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|
Attributes | |
ACN | 579708 |
Time | |
Date | 200304 |
Day | Fri |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : tol.airport |
State Reference | OH |
Altitude | msl single value : 1100 |
Environment | |
Flight Conditions | Marginal |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tower : tol.tower |
Operator | common carrier : air carrier |
Make Model Name | Regional Jet CL65, Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Navigation In Use | ils localizer only : 25 |
Flight Phase | descent : approach |
Route In Use | approach : instrument non precision |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Experience | flight time last 90 days : 60 flight time total : 15700 flight time type : 900 |
ASRS Report | 579708 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Events | |
Anomaly | non adherence : clearance non adherence : published procedure non adherence : company policies non adherence : far |
Independent Detector | atc equipment : msaw atc equipment other atc equipment : radar other controllera |
Resolutory Action | controller : issued alert |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
Briefed and set up for the ILS runway 25 with GS out. Approximately 180 NM from tol. ATIS reported marginal VMC conditions at time of FMS setup. Some 10-12 mins later, while vectored to and cleared for the approach, I called for the MDA to be set into the altitude selector. Upon crossing FAF, I initiated a descent to MOA. After breaking out of cloud cover at approximately 1500 ft MSL with the runway in sight approximately 2 mi ahead, tower issued a 'low altitude alert' and advised that lowest altitude in my area was 1240 ft. Initiated a slight climb and then continued approach with VASI guidance. After landing and quite puzzled by the event, I looked again at the chart. That's when I found my error. Even though we had briefed and set up into the FMS the correct approach, including the published step down after the FAF, I inadvertently called for and received from the PNF the lower MDA of this approach. The saving grace of this event was descending into VMC conditions prior to descending below the step down altitude and WX conditions that allowed for runway visual contact. No GPWS alerts were received. I'm very disappointed in myself that after nearly 25 yrs of flight experience, I made this mistake. I'm also bewildered as to why the other pilot didn't catch the error. I am, however, encouraged to know that the checks and balances worked, ie, after crew failed to level at MDA -- controller notified and GPWS system was onboard to back up all. Lesson learned: you're never too old and experienced to make a mistake. I must strive to be more vigilant and continue to practice the good deeds of CRM.
Original NASA ASRS Text
Title: CL65 CREW DSNDED TO AN INAPPROPRIATE ALT ON THE ILS RWY 25 APCH, (GS OUT) AT TOL.
Narrative: BRIEFED AND SET UP FOR THE ILS RWY 25 WITH GS OUT. APPROX 180 NM FROM TOL. ATIS RPTED MARGINAL VMC CONDITIONS AT TIME OF FMS SETUP. SOME 10-12 MINS LATER, WHILE VECTORED TO AND CLRED FOR THE APCH, I CALLED FOR THE MDA TO BE SET INTO THE ALT SELECTOR. UPON XING FAF, I INITIATED A DSCNT TO MOA. AFTER BREAKING OUT OF CLOUD COVER AT APPROX 1500 FT MSL WITH THE RWY IN SIGHT APPROX 2 MI AHEAD, TWR ISSUED A 'LOW ALT ALERT' AND ADVISED THAT LOWEST ALT IN MY AREA WAS 1240 FT. INITIATED A SLIGHT CLB AND THEN CONTINUED APCH WITH VASI GUIDANCE. AFTER LNDG AND QUITE PUZZLED BY THE EVENT, I LOOKED AGAIN AT THE CHART. THAT'S WHEN I FOUND MY ERROR. EVEN THOUGH WE HAD BRIEFED AND SET UP INTO THE FMS THE CORRECT APCH, INCLUDING THE PUBLISHED STEP DOWN AFTER THE FAF, I INADVERTENTLY CALLED FOR AND RECEIVED FROM THE PNF THE LOWER MDA OF THIS APCH. THE SAVING GRACE OF THIS EVENT WAS DSNDING INTO VMC CONDITIONS PRIOR TO DSNDING BELOW THE STEP DOWN ALT AND WX CONDITIONS THAT ALLOWED FOR RWY VISUAL CONTACT. NO GPWS ALERTS WERE RECEIVED. I'M VERY DISAPPOINTED IN MYSELF THAT AFTER NEARLY 25 YRS OF FLT EXPERIENCE, I MADE THIS MISTAKE. I'M ALSO BEWILDERED AS TO WHY THE OTHER PLT DIDN'T CATCH THE ERROR. I AM, HOWEVER, ENCOURAGED TO KNOW THAT THE CHKS AND BALS WORKED, IE, AFTER CREW FAILED TO LEVEL AT MDA -- CTLR NOTIFIED AND GPWS SYS WAS ONBOARD TO BACK UP ALL. LESSON LEARNED: YOU'RE NEVER TOO OLD AND EXPERIENCED TO MAKE A MISTAKE. I MUST STRIVE TO BE MORE VIGILANT AND CONTINUE TO PRACTICE THE GOOD DEEDS OF CRM.
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.