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|
Attributes | |
ACN | 720362 |
Time | |
Date | 200612 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : teb.airport |
State Reference | NJ |
Altitude | msl bound lower : 1500 msl bound upper : 2000 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | tracon : n90.tracon |
Operator | general aviation : corporate |
Make Model Name | Learjet 45 |
Operating Under FAR Part | Part 91 |
Flight Phase | climbout : initial |
Route In Use | departure sid : teb5 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : corporate |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp pilot : multi engine pilot : instrument pilot : cfi |
Experience | flight time last 90 days : 100 flight time total : 6000 flight time type : 700 |
ASRS Report | 720362 |
Person 2 | |
Affiliation | company : corporate |
Function | flight crew : first officer |
Qualification | pilot : flight engineer pilot : atp |
Experience | flight time last 90 days : 50 flight time total : 7050 flight time type : 90 |
ASRS Report | 720359 |
Events | |
Anomaly | aircraft equipment problem : less severe altitude deviation : overshoot non adherence : clearance non adherence : far non adherence : published procedure |
Independent Detector | other controllera other flight crewa other flight crewb |
Resolutory Action | none taken : detected after the fact |
Consequence | faa : reviewed incident with flight crew |
Supplementary | |
Problem Areas | Flight Crew Human Performance Aircraft |
Primary Problem | Flight Crew Human Performance |
Situations | |
Chart | sid : teb5 |
Narrative:
We had a multi leg trip with one of the legs being from teb to ZZZ. While on the ground at teb; we had encountered about a 2 hour ground delay. While waiting for departure clearance; the copilot and myself (acting as captain) had ample time to set up and review the departure SID which was the TEB5 departure as per the clearance received. Which was as follows; runway heading to 1500 ft -- right turn to 280 degrees until 4.5 DME from the teb VOR then climb to 2000 ft. We were cleared for takeoff and in the altitude pre-select we had 1500 ft so we could level off until the turn and 4.5 DME from the teb VOR; then we would initiate a climb to 2000 ft. After we rotated and in the climb out on the SID I turned the autoplt on at an altitude 500 ft MSL and selected heading and vertical speed on autoplt control panel. As the aircraft approached 1500 ft I started the turn with the heading select knob to 280 degree heading as per the departure and by the time I looked back at the primary flight display; I noticed that the autoplt never captured the 1500 ft altitude and continued the climb. By the time I was able to turn the autoplt off we had climbed up to 2000 ft before the 4.5 DME from the teb VOR as per the SID. The controller then asked our altitude and we told him. He then replied that it was an 'operational deviation.' we stayed at 2000 ft cause per the SID we were now supposed to be at that altitude. We continued the flight under normal operations. In the debrief of the flight the copilot and myself discussed the situation and deemed the cause of the missed altitude was a failure of the autoplt altitude pre-select to capture the 1500 ft altitude (which we wrote up for maintenance); in combination with our CRM callouts for approaching assigned altitudes. We discussed the fact that we did not have any callouts for climbing and leveling off at low level altitudes. Our standard callouts we have for leveling off at altitudes is only a 1000 ft prior call before arriving at the assigned altitude. In this event we were calling for flaps up 1000 ft prior to the assigned altitude; so the 1000 ft prior call never happened. We have now implemented a 500 ft to go callout prior to arriving at pre-selected assigned altitudes; and also a callout of approaching altitude which signifies that we have 100 ft to go til the pre-selected assigned altitude. So even with an autoplt system failure we would have much better situational awareness in regards to approaching our assigned altitude; and in this instance we would have caught the aircraft not leveling off due to the more frequent mandatory approaching altitude callouts.
Original NASA ASRS Text
Title: A LR45 ON THE TEB5 SID LEVELED AT 2000 FT WHEN THE AUTOPLT FAILED TO CAPTURE 1500 FT.
