37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 492664 |
Time | |
Date | 200011 |
Day | Mon |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | navaid : bld.vortac |
State Reference | NV |
Altitude | msl bound lower : 12000 msl bound upper : 18000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zla.artcc |
Operator | common carrier : air carrier |
Make Model Name | B737-700 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other other vortac |
Flight Phase | descent : intermediate altitude |
Route In Use | arrival star : creso.3 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 165 flight time total : 20000 flight time type : 19000 |
ASRS Report | 492664 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : multi engine pilot : instrument pilot : commercial |
Experience | flight time last 90 days : 115 flight time total : 20000 flight time type : 14000 |
ASRS Report | 492460 |
Events | |
Anomaly | altitude deviation : crossing restriction not met non adherence : clearance non adherence : company policies non adherence : published procedure |
Independent Detector | other controllerb |
Resolutory Action | controller : issued new clearance controller : issued advisory |
Consequence | other |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Level at FL240, I received clearance to descend now to FL230, then cross whigg at 12000 ft. First officer was flying but talking on PA, so I repeated the clearance to him. He entered the descent into the CDU and started down to FL230. Top of descent was very close to correct for making the whigg restr and neither of us noticed he had incorrectly selected creso as the crossing point. That is, of course, until ZLA requested our altitude over whigg and we realized what had happened. This was caused by a simple inattn to detail/human error. The clearance was received and passed on accurately, raw data monitoring took place and the descent was initiated on schedule. We simply missed the fact that the end of descent point was incorrect. Supplemental information from acn 492460: I made several errors that caused me to lose situational awareness and led to the event. I allowed myself to be distraction by our conversation. I did not doublechk my descent profile against the DME. And, I did not doublechk the CDU for the correct crossing restr.
Original NASA ASRS Text
Title: XING RESTR NOT MET ON ARR TO LAS, NV.
Narrative: LEVEL AT FL240, I RECEIVED CLRNC TO DSND NOW TO FL230, THEN CROSS WHIGG AT 12000 FT. FO WAS FLYING BUT TALKING ON PA, SO I REPEATED THE CLRNC TO HIM. HE ENTERED THE DSCNT INTO THE CDU AND STARTED DOWN TO FL230. TOP OF DSCNT WAS VERY CLOSE TO CORRECT FOR MAKING THE WHIGG RESTR AND NEITHER OF US NOTICED HE HAD INCORRECTLY SELECTED CRESO AS THE XING POINT. THAT IS, OF COURSE, UNTIL ZLA REQUESTED OUR ALT OVER WHIGG AND WE REALIZED WHAT HAD HAPPENED. THIS WAS CAUSED BY A SIMPLE INATTN TO DETAIL/HUMAN ERROR. THE CLRNC WAS RECEIVED AND PASSED ON ACCURATELY, RAW DATA MONITORING TOOK PLACE AND THE DSCNT WAS INITIATED ON SCHEDULE. WE SIMPLY MISSED THE FACT THAT THE END OF DSCNT POINT WAS INCORRECT. SUPPLEMENTAL INFO FROM ACN 492460: I MADE SEVERAL ERRORS THAT CAUSED ME TO LOSE SITUATIONAL AWARENESS AND LED TO THE EVENT. I ALLOWED MYSELF TO BE DISTR BY OUR CONVERSATION. I DID NOT DOUBLECHK MY DSCNT PROFILE AGAINST THE DME. AND, I DID NOT DOUBLECHK THE CDU FOR THE CORRECT XING RESTR.
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.