRONG WAY IN THE HOLD IN ZTL CLASS A.
Narrative: AFTER A PARALLEL ENTRY WAS MADE INTO A PUBLISHED HOLDING PATTERN (ENTRY WAS A L TURN), THE NEXT SUBSEQUENT TURN AT THE FIX WAS A PUBLISHED R TURN. FO WAS FLYING AND UPON REACHING THE FIX MADE A L TURN INSTEAD OF A R TURN. THE FE NOTICED THE MISTAKE AFTER ABOUT 30 DEG OF TURN AND CALLED IT TO THE CREW'S ATTN. THE FO PROMPTLY CORRECTED THE TURN BACK TO THE R. ATC QUERIED OUR TURN AND WAS NOTIFIED OF THE MISTAKE. THE L TURN TO MAKE A PARALLEL ENTRY WAS PROBABLY A CONTRIBUTING FACTOR TO THE L TURN AT THE FIX. ALSO, FATIGUE COULD HAVE BEEN A FACTOR BECAUSE OUR CREW REST WAS SHORTENED THE NIGHT PRIOR TO 8 HRS BECAUSE OF DELAYS AND OUR DUTY DAY WAS IN EXCESS OF 13 HRS TO BE MORE CLR WE HAD A 13+ HR DUTY DAY, 8 HRS OF REST AND THEN THE MISTAKE ON THE NEXT EARLY MORNING FLT. SUPPLEMENTAL INFO FROM ACN 484471: ABOUT 70 DEGS INTO THE TURN AND STILL DSNDING TO FL210, THE SO QUERIED MY TURN AND I BEGAN A STANDARD RATE (OR BETTER) TURN BACK TO THE R. THE CTR CTLR QUERIED OUR ACTIONS AND CAPT TOLD HIM OF OUR CORRECTING MANEUVER. NO LOSS OF SEPARATION THAT WE WERE AWARE OF. AUTOPLT WAS NOT COOPERATING TO MY SATISFACTION SO I DISCONNECTED IT AND COMPLETED TURN AND LEVELOFF MANUALLY. LEVELOFF WAS ROUGH, +/-200 FT. NO INTERACTION WITH CTLR AFTER INITIAL QUERY AND CAPT'S RESPONSE. FO COMPLETED NICE PARALLEL ENTRY AND GOT A L HAND MINDSET. SO VIGILANCE SAVED THE DAY (HOPEFULLY). FATIGUE A POSSIBLE FACTOR DUE TO 13 HR DUTY DAY THE PREVIOUS DAY AND MINIMUM 8 HR REST PERIOD.
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.