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|
Attributes | |
ACN | 571991 |
Time | |
Date | 200301 |
Day | Mon |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | airport : las.airport |
State Reference | NV |
Altitude | msl bound lower : 11000 msl bound upper : 13000 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | tracon : l30.tracon |
Operator | common carrier : air carrier |
Make Model Name | B737-300 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | descent : intermediate altitude |
Route In Use | arrival star : skebr |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Experience | flight time last 90 days : 200 flight time total : 15000 flight time type : 10000 |
ASRS Report | 571991 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Experience | flight time last 90 days : 290 flight time total : 5000 flight time type : 1200 |
ASRS Report | 571992 |
Events | |
Anomaly | non adherence : clearance non adherence : company policies non adherence : far non adherence : published procedure other spatial deviation |
Independent Detector | atc equipment other atc equipment : radar other controllera |
Resolutory Action | controller : issued alert controller : issued new clearance flight crew : returned to intended or assigned course flight crew : overrode automation |
Consequence | faa : reviewed incident with flight crew other |
Supplementary | |
Problem Areas | Flight Crew Human Performance FAA Company Aircraft |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
During descent into las on the skebr RNAV 2 arrival, I changed the altitude in the CDU at misen to FL240 (vice the FL240A, which is never issued) and verified the rteing as far as skebr. I was behind the power curve getting the ATIS, so went off, recorded it, and computed the landing data. Distred now, I failed to return to the CDU and verify the rteing and approach the first officer had selected after skebr. After skebr, the aircraft turned direct shand on the ILS runway 25L. The controller quickly noticed we missed the turn to kepec and issued a heading of 320 degrees. We checked the CDU and saw that all the fixes after skebr on the arrival had been somehow deleted. We re-entered the arrival in the CDU and resumed the arrival direct ipumy. Fortunately, there was no traffic conflict or any problem caused by the deviation. The first officer, who had programmed the arrival, was unable to explain how the fixes were deleted. He recalled setting up the arrival, but said he did not line-select any fixes that would have caused the deletion of the RNAV fixes. I talked to a controller at las TRACON after the flight, and he told me he had seen aircraft proceed erroneously skebr-shand previously. He assured me there was no conflict and that no paperwork would be filed. Lesson learned -- I always verify the arrival rteing and approach, usually prior to descent. From now on, I will not allow any disruptions during this task.
Original NASA ASRS Text
Title: A B737-300 CREW HAD TRACK DEV WHILE FLYING THE SKEBR 2 RNAV APCH INTO LAS.
Narrative: DURING DSCNT INTO LAS ON THE SKEBR RNAV 2 ARR, I CHANGED THE ALT IN THE CDU AT MISEN TO FL240 (VICE THE FL240A, WHICH IS NEVER ISSUED) AND VERIFIED THE RTEING AS FAR AS SKEBR. I WAS BEHIND THE PWR CURVE GETTING THE ATIS, SO WENT OFF, RECORDED IT, AND COMPUTED THE LNDG DATA. DISTRED NOW, I FAILED TO RETURN TO THE CDU AND VERIFY THE RTEING AND APCH THE FO HAD SELECTED AFTER SKEBR. AFTER SKEBR, THE ACFT TURNED DIRECT SHAND ON THE ILS RWY 25L. THE CTLR QUICKLY NOTICED WE MISSED THE TURN TO KEPEC AND ISSUED A HDG OF 320 DEGS. WE CHKED THE CDU AND SAW THAT ALL THE FIXES AFTER SKEBR ON THE ARR HAD BEEN SOMEHOW DELETED. WE RE-ENTERED THE ARR IN THE CDU AND RESUMED THE ARR DIRECT IPUMY. FORTUNATELY, THERE WAS NO TFC CONFLICT OR ANY PROB CAUSED BY THE DEV. THE FO, WHO HAD PROGRAMMED THE ARR, WAS UNABLE TO EXPLAIN HOW THE FIXES WERE DELETED. HE RECALLED SETTING UP THE ARR, BUT SAID HE DID NOT LINE-SELECT ANY FIXES THAT WOULD HAVE CAUSED THE DELETION OF THE RNAV FIXES. I TALKED TO A CTLR AT LAS TRACON AFTER THE FLT, AND HE TOLD ME HE HAD SEEN ACFT PROCEED ERRONEOUSLY SKEBR-SHAND PREVIOUSLY. HE ASSURED ME THERE WAS NO CONFLICT AND THAT NO PAPERWORK WOULD BE FILED. LESSON LEARNED -- I ALWAYS VERIFY THE ARR RTEING AND APCH, USUALLY PRIOR TO DSCNT. FROM NOW ON, I WILL NOT ALLOW ANY DISRUPTIONS DURING THIS TASK.
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.