Narrative: WE HAD A MULTI LEG TRIP WITH ONE OF THE LEGS BEING FROM TEB TO ZZZ. WHILE ON THE GND AT TEB; WE HAD ENCOUNTERED ABOUT A 2 HOUR GND DELAY. WHILE WAITING FOR DEP CLRNC; THE COPLT AND MYSELF (ACTING AS CAPT) HAD AMPLE TIME TO SET UP AND REVIEW THE DEP SID WHICH WAS THE TEB5 DEP AS PER THE CLRNC RECEIVED. WHICH WAS AS FOLLOWS; RWY HDG TO 1500 FT -- RIGHT TURN TO 280 DEGS UNTIL 4.5 DME FROM THE TEB VOR THEN CLB TO 2000 FT. WE WERE CLRED FOR TKOF AND IN THE ALT PRE-SELECT WE HAD 1500 FT SO WE COULD LEVEL OFF UNTIL THE TURN AND 4.5 DME FROM THE TEB VOR; THEN WE WOULD INITIATE A CLB TO 2000 FT. AFTER WE ROTATED AND IN THE CLB OUT ON THE SID I TURNED THE AUTOPLT ON AT AN ALT 500 FT MSL AND SELECTED HDG AND VERT SPD ON AUTOPLT CTL PANEL. AS THE ACFT APCHED 1500 FT I STARTED THE TURN WITH THE HDG SELECT KNOB TO 280 DEG HDG AS PER THE DEP AND BY THE TIME I LOOKED BACK AT THE PRIMARY FLT DISPLAY; I NOTICED THAT THE AUTOPLT NEVER CAPTURED THE 1500 FT ALT AND CONTINUED THE CLB. BY THE TIME I WAS ABLE TO TURN THE AUTOPLT OFF WE HAD CLBED UP TO 2000 FT BEFORE THE 4.5 DME FROM THE TEB VOR AS PER THE SID. THE CTLR THEN ASKED OUR ALT AND WE TOLD HIM. HE THEN REPLIED THAT IT WAS AN 'OPERATIONAL DEV.' WE STAYED AT 2000 FT CAUSE PER THE SID WE WERE NOW SUPPOSED TO BE AT THAT ALT. WE CONTINUED THE FLT UNDER NORMAL OPERATIONS. IN THE DEBRIEF OF THE FLT THE COPLT AND MYSELF DISCUSSED THE SITUATION AND DEEMED THE CAUSE OF THE MISSED ALT WAS A FAILURE OF THE AUTOPLT ALT PRE-SELECT TO CAPTURE THE 1500 FT ALT (WHICH WE WROTE UP FOR MAINT); IN COMBINATION WITH OUR CRM CALLOUTS FOR APCHING ASSIGNED ALTS. WE DISCUSSED THE FACT THAT WE DID NOT HAVE ANY CALLOUTS FOR CLBING AND LEVELING OFF AT LOW LEVEL ALTS. OUR STANDARD CALLOUTS WE HAVE FOR LEVELING OFF AT ALTS IS ONLY A 1000 FT PRIOR CALL BEFORE ARRIVING AT THE ASSIGNED ALT. IN THIS EVENT WE WERE CALLING FOR FLAPS UP 1000 FT PRIOR TO THE ASSIGNED ALT; SO THE 1000 FT PRIOR CALL NEVER HAPPENED. WE HAVE NOW IMPLEMENTED A 500 FT TO GO CALLOUT PRIOR TO ARRIVING AT PRE-SELECTED ASSIGNED ALTS; AND ALSO A CALLOUT OF APCHING ALT WHICH SIGNIFIES THAT WE HAVE 100 FT TO GO TIL THE PRE-SELECTED ASSIGNED ALT. SO EVEN WITH AN AUTOPLT SYSTEM FAILURE WE WOULD HAVE MUCH BETTER SITUATIONAL AWARENESS IN REGARDS TO APCHING OUR ASSIGNED ALT; AND IN THIS INSTANCE WE WOULD HAVE CAUGHT THE ACFT NOT LEVELING OFF DUE TO THE MORE FREQUENT MANDATORY APCHING ALT CALLOUTS.
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.