37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 594149 |
Time | |
Date | 200309 |
Day | Thu |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | atc facility : zzz.artcc |
State Reference | US |
Altitude | msl bound lower : 12500 msl bound upper : 13000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zzz.artcc |
Operator | Other |
Make Model Name | Rockwell Aero Commander Twin Turboprop Undifferentiated or Other |
Operating Under FAR Part | Part 91 |
Flight Phase | descent : intermediate altitude |
Flight Plan | IFR |
Person 1 | |
Function | flight crew : single pilot |
Qualification | pilot : atp pilot : flight engineer pilot : cfi |
Experience | flight time last 90 days : 90 flight time total : 6500 flight time type : 240 |
ASRS Report | 594149 |
Person 2 | |
Affiliation | government : faa |
Function | controller : radar |
Events | |
Anomaly | altitude deviation : overshoot non adherence : clearance non adherence other other anomaly other |
Independent Detector | other controllera |
Resolutory Action | controller : issued advisory controller : issued new clearance |
Supplementary | |
Problem Areas | ATC Human Performance Flight Crew Human Performance |
Primary Problem | ATC Human Performance |
Narrative:
I was flying on an IFR flight plan from XXX to YYY. Flight conditions were VMC. Level at 14000 ft MSL, I was given the following clearance: '...cross intersection at and maintain 12000 ft....' I read back the clearance and dialed the altitude in the altitude alerter box. Approximately 1 min later, I made the following transmission to center: 'center, (my call sign) is leaving one-four thousand for one-two, twelve thousand.' ZSE responded with 'roger.' as I was passing 12600 ft, ZSE made a call to me stating my cleared altitude was 'one-three thousand,' and he was showing me approaching 'one-two thousand five hundred.' I stopped my descent and said that I was sorry, I had back 'one-two, twelve thousand.' center then responded back that I could continue descent to maintain 'one-two thousand.' I was handed off to approach shortly thereafter. I have always been extra vigilant about altitude assignments and follow appropriate SOP's/protocol religiously. I am not sure where the confusion started, but clearly there was a miscom. My only thought is that if I, in fact, have some sort of culpability in the miscom, that this event will demonstrate a few things: 1) even a high degree of awareness and procedure cannot protect against this sort of situation unless both pilot and controller share the same degree of alertness and prevention at the same time. 2) no matter how experienced, each pilot has a lot to re-learn each flight. Complacency may not be obvious, it can be subtle and not just be in the cockpit.
Original NASA ASRS Text
Title: A LIFEGUARD ATP PLT DSNDS BELOW THE ALT THAT ATC THOUGHT THEY HAD ISSUED, WITH ATC ADVISING PLT OF DEV. ATC THEN RECLRED FLT TO THE SAME ALT AS FIRST CLRED TO 2000 FT ON FREQ WITH ZZZ, US.
Narrative: I WAS FLYING ON AN IFR FLT PLAN FROM XXX TO YYY. FLT CONDITIONS WERE VMC. LEVEL AT 14000 FT MSL, I WAS GIVEN THE FOLLOWING CLRNC: '...CROSS INTXN AT AND MAINTAIN 12000 FT....' I READ BACK THE CLRNC AND DIALED THE ALT IN THE ALT ALERTER BOX. APPROX 1 MIN LATER, I MADE THE FOLLOWING XMISSION TO CTR: 'CTR, (MY CALL SIGN) IS LEAVING ONE-FOUR THOUSAND FOR ONE-TWO, TWELVE THOUSAND.' ZSE RESPONDED WITH 'ROGER.' AS I WAS PASSING 12600 FT, ZSE MADE A CALL TO ME STATING MY CLRED ALT WAS 'ONE-THREE THOUSAND,' AND HE WAS SHOWING ME APCHING 'ONE-TWO THOUSAND FIVE HUNDRED.' I STOPPED MY DSCNT AND SAID THAT I WAS SORRY, I HAD BACK 'ONE-TWO, TWELVE THOUSAND.' CTR THEN RESPONDED BACK THAT I COULD CONTINUE DSCNT TO MAINTAIN 'ONE-TWO THOUSAND.' I WAS HANDED OFF TO APCH SHORTLY THEREAFTER. I HAVE ALWAYS BEEN EXTRA VIGILANT ABOUT ALT ASSIGNMENTS AND FOLLOW APPROPRIATE SOP'S/PROTOCOL RELIGIOUSLY. I AM NOT SURE WHERE THE CONFUSION STARTED, BUT CLRLY THERE WAS A MISCOM. MY ONLY THOUGHT IS THAT IF I, IN FACT, HAVE SOME SORT OF CULPABILITY IN THE MISCOM, THAT THIS EVENT WILL DEMONSTRATE A FEW THINGS: 1) EVEN A HIGH DEG OF AWARENESS AND PROC CANNOT PROTECT AGAINST THIS SORT OF SIT UNLESS BOTH PLT AND CTLR SHARE THE SAME DEG OF ALERTNESS AND PREVENTION AT THE SAME TIME. 2) NO MATTER HOW EXPERIENCED, EACH PLT HAS A LOT TO RE-LEARN EACH FLT. COMPLACENCY MAY NOT BE OBVIOUS, IT CAN BE SUBTLE AND NOT JUST BE IN THE COCKPIT.
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.