37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 535542 |
Time | |
Date | 200201 |
Day | Sat |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : las.airport |
State Reference | NV |
Altitude | msl single value : 34000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zla.artcc |
Operator | common carrier : air carrier |
Make Model Name | B737-300 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | cruise : level |
Route In Use | departure sid : wyldd.1 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 260 flight time total : 18000 flight time type : 13200 |
ASRS Report | 535542 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Experience | flight time last 90 days : 240 flight time total : 8000 flight time type : 2500 |
ASRS Report | 535994 |
Events | |
Anomaly | non adherence : published procedure non adherence : clearance non adherence : company policies other spatial deviation |
Independent Detector | other controllera other flight crewa |
Resolutory Action | controller : issued advisory controller : issued new clearance flight crew : became reoriented |
Consequence | faa : reviewed incident with flight crew other |
Supplementary | |
Problem Areas | Flight Crew Human Performance Company Aircraft |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Flight from las lbb wyldd 1 departure gup transition. As flight departed las via LNAV we were returned almost immediately off of the SID to a point further out on the SID. After that point the plane turned about 30 degrees right. I looked on the box and saw the route it was flying. It looked ok to me. We hadn't gone but a few mi when ATC turned us about 30 degrees left with the comment 'there seems to be some confusion about your routing, give us a call when you get to your destination.' as I pursue the release harder I saw the problem: LASLBB01 was programmed into the CDU. The release was 'wyldd 1 gup transition but also stated instead of LASLBB02 it stated 'see filed route,' I did check that box earlier and saw wyldd 1 with gup further down the road thinking everything was correct. We should have noticed 'see filed route' and checked every leg on the next page. I called company ATC specialist when we arrived in lbb. It turns out that there have been many incursions of the same type. I think one suggestion would be would make 'see filed route' in capital letters or state 'nonstd routing.' supplemental information from acn 535994: we had a quick turn in las, running behind schedule I went ot get something to eat and when I got back I had very little time to set up the cockpit and FMS. On the route plate I selected las.LBB01, and checked it with the field release routing. It showed the wyldd one departure with what looked like the gup transition. Normally I go to the legs page for verification, but did not do this for some reason. On the release it had 'see filed route' this should have rang a bell in my head, but obviously did not. I'm not sure the captain verified the routing. The as filed routing was the gup transition, but the box had the drake transition. As we crossed wyldd intersections I sensed we were going the wrong direction. I told the captain what I thought had happened. About that time ATC gave us a vector back to the northeast. I dropped the ball back at the gate when I didn't select the correct transition. I think it was a little misleading when I saw gup behind the SID on the route plate. But the bottom line is that I should have gone to the legs page and verified every fix. This could have been avoided if I had checked the legs page and/or checked the correct transition in the departure/arrival page.
Original NASA ASRS Text
Title: A B737-300 FLC DEPARTS FROM THEIR ASSIGNED CLRNC WHEN NOT PROGRAMMING THEIR FMC TO THE ASSIGNED TRANSITION OUT OF LAS, NV.
Narrative: FLT FROM LAS LBB WYLDD 1 DEP GUP TRANSITION. AS FLT DEPARTED LAS VIA LNAV WE WERE RETURNED ALMOST IMMEDIATELY OFF OF THE SID TO A POINT FURTHER OUT ON THE SID. AFTER THAT POINT THE PLANE TURNED ABOUT 30 DEGS RIGHT. I LOOKED ON THE BOX AND SAW THE RTE IT WAS FLYING. IT LOOKED OK TO ME. WE HADN'T GONE BUT A FEW MI WHEN ATC TURNED US ABOUT 30 DEGS LEFT WITH THE COMMENT 'THERE SEEMS TO BE SOME CONFUSION ABOUT YOUR RTING, GIVE US A CALL WHEN YOU GET TO YOUR DESTINATION.' AS I PURSUE THE RELEASE HARDER I SAW THE PROB: LASLBB01 WAS PROGRAMMED INTO THE CDU. THE RELEASE WAS 'WYLDD 1 GUP TRANSITION BUT ALSO STATED INSTEAD OF LASLBB02 IT STATED 'SEE FILED RTE,' I DID CHECK THAT BOX EARLIER AND SAW WYLDD 1 WITH GUP FURTHER DOWN THE ROAD THINKING EVERYTHING WAS CORRECT. WE SHOULD HAVE NOTICED 'SEE FILED RTE' AND CHECKED EVERY LEG ON THE NEXT PAGE. I CALLED COMPANY ATC SPECIALIST WHEN WE ARRIVED IN LBB. IT TURNS OUT THAT THERE HAVE BEEN MANY INCURSIONS OF THE SAME TYPE. I THINK ONE SUGGESTION WOULD BE WOULD MAKE 'SEE FILED RTE' IN CAPITAL LETTERS OR STATE 'NONSTD ROUTING.' SUPPLEMENTAL INFO FROM ACN 535994: WE HAD A QUICK TURN IN LAS, RUNNING BEHIND SCHEDULE I WENT OT GET SOMETHING TO EAT AND WHEN I GOT BACK I HAD VERY LITTLE TIME TO SET UP THE COCKPIT AND FMS. ON THE RTE PLATE I SELECTED LAS.LBB01, AND CHKED IT WITH THE FIELD RELEASE ROUTING. IT SHOWED THE WYLDD ONE DEP WITH WHAT LOOKED LIKE THE GUP TRANSITION. NORMALLY I GO TO THE LEGS PAGE FOR VERIFICATION, BUT DID NOT DO THIS FOR SOME REASON. ON THE RELEASE IT HAD 'SEE FILED RTE' THIS SHOULD HAVE RANG A BELL IN MY HEAD, BUT OBVIOUSLY DID NOT. I'M NOT SURE THE CAPT VERIFIED THE ROUTING. THE AS FILED ROUTING WAS THE GUP TRANSITION, BUT THE BOX HAD THE DRAKE TRANSITION. AS WE CROSSED WYLDD INTERSECTIONS I SENSED WE WERE GOING THE WRONG DIRECTION. I TOLD THE CAPT WHAT I THOUGHT HAD HAPPENED. ABOUT THAT TIME ATC GAVE US A VECTOR BACK TO THE NORTHEAST. I DROPPED THE BALL BACK AT THE GATE WHEN I DIDN'T SELECT THE CORRECT TRANSITION. I THINK IT WAS A LITTLE MISLEADING WHEN I SAW GUP BEHIND THE SID ON THE ROUTE PLATE. BUT THE BOTTOM LINE IS THAT I SHOULD HAVE GONE TO THE LEGS PAGE AND VERIFIED EVERY FIX. THIS COULD HAVE BEEN AVOIDED IF I HAD CHECKED THE LEGS PAGE AND/OR CHECKED THE CORRECT TRANSITION IN THE DEP/ARR PAGE.
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.