37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 581485 |
Time | |
Date | 200305 |
Day | Mon |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : sea.airport |
State Reference | WA |
Altitude | msl bound lower : 1000 msl bound upper : 2000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : s46.tracon |
Operator | common carrier : air carrier |
Make Model Name | B737-700 |
Operating Under FAR Part | Part 121 |
Navigation In Use | other |
Flight Phase | climbout : intermediate altitude |
Route In Use | departure sid : mountain |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Experience | flight time last 90 days : 150 flight time total : 9500 flight time type : 2800 |
ASRS Report | 581485 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Experience | flight time last 90 days : 200 flight time total : 17000 flight time type : 8000 |
ASRS Report | 581276 |
Events | |
Anomaly | non adherence : clearance non adherence : published procedure other spatial deviation |
Independent Detector | other controllera other flight crewa |
Resolutory Action | controller : issued new clearance controller : issued advisory flight crew : became reoriented |
Consequence | faa : reviewed incident with flight crew |
Supplementary | |
Problem Areas | Flight Crew Human Performance Aircraft Airspace Structure |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | Pilot Deviation |
Narrative:
At the gate, I obtained the clearance (mountain 5) and set up the FMC expecting a runway 16L takeoff. We pushed on time in VMC conditions and ground cleared us to runway 16R where the tower cleared us for takeoff. The FMC position was updated and our takeoff uneventful. At approximately 1000 ft, I selected 'heading' and cleaned up on schedule. At what I believed to be 5 DME and at approximately 2000 ft, I selected LNAV, the 'B' autoplt, and soon the aircraft began a left turn. The captain quickly caught my error and immediately deselected LNAV and began to roll back to the correct heading when the controller called us on the radio. The aircraft had turned to a heading of approximately 130 degrees (approximately 30 degrees off course) when captain caught my mistake. Departure gave us a stern comment and a new heading. I am not sure as to how I misinterped my position from the field as I had the VOR frequency selected in the #2 navigation head as a back up. I think my screw-up was in not verbalizing that I was on the mountain 5 departure instead of the bluit as we usually receive. Also, I don't xchk what the FMC was doing (which was what I asked it to do) with the DME that I had as a back up. I apparently became complacent because I knew that the FMC does a great job and I didn't xchk what I asked it to do. Fortunately, the captain quickly caught my error although, not before I had blundered into a possibly serious situation. Supplemental information from acn 581276: I believe our situational awareness would have been much higher had we selected the legs page on the CDU immediately after LNAV selection. Ideally we would have seen bluit as the first fix and realized the aircraft was not correcting course, but turning to the first fix. If so, we would have disengaged LNAV before any significant course deviation took place. In retrospect, I was way too slow in reacting when I felt something was amiss. I had let my guard down. I was paired with a very experienced, very competent first officer, the WX was nice, and we had just finished cleaning up the aircraft after takeoff. I should have immediately asked the first officer where the aircraft was turning, simultaneously disengaged the autoplt, and hand flown the SID until my situational awareness improved.
Original NASA ASRS Text
Title: B737-700 FLT CREW DEVIATES FROM ASSIGNED SID AT SEA.
Narrative: AT THE GATE, I OBTAINED THE CLRNC (MOUNTAIN 5) AND SET UP THE FMC EXPECTING A RWY 16L TKOF. WE PUSHED ON TIME IN VMC CONDITIONS AND GND CLRED US TO RWY 16R WHERE THE TWR CLRED US FOR TKOF. THE FMC POS WAS UPDATED AND OUR TKOF UNEVENTFUL. AT APPROX 1000 FT, I SELECTED 'HEADING' AND CLEANED UP ON SCHEDULE. AT WHAT I BELIEVED TO BE 5 DME AND AT APPROX 2000 FT, I SELECTED LNAV, THE 'B' AUTOPLT, AND SOON THE ACFT BEGAN A L TURN. THE CAPT QUICKLY CAUGHT MY ERROR AND IMMEDIATELY DESELECTED LNAV AND BEGAN TO ROLL BACK TO THE CORRECT HEADING WHEN THE CTLR CALLED US ON THE RADIO. THE ACFT HAD TURNED TO A HEADING OF APPROX 130 DEGS (APPROX 30 DEGS OFF COURSE) WHEN CAPT CAUGHT MY MISTAKE. DEP GAVE US A STERN COMMENT AND A NEW HEADING. I AM NOT SURE AS TO HOW I MISINTERPED MY POS FROM THE FIELD AS I HAD THE VOR FREQ SELECTED IN THE #2 NAV HEAD AS A BACK UP. I THINK MY SCREW-UP WAS IN NOT VERBALIZING THAT I WAS ON THE MOUNTAIN 5 DEP INSTEAD OF THE BLUIT AS WE USUALLY RECEIVE. ALSO, I DON'T XCHK WHAT THE FMC WAS DOING (WHICH WAS WHAT I ASKED IT TO DO) WITH THE DME THAT I HAD AS A BACK UP. I APPARENTLY BECAME COMPLACENT BECAUSE I KNEW THAT THE FMC DOES A GREAT JOB AND I DIDN'T XCHK WHAT I ASKED IT TO DO. FORTUNATELY, THE CAPT QUICKLY CAUGHT MY ERROR ALTHOUGH, NOT BEFORE I HAD BLUNDERED INTO A POSSIBLY SERIOUS SIT. SUPPLEMENTAL INFO FROM ACN 581276: I BELIEVE OUR SITUATIONAL AWARENESS WOULD HAVE BEEN MUCH HIGHER HAD WE SELECTED THE LEGS PAGE ON THE CDU IMMEDIATELY AFTER LNAV SELECTION. IDEALLY WE WOULD HAVE SEEN BLUIT AS THE FIRST FIX AND REALIZED THE ACFT WAS NOT CORRECTING COURSE, BUT TURNING TO THE FIRST FIX. IF SO, WE WOULD HAVE DISENGAGED LNAV BEFORE ANY SIGNIFICANT COURSE DEV TOOK PLACE. IN RETROSPECT, I WAS WAY TOO SLOW IN REACTING WHEN I FELT SOMETHING WAS AMISS. I HAD LET MY GUARD DOWN. I WAS PAIRED WITH A VERY EXPERIENCED, VERY COMPETENT FO, THE WX WAS NICE, AND WE HAD JUST FINISHED CLEANING UP THE ACFT AFTER TKOF. I SHOULD HAVE IMMEDIATELY ASKED THE FO WHERE THE ACFT WAS TURNING, SIMULTANEOUSLY DISENGAGED THE AUTOPLT, AND HAND FLOWN THE SID UNTIL MY SITUATIONAL AWARENESS IMPROVED.
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.