 |
37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
A B767 on a night VFR approach descended low enough to activate the egpws followed by an ATC low altitude alert.
| Attributes | |
| ACN | 720472 |
| Time | |
| Date | 200612 |
| Local Time Of Day | 0001 To 0600 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 700 |
| Environment | |
| Flight Conditions | VMC |
| Light | Night |
| Aircraft 1 | |
| Controlling Facilities | tower : zzz.tower |
| Operator | common carrier : air carrier |
| Make Model Name | B767 Undifferentiated or Other Model |
| Operating Under FAR Part | Part 121 |
| Navigation In Use | other |
| Flight Phase | descent : approach |
| Route In Use | approach : traffic pattern approach : visual |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | flight crew : first officer |
| Experience | flight time last 90 days : 24 flight time total : 12020 flight time type : 850 |
| ASRS Report | 720472 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | flight crew : captain oversight : pic |
| Events | |
| Anomaly | non adherence : company policies other anomaly other spatial deviation |
| Independent Detector | aircraft equipment : gpws other controllera |
| Resolutory Action | flight crew : returned to assigned altitude |
| Supplementary | |
| Problem Areas | Airport Flight Crew Human Performance |
| Primary Problem | Flight Crew Human Performance |
Narrative:
During a visual approach (good VMC); from a right downwind at ZZZ; the PF began a base leg at approximately 5-6 mi from runway threshold. During turn to base leg; aircraft descended to approximately 700-1000 ft AGL. ATC notified us of a low altitude alert. Aircraft was leveled off and glide path reestablished. Shortly after ATC's notification; egpws gave us an obstacle caution alert. Once established on glide path the landing was uneventful. Several factors contributed to this event. 1) no published approach to runway xx at ZZZ (GPS runway xx is available; but B757/767 fleet not authority/authorized). 2) VASI was NOTAM'ed OTS. 3) right downwind entry with captain as PF. 4) over-reliance on automation -- crew programmed a runway extension and built a 3 degree path -- this is a rarely used feature. Once the base leg was initiated; PF requested the runway to be extended; pm complied -- this removed the correct path information. 5) cumulative effects of fatigue; 4TH night of backside of the clock flying with some sleep debt due to poor quality of rest on 2 of the 4 nights. 6) pm should have been more assertive as situation began to unfold; somewhat reluctant due to initial crew pairing; very good VMC; etc.
Original NASA ASRS Text
Title: A B767 ON A NIGHT VFR APCH DSNDED LOW ENOUGH TO ACTIVATE THE EGPWS FOLLOWED BY AN ATC LOW ALT ALERT.
Narrative: DURING A VISUAL APCH (GOOD VMC); FROM A R DOWNWIND AT ZZZ; THE PF BEGAN A BASE LEG AT APPROX 5-6 MI FROM RWY THRESHOLD. DURING TURN TO BASE LEG; ACFT DSNDED TO APPROX 700-1000 FT AGL. ATC NOTIFIED US OF A LOW ALT ALERT. ACFT WAS LEVELED OFF AND GLIDE PATH REESTABLISHED. SHORTLY AFTER ATC'S NOTIFICATION; EGPWS GAVE US AN OBSTACLE CAUTION ALERT. ONCE ESTABLISHED ON GLIDE PATH THE LNDG WAS UNEVENTFUL. SEVERAL FACTORS CONTRIBUTED TO THIS EVENT. 1) NO PUBLISHED APCH TO RWY XX AT ZZZ (GPS RWY XX IS AVAILABLE; BUT B757/767 FLEET NOT AUTH). 2) VASI WAS NOTAM'ED OTS. 3) R DOWNWIND ENTRY WITH CAPT AS PF. 4) OVER-RELIANCE ON AUTOMATION -- CREW PROGRAMMED A RWY EXTENSION AND BUILT A 3 DEG PATH -- THIS IS A RARELY USED FEATURE. ONCE THE BASE LEG WAS INITIATED; PF REQUESTED THE RWY TO BE EXTENDED; PM COMPLIED -- THIS REMOVED THE CORRECT PATH INFO. 5) CUMULATIVE EFFECTS OF FATIGUE; 4TH NIGHT OF BACKSIDE OF THE CLOCK FLYING WITH SOME SLEEP DEBT DUE TO POOR QUALITY OF REST ON 2 OF THE 4 NIGHTS. 6) PM SHOULD HAVE BEEN MORE ASSERTIVE AS SIT BEGAN TO UNFOLD; SOMEWHAT RELUCTANT DUE TO INITIAL CREW PAIRING; VERY GOOD VMC; ETC.
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.