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Attributes | |
ACN | 658414 |
Time | |
Date | 200505 |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : ith.airport |
State Reference | NY |
Altitude | agl single value : 0 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tower : ith.tower |
Operator | general aviation : personal |
Make Model Name | PA-28 Cherokee Arrow IV |
Operating Under FAR Part | Part 91 |
Flight Phase | descent : approach landing : roll ground : maintenance |
Flight Plan | VFR |
Person 1 | |
Affiliation | other |
Function | flight crew : single pilot |
Qualification | pilot : instrument pilot : private |
Experience | flight time last 90 days : 24 flight time total : 561 flight time type : 561 |
ASRS Report | 658414 |
Person 2 | |
Affiliation | government : faa |
Function | controller : local |
Events | |
Anomaly | aircraft equipment problem : critical ground encounters : gear up landing |
Independent Detector | other flight crewa |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Narrative:
Departed ZZZ1 VFR; climbed to 4500 ft MSL. Contacted approach and set up flight following. When handed off; I checked ATIS at ZZZ2. When 15 NM from ZZZ2; asked approach for local IFR clearance to descend through scattered clouds at 3000 ft MSL. Once ZZZ2 was in sight; was cleared for visual approach and over to ZZZ2 tower. ZZZ2 cleared to land visual runway 32. Ran mental checklist (local control gump). At the same time; tower noted other traffic in pattern. I set up a short approach to stay clear of unseen traffic doing a '360 degree turn.' all system seemed fine. No warning buzzers; no warning lights -- until the sound of metal. I had landed 'gear up!' thoughts: though I had thought I had placed the gear down; tower's calls about other traffic made me skip lowering gear; though I did set propeller; mixture; fuel pump on; etc. Short approach caused me to skip final 3 green check. And finally automatic gear drop and warning lights/buzzer did not function. What I have learned: I know some may say better use of checklist would have resolved this problem. But the bottom line is; I am good about checklists -- both written and verbal queues. There was something about this approach that interrupted my process at a key moment. Yes; I need to create a 'fail safe' double/triple checklist process; and it is hard to imagine a more life changing event than a gear-up landing. But where I really failed was not periodically checking the gear down warning and fail safe system in the plane. The plane was just out of an annual; but I did not do an in-flight system check. This is the new area/process I will add. A working warning system would have 'saved' me when all other best intentions failed.
Original NASA ASRS Text
Title: A PA28 PLT LANDED GEAR UP FOLLOWING A SHORT APCH FOR TFC AND AN INOP GEAR WARNING HORN. MENTAL VERSUS PAPER CHKLIST USED.
Narrative: DEPARTED ZZZ1 VFR; CLBED TO 4500 FT MSL. CONTACTED APCH AND SET UP FLT FOLLOWING. WHEN HANDED OFF; I CHKED ATIS AT ZZZ2. WHEN 15 NM FROM ZZZ2; ASKED APCH FOR LCL IFR CLRNC TO DSND THROUGH SCATTERED CLOUDS AT 3000 FT MSL. ONCE ZZZ2 WAS IN SIGHT; WAS CLRED FOR VISUAL APCH AND OVER TO ZZZ2 TWR. ZZZ2 CLRED TO LAND VISUAL RWY 32. RAN MENTAL CHKLIST (LC GUMP). AT THE SAME TIME; TWR NOTED OTHER TFC IN PATTERN. I SET UP A SHORT APCH TO STAY CLR OF UNSEEN TFC DOING A '360 DEG TURN.' ALL SYS SEEMED FINE. NO WARNING BUZZERS; NO WARNING LIGHTS -- UNTIL THE SOUND OF METAL. I HAD LANDED 'GEAR UP!' THOUGHTS: THOUGH I HAD THOUGHT I HAD PLACED THE GEAR DOWN; TWR'S CALLS ABOUT OTHER TFC MADE ME SKIP LOWERING GEAR; THOUGH I DID SET PROP; MIXTURE; FUEL PUMP ON; ETC. SHORT APCH CAUSED ME TO SKIP FINAL 3 GREEN CHK. AND FINALLY AUTO GEAR DROP AND WARNING LIGHTS/BUZZER DID NOT FUNCTION. WHAT I HAVE LEARNED: I KNOW SOME MAY SAY BETTER USE OF CHKLIST WOULD HAVE RESOLVED THIS PROB. BUT THE BOTTOM LINE IS; I AM GOOD ABOUT CHKLISTS -- BOTH WRITTEN AND VERBAL QUEUES. THERE WAS SOMETHING ABOUT THIS APCH THAT INTERRUPTED MY PROCESS AT A KEY MOMENT. YES; I NEED TO CREATE A 'FAIL SAFE' DOUBLE/TRIPLE CHKLIST PROCESS; AND IT IS HARD TO IMAGINE A MORE LIFE CHANGING EVENT THAN A GEAR-UP LNDG. BUT WHERE I REALLY FAILED WAS NOT PERIODICALLY CHKING THE GEAR DOWN WARNING AND FAIL SAFE SYS IN THE PLANE. THE PLANE WAS JUST OUT OF AN ANNUAL; BUT I DID NOT DO AN INFLT SYS CHK. THIS IS THE NEW AREA/PROCESS I WILL ADD. A WORKING WARNING SYS WOULD HAVE 'SAVED' ME WHEN ALL OTHER BEST INTENTIONS FAILED.
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.