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|
Attributes | |
ACN | 740720 |
Time | |
Date | 200706 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : dal.airport |
State Reference | TX |
Altitude | msl single value : 3000 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : d10.tracon |
Operator | common carrier : charter |
Make Model Name | Learjet 25 |
Operating Under FAR Part | Part 135 |
Flight Phase | climbout : takeoff |
Route In Use | departure sid : n/s |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : charter |
Function | flight crew : captain oversight : pic |
Qualification | pilot : multi engine pilot : atp pilot : cfi |
Experience | flight time last 90 days : 30 flight time total : 7500 flight time type : 3500 |
ASRS Report | 740507 |
Person 2 | |
Affiliation | company : charter |
Function | flight crew : first officer |
Qualification | pilot : multi engine pilot : instrument pilot : cfi pilot : atp |
Experience | flight time last 90 days : 40 flight time total : 3100 flight time type : 350 |
ASRS Report | 740720 |
Events | |
Anomaly | altitude deviation : undershoot non adherence : clearance non adherence : far non adherence : published procedure other spatial deviation |
Resolutory Action | controller : issued new clearance controller : issued advisory |
Consequence | faa : assigned or threatened penalties faa : investigated |
Supplementary | |
Problem Areas | Airspace Structure Chart Or Publication Flight Crew Human Performance ATC Human Performance |
Primary Problem | Flight Crew Human Performance |
Situations | |
Chart | sid : joepool |
Narrative:
I conducted a flight from dal to ZZZ. During the takeoff phase of that operation; I was performing the crew takeoff briefing when I stated our initial altitude of 3000 ft to which the copilot did not respond. I should have challenged his lack of response. This copilot has always been competent at his position and I became complacent with his cockpit setup. I also later discovered that he utilized a SID with the same title from a different airport which regrettably caused us to fly an incorrect route and altitude for the SID. Another item that I believe to have contributed to this deviation; is that fact we were out of told cards which we display at the center divider beam where both pilots can see and review the takeoff clearance limits; altitudes; speed restrs; and rtes; so we used thin note pads which will not stay in place at our normal mounting point. The copilot had that note pad at his right where I could not read it. If that told card was in place; I am confident that at least we would have not missed our altitude requirement. My lack of supervision of my copilot and my decision to accept the altitude on the altitude alerter as correct and to confirm and review the departure SID caused this situation. In the future; I will demand that both pilots be present during the issuance of our clearance and that both pilots review the SID's or STAR's together. I will never trust even a competent pilot again without confirming all pertinent data required to conduct a safe and pilot deviation free flight. Supplemental information from acn 740507: I normally receive the IFR clrncs from clearance delivery in the airplane. Today; I elected to use the radio inside the FBO. Since I was not in the airplane; I failed to enter the transponder code and initial altitude into the alerter. Our company has recently switched from commercial charts to the government charts. Most of our pilots have always used the commercial charts; and are not familiar with the government charts or their layout. As we were taxiing; I started flipping through the book to see what was on the departure procedure from dal. Because the pages are in a different order; as compared from commercial chart; I accidentally looked up rbd's departure procedure; rather than dal's departure procedure. The passenger were already at the FBO when we arrived; so the captain and I felt very rushed to get them on their way. We loaded the passenger up and started the engines. Normally; the GPS is loaded; and we run the after-start checklist before we start taxiing. Because we were in a rush; the captain started taxiing without running the checklist and loading the GPS. So; I was loading the GPS as we were taxiing. This did not leave any time for a pre-departure briefing; where the crew verifies the altitudes and reviews the departure procedure. No matter how big of a rush the crew is in; it is imperative to make sure the plane and pilots are ready for departure. There should always be a pre-departure briefing; and then back it up with the correct departure procedure. Also; if pilots are unfamiliar with the charts that they are using; they should take the time to familiarize themselves with the format used. Callback conversation with reporter acn 740507 revealed the following information: the reporter was aware of the different dfw area airports having the same named departures. In this case the govt charts added a level of confusion.
Original NASA ASRS Text
Title: A LR25 REPORTS DEPARTING DAL USING A SIMILARLY NAMED DEP PROC FOR RBD. THE INITIAL LEVEL OFF ALT WAS INCORRECT. THE CREW WAS RUSHED.
