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SD3-60 flight crew enters runway at ont without clearance and causes go around.
| Attributes | |
| ACN | 595351 |
| Time | |
| Date | 200309 |
| Day | Wed |
| Local Time Of Day | 0601 To 1200 |
| Place | |
| Locale Reference | airport : ont.airport |
| State Reference | CA |
| Altitude | agl single value : 0 |
| Environment | |
| Flight Conditions | IMC |
| Light | Daylight |
| Aircraft 1 | |
| Controlling Facilities | tower : ont.tower |
| Operator | common carrier : air taxi |
| Make Model Name | Shorts SD-360 |
| Operating Under FAR Part | Part 135 |
| Flight Phase | ground : taxi |
| Flight Plan | IFR |
| Aircraft 2 | |
| Controlling Facilities | tower : ont.tower |
| Make Model Name | Any Unknown or Unlisted Aircraft Manufacturer |
| Flight Phase | landing : go around |
| Person 1 | |
| Affiliation | company : air taxi |
| Function | flight crew : captain oversight : pic |
| Qualification | flight attendant : currently qualified pilot : atp |
| Experience | flight time last 90 days : 180 flight time total : 6000 flight time type : 200 |
| ASRS Report | 595351 |
| Person 2 | |
| Affiliation | company : air taxi |
| Function | flight crew : first officer |
| Events | |
| Anomaly | conflict : ground less severe incursion : runway non adherence : clearance non adherence : published procedure non adherence : far |
| Independent Detector | other flight crewa other flight crewb |
| Resolutory Action | controller : issued new clearance flight crew : executed go around |
| Consequence | faa : reviewed incident with flight crew |
| Supplementary | |
| Problem Areas | ATC Human Performance Flight Crew Human Performance |
| Primary Problem | Flight Crew Human Performance |
| Air Traffic Incident | Pilot Deviation |
Narrative:
We were holding short of taxiway sierra on taxiway whisky as we advised tower that we were ready for departure. We believed we had been instructed to taxi up and hold on runway 26L. My first officer read the instructions and replied taxi up and hold on runway 26. Tower replied back and said runway 26L. My first officer and I at that point understood that the instruction was indeed for us to taxi and hold on runway 26L. Again, my first officer read back the instructions to taxi up and hold on runway 26L, but there was no response from tower at this time. We assumed everything was right, went ahead and lined up and hold on runway 26L. While taxiing up, we were aware that tower cleared a landing traffic on runway 26L. While holding on runway 26L, I told my first officer to remind tower that we were holding on runway 26L. Tower verified our position and thereafter instructed the landing traffic to go around. We were then instructed to taxi out the runway and exit on taxiway tango. We stayed on taxiway sierra until we got our takeoff clearance. Upon airborne and just before we switched to socal departure, we were told by tower to call a phone number after we land in ipl (imperial, ca). I called up the number and was able to talk to the ATC manager in ontario. He told me what transpired earlier on in ont. He said that the instructions were for us to taxi up and hold short of runway 26L. Tower's response to our first readback was indeed only runway 26L. There was no response from tower to our second readback apparently because according to the ATC manager, we were stepped on. We however, did not know. We did not hear any other transmitting when we made our last radio call to tower to confirm/read back the instructions. Obviously, communication was the major fault in the above mentioned of events. Vigilance and aggressiveness shall always be exercised. Phraseology should be standard at all times and reading back of instructions couldn't be overemphasized.
Original NASA ASRS Text
Title: SD3-60 FLT CREW ENTERS RWY AT ONT WITHOUT CLRNC AND CAUSES GAR.
Narrative: WE WERE HOLDING SHORT OF TXWY SIERRA ON TXWY WHISKY AS WE ADVISED TWR THAT WE WERE READY FOR DEP. WE BELIEVED WE HAD BEEN INSTRUCTED TO TAXI UP AND HOLD ON RWY 26L. MY FO READ THE INSTRUCTIONS AND REPLIED TAXI UP AND HOLD ON RWY 26. TWR REPLIED BACK AND SAID RWY 26L. MY FO AND I AT THAT POINT UNDERSTOOD THAT THE INSTRUCTION WAS INDEED FOR US TO TAXI AND HOLD ON RWY 26L. AGAIN, MY FO READ BACK THE INSTRUCTIONS TO TAXI UP AND HOLD ON RWY 26L, BUT THERE WAS NO RESPONSE FROM TWR AT THIS TIME. WE ASSUMED EVERYTHING WAS RIGHT, WENT AHEAD AND LINED UP AND HOLD ON RWY 26L. WHILE TAXIING UP, WE WERE AWARE THAT TWR CLRED A LNDG TFC ON RWY 26L. WHILE HOLDING ON RWY 26L, I TOLD MY FO TO REMIND TWR THAT WE WERE HOLDING ON RWY 26L. TWR VERIFIED OUR POS AND THEREAFTER INSTRUCTED THE LNDG TFC TO GAR. WE WERE THEN INSTRUCTED TO TAXI OUT THE RWY AND EXIT ON TXWY TANGO. WE STAYED ON TXWY SIERRA UNTIL WE GOT OUR TAKEOFF CLRNC. UPON AIRBORNE AND JUST BEFORE WE SWITCHED TO SOCAL DEP, WE WERE TOLD BY TWR TO CALL A PHONE NUMBER AFTER WE LAND IN IPL (IMPERIAL, CA). I CALLED UP THE NUMBER AND WAS ABLE TO TALK TO THE ATC MANAGER IN ONTARIO. HE TOLD ME WHAT TRANSPIRED EARLIER ON IN ONT. HE SAID THAT THE INSTRUCTIONS WERE FOR US TO TAXI UP AND HOLD SHORT OF RWY 26L. TWR'S RESPONSE TO OUR FIRST READBACK WAS INDEED ONLY RWY 26L. THERE WAS NO RESPONSE FROM TWR TO OUR SECOND READBACK APPARENTLY BECAUSE ACCORDING TO THE ATC MANAGER, WE WERE STEPPED ON. WE HOWEVER, DID NOT KNOW. WE DID NOT HEAR ANY OTHER TRANSMITTING WHEN WE MADE OUR LAST RADIO CALL TO TWR TO CONFIRM/READ BACK THE INSTRUCTIONS. OBVIOUSLY, COM WAS THE MAJOR FAULT IN THE ABOVE MENTIONED OF EVENTS. VIGILANCE AND AGGRESSIVENESS SHALL ALWAYS BE EXERCISED. PHRASEOLOGY SHOULD BE STANDARD AT ALL TIMES AND READING BACK OF INSTRUCTIONS COULDN'T BE OVEREMPHASIZED.
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.