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|
Attributes | |
ACN | 637515 |
Time | |
Date | 200411 |
Day | Thu |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : lfpg.airport |
State Reference | FO |
Altitude | agl single value : 0 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B767-300 and 300 ER |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : pushback |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
ASRS Report | 637515 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Events | |
Anomaly | aircraft equipment problem : less severe conflict : ground less severe ground encounters : person ground encounters : vehicle non adherence : published procedure non adherence : company policies |
Independent Detector | other flight crewa other other : 3 |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Supplementary | |
Problem Areas | Aircraft Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Narrative:
This was a routine pushback from a hardstand at lfpg. At the conclusion of the pushback, I was routinely told to set brakes, and did so. While the ground crew was disconnecting, the first officer requested a frequency change to go to ground control. I took a moment to glance at the airport diagram on the side window clipboard. As I did, I discerned that the aircraft was moving. I stopped the plane and called to the ground crew to determine if anything untoward had occurred. The ground crew told me that no damage had occurred, and that all personnel were ok, but that the plane had moved forward with the tow bar still attached. She was deservedly angry, and I was quite humiliated. It was fortunate that the plane moved only inches, and that both the pushback tug, and the person disconnecting the tow bar were clear. 1 of 3 quite unlikely things had occurred: 1) either I failed to properly set the brake, 2) it disconnected on its own, or 3) for no reason at all I released it. Though all quite improbable, one of these must have occurred. The truth is that I am certain I set the parking brake, and had no reason at all to have released it prematurely. There was no rush, yet this did happen. I submit this because I would have considered this to have been a completely benign phase of flight -- parked with engines running. Yet, clearly damage or injury could have occurred. After 30 yrs of this, I learned yet again that there are no benign phases of flight, and that your head had better be in the game at all times, or you're not really in the game at all.
Original NASA ASRS Text
Title: AFTER PUSHBACK WITH ENGS RUNNING AT LFPG, B767 CAPT NOTES ACFT MOVEMENT AFTER SETTING PARKING BRAKE.
Narrative: THIS WAS A ROUTINE PUSHBACK FROM A HARDSTAND AT LFPG. AT THE CONCLUSION OF THE PUSHBACK, I WAS ROUTINELY TOLD TO SET BRAKES, AND DID SO. WHILE THE GND CREW WAS DISCONNECTING, THE FO REQUESTED A FREQ CHANGE TO GO TO GND CTL. I TOOK A MOMENT TO GLANCE AT THE ARPT DIAGRAM ON THE SIDE WINDOW CLIPBOARD. AS I DID, I DISCERNED THAT THE ACFT WAS MOVING. I STOPPED THE PLANE AND CALLED TO THE GND CREW TO DETERMINE IF ANYTHING UNTOWARD HAD OCCURRED. THE GND CREW TOLD ME THAT NO DAMAGE HAD OCCURRED, AND THAT ALL PERSONNEL WERE OK, BUT THAT THE PLANE HAD MOVED FORWARD WITH THE TOW BAR STILL ATTACHED. SHE WAS DESERVEDLY ANGRY, AND I WAS QUITE HUMILIATED. IT WAS FORTUNATE THAT THE PLANE MOVED ONLY INCHES, AND THAT BOTH THE PUSHBACK TUG, AND THE PERSON DISCONNECTING THE TOW BAR WERE CLR. 1 OF 3 QUITE UNLIKELY THINGS HAD OCCURRED: 1) EITHER I FAILED TO PROPERLY SET THE BRAKE, 2) IT DISCONNECTED ON ITS OWN, OR 3) FOR NO REASON AT ALL I RELEASED IT. THOUGH ALL QUITE IMPROBABLE, ONE OF THESE MUST HAVE OCCURRED. THE TRUTH IS THAT I AM CERTAIN I SET THE PARKING BRAKE, AND HAD NO REASON AT ALL TO HAVE RELEASED IT PREMATURELY. THERE WAS NO RUSH, YET THIS DID HAPPEN. I SUBMIT THIS BECAUSE I WOULD HAVE CONSIDERED THIS TO HAVE BEEN A COMPLETELY BENIGN PHASE OF FLT -- PARKED WITH ENGS RUNNING. YET, CLRLY DAMAGE OR INJURY COULD HAVE OCCURRED. AFTER 30 YRS OF THIS, I LEARNED YET AGAIN THAT THERE ARE NO BENIGN PHASES OF FLT, AND THAT YOUR HEAD HAD BETTER BE IN THE GAME AT ALL TIMES, OR YOU'RE NOT REALLY IN THE GAME AT ALL.
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.