Narrative: I CONDUCTED A FLT FROM DAL TO ZZZ. DURING THE TKOF PHASE OF THAT OP; I WAS PERFORMING THE CREW TKOF BRIEFING WHEN I STATED OUR INITIAL ALT OF 3000 FT TO WHICH THE COPLT DID NOT RESPOND. I SHOULD HAVE CHALLENGED HIS LACK OF RESPONSE. THIS COPLT HAS ALWAYS BEEN COMPETENT AT HIS POS AND I BECAME COMPLACENT WITH HIS COCKPIT SETUP. I ALSO LATER DISCOVERED THAT HE UTILIZED A SID WITH THE SAME TITLE FROM A DIFFERENT ARPT WHICH REGRETTABLY CAUSED US TO FLY AN INCORRECT RTE AND ALT FOR THE SID. ANOTHER ITEM THAT I BELIEVE TO HAVE CONTRIBUTED TO THIS DEV; IS THAT FACT WE WERE OUT OF TOLD CARDS WHICH WE DISPLAY AT THE CTR DIVIDER BEAM WHERE BOTH PLTS CAN SEE AND REVIEW THE TAKEOFF CLRNC LIMITS; ALTS; SPD RESTRS; AND RTES; SO WE USED THIN NOTE PADS WHICH WILL NOT STAY IN PLACE AT OUR NORMAL MOUNTING POINT. THE COPLT HAD THAT NOTE PAD AT HIS RIGHT WHERE I COULD NOT READ IT. IF THAT TOLD CARD WAS IN PLACE; I AM CONFIDENT THAT AT LEAST WE WOULD HAVE NOT MISSED OUR ALT REQUIREMENT. MY LACK OF SUPERVISION OF MY COPLT AND MY DECISION TO ACCEPT THE ALT ON THE ALT ALERTER AS CORRECT AND TO CONFIRM AND REVIEW THE DEP SID CAUSED THIS SITUATION. IN THE FUTURE; I WILL DEMAND THAT BOTH PLTS BE PRESENT DURING THE ISSUANCE OF OUR CLRNC AND THAT BOTH PLTS REVIEW THE SID'S OR STAR'S TOGETHER. I WILL NEVER TRUST EVEN A COMPETENT PLT AGAIN WITHOUT CONFIRMING ALL PERTINENT DATA REQUIRED TO CONDUCT A SAFE AND PLTDEV FREE FLT. SUPPLEMENTAL INFO FROM ACN 740507: I NORMALLY RECEIVE THE IFR CLRNCS FROM CLRNC DELIVERY IN THE AIRPLANE. TODAY; I ELECTED TO USE THE RADIO INSIDE THE FBO. SINCE I WAS NOT IN THE AIRPLANE; I FAILED TO ENTER THE XPONDER CODE AND INITIAL ALT INTO THE ALERTER. OUR COMPANY HAS RECENTLY SWITCHED FROM COMMERCIAL CHARTS TO THE GOV CHARTS. MOST OF OUR PLTS HAVE ALWAYS USED THE COMMERCIAL CHARTS; AND ARE NOT FAMILIAR WITH THE GOV CHARTS OR THEIR LAYOUT. AS WE WERE TAXIING; I STARTED FLIPPING THROUGH THE BOOK TO SEE WHAT WAS ON THE DEP PROC FROM DAL. BECAUSE THE PAGES ARE IN A DIFFERENT ORDER; AS COMPARED FROM COMMERCIAL CHART; I ACCIDENTALLY LOOKED UP RBD'S DEP PROC; RATHER THAN DAL'S DEP PROC. THE PAX WERE ALREADY AT THE FBO WHEN WE ARRIVED; SO THE CAPT AND I FELT VERY RUSHED TO GET THEM ON THEIR WAY. WE LOADED THE PAX UP AND STARTED THE ENGS. NORMALLY; THE GPS IS LOADED; AND WE RUN THE AFTER-START CHKLIST BEFORE WE START TAXIING. BECAUSE WE WERE IN A RUSH; THE CAPT STARTED TAXIING WITHOUT RUNNING THE CHKLIST AND LOADING THE GPS. SO; I WAS LOADING THE GPS AS WE WERE TAXIING. THIS DID NOT LEAVE ANY TIME FOR A PRE-DEP BRIEFING; WHERE THE CREW VERIFIES THE ALTS AND REVIEWS THE DEP PROC. NO MATTER HOW BIG OF A RUSH THE CREW IS IN; IT IS IMPERATIVE TO MAKE SURE THE PLANE AND PLTS ARE READY FOR DEP. THERE SHOULD ALWAYS BE A PRE-DEP BRIEFING; AND THEN BACK IT UP WITH THE CORRECT DEP PROC. ALSO; IF PLTS ARE UNFAMILIAR WITH THE CHARTS THAT THEY ARE USING; THEY SHOULD TAKE THE TIME TO FAMILIARIZE THEMSELVES WITH THE FORMAT USED. CALLBACK CONVERSATION WITH RPTR ACN 740507 REVEALED THE FOLLOWING INFO: THE RPTR WAS AWARE OF THE DIFFERENT DFW AREA ARPTS HAVING THE SAME NAMED DEPS. IN THIS CASE THE GOVT CHARTS ADDED A LEVEL OF CONFUSION.
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.