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ZME controller observes E145 descend through assigned altitude of FL330 and conflict with en route DC9 at FL310.
| Attributes | |
| ACN | 506543 |
| Time | |
| Date | 200104 |
| Day | Wed |
| Local Time Of Day | 0601 To 1200 |
| Place | |
| Locale Reference | navaid : cgi.vor |
| State Reference | MO |
| Altitude | msl bound lower : 31500 msl bound upper : 33000 |
| Environment | |
| Flight Conditions | VMC |
| Light | Daylight |
| Aircraft 1 | |
| Controlling Facilities | artcc : zme.artcc |
| Operator | common carrier : air carrier |
| Make Model Name | EMB ERJ 145 ER&LR |
| Operating Under FAR Part | Part 121 |
| Navigation In Use | other |
| Flight Phase | climbout : intermediate altitude |
| Route In Use | arrival star : qba11 |
| Flight Plan | IFR |
| Aircraft 2 | |
| Controlling Facilities | artcc : zme.artcc |
| Operator | common carrier : air carrier |
| Make Model Name | DC-9 Undifferentiated or Other Model |
| Operating Under FAR Part | Part 121 |
| Flight Phase | cruise : level |
| Route In Use | enroute : on vectors |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | government : faa |
| Function | controller : radar |
| Qualification | controller : radar |
| Experience | controller limited radar : 8 controller non radar : 10 controller radar : 8 controller time certified in position1 : 8 |
| ASRS Report | 506543 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | flight crew : first officer |
| Qualification | pilot : atp |
| Experience | flight time last 90 days : 150 flight time total : 4000 flight time type : 700 |
| Events | |
| Anomaly | altitude deviation : overshoot conflict : airborne less severe non adherence : clearance |
| Independent Detector | atc equipment : conflict alert atc equipment other atc equipment : radar other controllera |
| Resolutory Action | controller : issued alert controller : issued new clearance |
| Consequence | faa : investigated faa : reviewed incident with flight crew |
| Miss Distance | horizontal : 4500 vertical : 600 |
| Supplementary | |
| Problem Areas | Flight Crew Human Performance |
| Primary Problem | Flight Crew Human Performance |
| Air Traffic Incident | Pilot Deviation |
Narrative:
Air carrier X was issued descent to FL330 from FL350. Air carrier Y was level FL310. Air carrier X acknowledged descent to FL330, but descended lower. Around FL320, I asked air carrier X to verify level FL330. He said 'I thought you issued FL300' and I said 'negative.' to try and achieve separation, I issued FL280 to air carrier X and called his traffic. I continued the descent because air carrier X was rapidly descending and I felt it was more dangerous to climb back to FL330. Supplemental information from acn 506443: the controller said we had 'crossing traffic at 2 O'clock position, descend to FL330, expect FL280 after crossing traffic.' I thought he said FL300. I put FL300 in the altitude controller. ZME called and said, 'air carrier X, are you leveling FL330?' 'no sir, I thought you said FL300.' controller said 'no, I said FL330. Descend to FL280 immediately.' I said, 'roger FL280 immediately.' I saw the 2 O'clock position traffic, a DC9 or MD80. I said, 'I have the traffic in sight.' I told ZME we would level off and climb back to FL330. Traffic crossed under about 1500 ft and also he said they had us in sight. No TCASII factor or evasive action. After passing, controller said 'descend to FL280, contact ZME.' factors: lack of sleep, fatigue, bad communications, judgement. Supplemental information from acn 506440: the first officer put in the wrong altitude and I did not catch the error. Became aware of the error, when center asked if we were level at FL330.
Original NASA ASRS Text
Title: ZME CTLR OBSERVES E145 DSND THROUGH ASSIGNED ALT OF FL330 AND CONFLICT WITH ENRTE DC9 AT FL310.
Narrative: ACR X WAS ISSUED DSCNT TO FL330 FROM FL350. ACR Y WAS LEVEL FL310. ACR X ACKNOWLEDGED DSCNT TO FL330, BUT DSNDED LOWER. AROUND FL320, I ASKED ACR X TO VERIFY LEVEL FL330. HE SAID 'I THOUGHT YOU ISSUED FL300' AND I SAID 'NEGATIVE.' TO TRY AND ACHIEVE SEPARATION, I ISSUED FL280 TO ACR X AND CALLED HIS TFC. I CONTINUED THE DSCNT BECAUSE ACR X WAS RAPIDLY DSNDING AND I FELT IT WAS MORE DANGEROUS TO CLB BACK TO FL330. SUPPLEMENTAL INFO FROM ACN 506443: THE CTLR SAID WE HAD 'XING TFC AT 2 O'CLOCK POS, DSND TO FL330, EXPECT FL280 AFTER XING TFC.' I THOUGHT HE SAID FL300. I PUT FL300 IN THE ALT CONTROLLER. ZME CALLED AND SAID, 'ACR X, ARE YOU LEVELING FL330?' 'NO SIR, I THOUGHT YOU SAID FL300.' CTLR SAID 'NO, I SAID FL330. DSND TO FL280 IMMEDIATELY.' I SAID, 'ROGER FL280 IMMEDIATELY.' I SAW THE 2 O'CLOCK POS TFC, A DC9 OR MD80. I SAID, 'I HAVE THE TFC IN SIGHT.' I TOLD ZME WE WOULD LEVEL OFF AND CLB BACK TO FL330. TFC CROSSED UNDER ABOUT 1500 FT AND ALSO HE SAID THEY HAD US IN SIGHT. NO TCASII FACTOR OR EVASIVE ACTION. AFTER PASSING, CTLR SAID 'DSND TO FL280, CONTACT ZME.' FACTORS: LACK OF SLEEP, FATIGUE, BAD COMS, JUDGEMENT. SUPPLEMENTAL INFO FROM ACN 506440: THE FO PUT IN THE WRONG ALT AND I DID NOT CATCH THE ERROR. BECAME AWARE OF THE ERROR, WHEN CTR ASKED IF WE WERE LEVEL AT FL330.
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.