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|
Attributes | |
ACN | 519481 |
Time | |
Date | 200107 |
Day | Mon |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | navaid : sln.vortac |
State Reference | KS |
Altitude | msl bound lower : 33000 msl bound upper : 34000 |
Environment | |
Light | Night |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B777 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Flight Phase | cruise : enroute altitude change |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time type : 415 |
ASRS Report | 519481 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Events | |
Anomaly | altitude deviation : overshoot non adherence : clearance non adherence : company policies non adherence : published procedure |
Independent Detector | other controllera |
Resolutory Action | flight crew : returned to assigned altitude |
Consequence | other |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
We experienced an altitude deviation/loss of separation with ZKC at FL340 after departing den. We had been delayed several hours and reassigned, so fatigue may have been a factor. Apparently, after a long hold down at FL270, we were cleared to FL330. We apparently read this back correctly, but missed the MCP to FL340. Our SOP in this case failed to discover the error. The controller asked us to verify our altitude as FL330. We were then level at FL340 with FL340 in the MCP. ATC directed an immediate descent to FL330. We complied, but a loss of separation was recorded. We had no TCASII indications. It is important to note that my innate awareness of improper directional flight level has been lessened with the advent of rvsm and flts east or west at all altitudes with 1000 ft separation. This just increases the necessity of strict cockpit discipline and adherence to SOP. In this incident, I was the PNF and I missed the MCP, the first officer failed to catch my error.
Original NASA ASRS Text
Title: A B777 CREW OVERSHOT ASSIGNED LEVELOFF ALT.
Narrative: WE EXPERIENCED AN ALT DEV/LOSS OF SEPARATION WITH ZKC AT FL340 AFTER DEPARTING DEN. WE HAD BEEN DELAYED SEVERAL HRS AND REASSIGNED, SO FATIGUE MAY HAVE BEEN A FACTOR. APPARENTLY, AFTER A LONG HOLD DOWN AT FL270, WE WERE CLRED TO FL330. WE APPARENTLY READ THIS BACK CORRECTLY, BUT MISSED THE MCP TO FL340. OUR SOP IN THIS CASE FAILED TO DISCOVER THE ERROR. THE CTLR ASKED US TO VERIFY OUR ALT AS FL330. WE WERE THEN LEVEL AT FL340 WITH FL340 IN THE MCP. ATC DIRECTED AN IMMEDIATE DSCNT TO FL330. WE COMPLIED, BUT A LOSS OF SEPARATION WAS RECORDED. WE HAD NO TCASII INDICATIONS. IT IS IMPORTANT TO NOTE THAT MY INNATE AWARENESS OF IMPROPER DIRECTIONAL FLT LEVEL HAS BEEN LESSENED WITH THE ADVENT OF RVSM AND FLTS E OR W AT ALL ALTS WITH 1000 FT SEPARATION. THIS JUST INCREASES THE NECESSITY OF STRICT COCKPIT DISCIPLINE AND ADHERENCE TO SOP. IN THIS INCIDENT, I WAS THE PNF AND I MISSED THE MCP, THE FO FAILED TO CATCH MY ERROR.
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.