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|
Attributes | |
ACN | 539352 |
Time | |
Date | 200202 |
Day | Tue |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : sea.airport |
State Reference | WA |
Altitude | msl single value : 4000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : s46.tracon |
Operator | common carrier : air carrier |
Make Model Name | B737 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Route In Use | departure sid : mountain 5 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain instruction : instructor other personnel other oversight : pic |
Qualification | pilot : atp pilot : commercial pilot : flight engineer pilot : instrument pilot : multi engine |
Experience | flight time last 90 days : 50 flight time total : 7000 flight time type : 1700 |
ASRS Report | 539352 |
Person 2 | |
Affiliation | government : faa |
Function | flight crew : first officer instruction : trainee other personnel other |
Events | |
Anomaly | non adherence : clearance non adherence : published procedure other spatial deviation |
Independent Detector | other controllerb |
Consequence | faa : reviewed incident with flight crew |
Supplementary | |
Problem Areas | Company Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
This was a missed turn on a departure procedure. I was safety pilot, in right seat, with an FAA certification test pilot in left seat. First takeoff of the day from sea en route to test airfield. Cleared, via pre departure clearance, for mountain departure. Inadvertently read and executed sea departure. Missed right turn to 070 degrees. Departure control called, asking which departure procedure we were cleared to fly, and gave us a turn to 130 degrees. I confirmed mountain departure procedure, confessed my error, and we turned as directed. No apparent traffic conflict. Many factors led to this mistake, mostly concerning new sits, distrs, and interruptions. 1) FAA pilot in left seat was not qualified on aircraft. I was taking great pains to explain everything as well as monitor his flying performance. Note that I briefed him, incorrectly, to fly runway heading after takeoff. He also didn't catch my error. 2) this was my first time as safety pilot. I felt competent, but challenged, by the task. 3) nonstandard fueling, deicing, flight planning procedures prior to flight very intensive. 4) numerous interruptions during preflight phase due deicing, test procedures, etc. 5) at pushback, ground crew noticed a leak, which we stopped to check. The mountain and seattle departure procedures are on opposing pages in my manual. I think I must have opened to the correct page, then read the wrong side. Perhaps there was a distraction during this process, but I can't say for sure. For the future, whenever we have a non qualified (or even non company) pilot in either seat, I will suggest we appoint another qualified company pilot to monitor all cockpit set-ups, briefings, etc -- just to try to provide the normal 'dual error trap' we usually have during regular line operations.
Original NASA ASRS Text
Title: A DEP TRACK DEV ON A PUBLISHED DEP. A NON ACFT QUALIFIED PLT FLYING WITH THE SAFETY PLT INSTRUCTOR ON HIS FIRST FLT IN THAT CAPACITY.
Narrative: THIS WAS A MISSED TURN ON A DEP PROC. I WAS SAFETY PLT, IN R SEAT, WITH AN FAA CERTIFICATION TEST PLT IN L SEAT. FIRST TKOF OF THE DAY FROM SEA ENRTE TO TEST AIRFIELD. CLRED, VIA PDC, FOR MOUNTAIN DEP. INADVERTENTLY READ AND EXECUTED SEA DEP. MISSED R TURN TO 070 DEGS. DEP CTL CALLED, ASKING WHICH DEP PROC WE WERE CLRED TO FLY, AND GAVE US A TURN TO 130 DEGS. I CONFIRMED MOUNTAIN DEP PROC, CONFESSED MY ERROR, AND WE TURNED AS DIRECTED. NO APPARENT TFC CONFLICT. MANY FACTORS LED TO THIS MISTAKE, MOSTLY CONCERNING NEW SITS, DISTRS, AND INTERRUPTIONS. 1) FAA PLT IN L SEAT WAS NOT QUALIFIED ON ACFT. I WAS TAKING GREAT PAINS TO EXPLAIN EVERYTHING AS WELL AS MONITOR HIS FLYING PERFORMANCE. NOTE THAT I BRIEFED HIM, INCORRECTLY, TO FLY RWY HDG AFTER TKOF. HE ALSO DIDN'T CATCH MY ERROR. 2) THIS WAS MY FIRST TIME AS SAFETY PLT. I FELT COMPETENT, BUT CHALLENGED, BY THE TASK. 3) NONSTANDARD FUELING, DEICING, FLT PLANNING PROCS PRIOR TO FLT VERY INTENSIVE. 4) NUMEROUS INTERRUPTIONS DURING PREFLT PHASE DUE DEICING, TEST PROCS, ETC. 5) AT PUSHBACK, GND CREW NOTICED A LEAK, WHICH WE STOPPED TO CHK. THE MOUNTAIN AND SEATTLE DEP PROCS ARE ON OPPOSING PAGES IN MY MANUAL. I THINK I MUST HAVE OPENED TO THE CORRECT PAGE, THEN READ THE WRONG SIDE. PERHAPS THERE WAS A DISTR DURING THIS PROCESS, BUT I CAN'T SAY FOR SURE. FOR THE FUTURE, WHENEVER WE HAVE A NON QUALIFIED (OR EVEN NON COMPANY) PLT IN EITHER SEAT, I WILL SUGGEST WE APPOINT ANOTHER QUALIFIED COMPANY PLT TO MONITOR ALL COCKPIT SET-UPS, BRIEFINGS, ETC -- JUST TO TRY TO PROVIDE THE NORMAL 'DUAL ERROR TRAP' WE USUALLY HAVE DURING REGULAR LINE OPS.
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.