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|
Attributes | |
ACN | 753163 |
Time | |
Date | 200709 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : lax.airport |
State Reference | CA |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B737-500 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : pushback |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain observation : company check pilot oversight : pic |
Experience | flight time last 90 days : 250 flight time total : 10000 flight time type : 4100 |
ASRS Report | 753163 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Events | |
Anomaly | non adherence : far non adherence : company policies |
Independent Detector | other other : 3 |
Resolutory Action | none taken : detected after the fact |
Supplementary | |
Problem Areas | Company |
Primary Problem | Company |
Narrative:
4TH day of a 4 day trip. 5TH leg and 9TH hour of a 5 leg 12 1/2 hour day. It was my first officer's leg and I had left the cockpit for a while to update the WX and pilot brief before we left for destination. When I returned to the cockpit he had all of his duties complete and all the preflight paperwork generated on ACARS. We briefed the taxi/runway plan and his leg to destination. Everything seemed to be going as planned as the ramp completed loading the aircraft. The forward pit was closed 10 mins prior to push and the aft pit was closed just prior to push; which was on time. We pushed into the alley from gate X; parking abeam gate Y; and started the #2 engine first for a 2 engine taxi. As I set the brake; the tug driver mentioned to me there was a problem with dangerous goods as I heard my first officer talking to the ramp about returning to the gate. I told the tug driver to stand by and came up on ramp frequency. I learned that hazmat/dangerous goods had been loaded in the forward pit and that the pilot notification form had been left attached to the box - the ramp lead had placed the box in the pit. I picked up the planned weights message and immediately noticed the 'dangerous goods - yes' note at the bottom; but it had been folded in half to fit in front of the throttle quadrant; covering that part of the message when laid flat. We shut down the engine and had the airplane towed back into the gate due to the tight quarters of the alley. The form was recovered from the pit and delivered to the cockpit. We pushed a couple of mins later after reinitializing ACARS and making sure that the cockpit was still set for departure. The rest of the flight proceeded without further incident. Personally; I am getting tired of being the final filter for the entire operation. If the cockpit crew is going to be held ultimately responsible for ensuring that all the T's are crossed and all the I's are dotted; then I need a more foolproof heads up than a 1 liner at the bottom of the planned weights message. If ACARS can generate that part of the message then a better idea is for it to generate a discrete message when the weights are requested during the cockpit setup. It should be titled 'dangerous goods' in the message queue and should prompt the crew to inquire about the notification form. While you're at it; do the same thing for live animals. Most stations do not give the cockpit notice of live animals and most passenger want to know if FIDO has been loaded.
Original NASA ASRS Text
Title: B737-500 IS PUSHED BACK FROM GATE WITH HAZARDOUS MATERIALS ONBOARD; BUT PROPER DOCUMENTATION HAS NOT BEEN PRESENTED TO THE FLT CREW.
Narrative: 4TH DAY OF A 4 DAY TRIP. 5TH LEG AND 9TH HR OF A 5 LEG 12 1/2 HR DAY. IT WAS MY FO'S LEG AND I HAD LEFT THE COCKPIT FOR A WHILE TO UPDATE THE WX AND PLT BRIEF BEFORE WE LEFT FOR DEST. WHEN I RETURNED TO THE COCKPIT HE HAD ALL OF HIS DUTIES COMPLETE AND ALL THE PREFLT PAPERWORK GENERATED ON ACARS. WE BRIEFED THE TAXI/RWY PLAN AND HIS LEG TO DEST. EVERYTHING SEEMED TO BE GOING AS PLANNED AS THE RAMP COMPLETED LOADING THE ACFT. THE FORWARD PIT WAS CLOSED 10 MINS PRIOR TO PUSH AND THE AFT PIT WAS CLOSED JUST PRIOR TO PUSH; WHICH WAS ON TIME. WE PUSHED INTO THE ALLEY FROM GATE X; PARKING ABEAM GATE Y; AND STARTED THE #2 ENG FIRST FOR A 2 ENG TAXI. AS I SET THE BRAKE; THE TUG DRIVER MENTIONED TO ME THERE WAS A PROB WITH DANGEROUS GOODS AS I HEARD MY FO TALKING TO THE RAMP ABOUT RETURNING TO THE GATE. I TOLD THE TUG DRIVER TO STAND BY AND CAME UP ON RAMP FREQ. I LEARNED THAT HAZMAT/DANGEROUS GOODS HAD BEEN LOADED IN THE FORWARD PIT AND THAT THE PLT NOTIFICATION FORM HAD BEEN LEFT ATTACHED TO THE BOX - THE RAMP LEAD HAD PLACED THE BOX IN THE PIT. I PICKED UP THE PLANNED WTS MESSAGE AND IMMEDIATELY NOTICED THE 'DANGEROUS GOODS - YES' NOTE AT THE BOTTOM; BUT IT HAD BEEN FOLDED IN HALF TO FIT IN FRONT OF THE THROTTLE QUADRANT; COVERING THAT PART OF THE MESSAGE WHEN LAID FLAT. WE SHUT DOWN THE ENG AND HAD THE AIRPLANE TOWED BACK INTO THE GATE DUE TO THE TIGHT QUARTERS OF THE ALLEY. THE FORM WAS RECOVERED FROM THE PIT AND DELIVERED TO THE COCKPIT. WE PUSHED A COUPLE OF MINS LATER AFTER REINITIALIZING ACARS AND MAKING SURE THAT THE COCKPIT WAS STILL SET FOR DEP. THE REST OF THE FLT PROCEEDED WITHOUT FURTHER INCIDENT. PERSONALLY; I AM GETTING TIRED OF BEING THE FINAL FILTER FOR THE ENTIRE OP. IF THE COCKPIT CREW IS GOING TO BE HELD ULTIMATELY RESPONSIBLE FOR ENSURING THAT ALL THE T'S ARE CROSSED AND ALL THE I'S ARE DOTTED; THEN I NEED A MORE FOOLPROOF HEADS UP THAN A 1 LINER AT THE BOTTOM OF THE PLANNED WTS MESSAGE. IF ACARS CAN GENERATE THAT PART OF THE MESSAGE THEN A BETTER IDEA IS FOR IT TO GENERATE A DISCRETE MESSAGE WHEN THE WTS ARE REQUESTED DURING THE COCKPIT SETUP. IT SHOULD BE TITLED 'DANGEROUS GOODS' IN THE MESSAGE QUEUE AND SHOULD PROMPT THE CREW TO INQUIRE ABOUT THE NOTIFICATION FORM. WHILE YOU'RE AT IT; DO THE SAME THING FOR LIVE ANIMALS. MOST STATIONS DO NOT GIVE THE COCKPIT NOTICE OF LIVE ANIMALS AND MOST PAX WANT TO KNOW IF FIDO HAS BEEN LOADED.
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.