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|
Attributes | |
ACN | 653138 |
Time | |
Date | 200503 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | navaid : fdy.vortac |
State Reference | OH |
Altitude | msl bound lower : 25000 msl bound upper : 26000 |
Environment | |
Flight Conditions | Marginal |
Weather Elements | Turbulence |
Light | Dusk |
Aircraft 1 | |
Controlling Facilities | artcc : zob.artcc |
Operator | common carrier : air taxi |
Make Model Name | Learjet 35 |
Operating Under FAR Part | Part 91 |
Navigation In Use | other vortac |
Flight Phase | climbout : intermediate altitude |
Flight Plan | IFR |
Aircraft 2 | |
Controlling Facilities | artcc : zob.artcc |
Operator | common carrier : air carrier |
Make Model Name | B737 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Flight Phase | climbout : intermediate altitude |
Flight Plan | IFR |
Person 1 | |
Affiliation | government : faa |
Function | controller : handoff position |
Qualification | controller : radar |
Experience | controller limited radar : 2 controller radar : 17 controller time certified in position1 : 1.25 |
ASRS Report | 653138 |
Person 2 | |
Affiliation | government : faa |
Function | controller : radar |
Events | |
Anomaly | altitude deviation : overshoot conflict : airborne less severe non adherence : required legal separation |
Independent Detector | atc equipment : conflict alert other controllera |
Resolutory Action | controller : issued alert |
Consequence | faa : investigated |
Miss Distance | horizontal : 27000 vertical : 500 |
Supplementary | |
Problem Areas | ATC Human Performance |
Primary Problem | ATC Human Performance |
Air Traffic Incident | Operational Error |
Narrative:
Lear cleared to FL250 on previous frequency. Read back FL250. Communication change to next frequency. Reported climbing FL260. Error not caught. Aircraft climbed above assigned altitude into traffic. Contributing factors? Where do I start? First and foremost would be noise in control room due to a headquarters directive which requires each area of specialization to an arbitrary 70% staffing requirement whether traffic or conditions warrant (ie; if the area has a staffing that shift of 20 (hypothetical) then 14 must be on position; even if only 10 position available. 10 aircraft with 14 controllers equals too much noise). This particular shift was a perfect example of too many people in control room at that time. When traffic and conditions warrant; I agree that staffing is necessary. However; for a 'pencil pusher' in washington to mandate; based on operational errors; the number of people in control room; or area; is typical of someone sadistically trying to make a name for one's self; thus leading back to the problem. Secondly; displays allow for personal preferences as to bright volume and font size. The latter being a factor in this situation; younger controller working 'radar;' more 'seasoned' controller working 'RA.' from the angle which 'RA' has to view flat panel; small fonts become indecipherable regardless of bright volume; as with all LCD displays (look great straight on; but from the side; forget it -- shadows). The small font numbers look similar (ie; 5; 6; 8).
Original NASA ASRS Text
Title: ZOB RADAR ASSOCIATE OBSERVED OPERROR DUE TO CTLR'S FAILURE TO HEAR INCORRECT ALT ASSIGNMENT READBACK AND COMMENTS ON CTL ROOM NOISE AND ALPHA NUMERIC DATA SIZE ON THE RADAR DISPLAYS.
Narrative: LEAR CLRED TO FL250 ON PREVIOUS FREQ. READ BACK FL250. COM CHANGE TO NEXT FREQ. RPTED CLBING FL260. ERROR NOT CAUGHT. ACFT CLBED ABOVE ASSIGNED ALT INTO TFC. CONTRIBUTING FACTORS? WHERE DO I START? FIRST AND FOREMOST WOULD BE NOISE IN CTL ROOM DUE TO A HEADQUARTERS DIRECTIVE WHICH REQUIRES EACH AREA OF SPECIALIZATION TO AN ARBITRARY 70% STAFFING REQUIREMENT WHETHER TFC OR CONDITIONS WARRANT (IE; IF THE AREA HAS A STAFFING THAT SHIFT OF 20 (HYPOTHETICAL) THEN 14 MUST BE ON POS; EVEN IF ONLY 10 POS AVAILABLE. 10 ACFT WITH 14 CTLRS EQUALS TOO MUCH NOISE). THIS PARTICULAR SHIFT WAS A PERFECT EXAMPLE OF TOO MANY PEOPLE IN CTL ROOM AT THAT TIME. WHEN TFC AND CONDITIONS WARRANT; I AGREE THAT STAFFING IS NECESSARY. HOWEVER; FOR A 'PENCIL PUSHER' IN WASHINGTON TO MANDATE; BASED ON OPERATIONAL ERRORS; THE NUMBER OF PEOPLE IN CTL ROOM; OR AREA; IS TYPICAL OF SOMEONE SADISTICALLY TRYING TO MAKE A NAME FOR ONE'S SELF; THUS LEADING BACK TO THE PROB. SECONDLY; DISPLAYS ALLOW FOR PERSONAL PREFERENCES AS TO BRIGHT VOLUME AND FONT SIZE. THE LATTER BEING A FACTOR IN THIS SIT; YOUNGER CTLR WORKING 'RADAR;' MORE 'SEASONED' CTLR WORKING 'RA.' FROM THE ANGLE WHICH 'RA' HAS TO VIEW FLAT PANEL; SMALL FONTS BECOME INDECIPHERABLE REGARDLESS OF BRIGHT VOLUME; AS WITH ALL LCD DISPLAYS (LOOK GREAT STRAIGHT ON; BUT FROM THE SIDE; FORGET IT -- SHADOWS). THE SMALL FONT NUMBERS LOOK SIMILAR (IE; 5; 6; 8).
Data retrieved from NASA's ASRS site as of January 2009 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.