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|
Attributes | |
ACN | 778875 |
Time | |
Date | 200803 |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | navaid : mgw.vortac |
State Reference | WV |
Altitude | msl bound lower : 17000 msl bound upper : 23000 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Controlling Facilities | artcc : zob.artcc tracon : pct.tracon |
Operator | common carrier : air carrier |
Make Model Name | Commercial Fixed Wing |
Operating Under FAR Part | Part 121 |
Navigation In Use | other vortac |
Flight Phase | cruise : level descent : approach |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : commercial pilot : atp pilot : multi engine pilot : instrument |
Experience | flight time last 90 days : 245 flight time total : 4100 flight time type : 1500 |
ASRS Report | 778875 |
Person 2 | |
Affiliation | government : faa |
Function | controller : radar |
Events | |
Anomaly | aircraft equipment problem : less severe altitude deviation : excursion from assigned altitude non adherence : clearance other spatial deviation |
Independent Detector | other controllera |
Resolutory Action | controller : issued new clearance flight crew : returned to assigned altitude flight crew : returned to intended or assigned course |
Supplementary | |
Problem Areas | Flight Crew Human Performance Aircraft |
Primary Problem | Flight Crew Human Performance |
Narrative:
We were told to call clearance 5 mins prior to push for flow to iad. 5 mins prior; first officer called and got clearance. I told him to call ramp for pushback. With a hesitation; ramp cleared us for pushback. When push crew disconnected headset he mistakenly also hit the nose gear door switch. This caused a master warning and a 'nose gear door' aural message. I called push crew back to the airplane to hook headset back up to us. I then told him he hit the wrong switch and he needed to put the nose gear switch back to the other position. He then pressed the APU shutdown switch. The aircraft went dark as we had not yet started an engine. I completely shut down the aircraft and restarted the APU and then checked the flight plan; etc. Ramp crew then pressed the nose gear door switch back to proper position. Called ground control who said we missed our clearance to iad. After speaking with first officer; realized he had originally mistakenly called ramp; not clearance; 5 mins prior to push. That is why ramp paused and; puzzled; replied 'cleared to push' as this was ramp's second time of clearing us to push. After takeoff; departure cleared us to direct VOR. While inputting VOR direct into FMS; the FMS went dead. We lost navigation on white needles and climb carrots for N1 reference and had an FMS red flag. I then requested a heading for VOR and departure gave a heading and told us to contact ZOB. On with center; we were marked as '/a' as we lost the FMS. They gave us a heading direct mgw VOR when able. I got out the chart and found the mgw VOR frequency and set our radios up. While at cruise; I left the radio #1 to the first officer so I could get ATIS on radio #2. (I had to turn off monitor of radio #1 as first officer voice was too loud to get ATIS when he transmitted on communication #1.) while getting ATIS; I saw first officer dial altitude to 17000 ft from FL230 and a heading bug move to about 30 degrees left. After I finished with ATIS; I was back on communication #1 and before I could tell first officer I was back; center asked if we were in the turn to the heading. I asked first officer what we were doing and he said we were supposed to be turning but we weren't. I noticed we were in roll mode and the aircraft was not turning. I told him to engage heading mode. He did; and the airplane started a very slow turn to the new heading. I then noticed the 1/2 bank was selected and asked first officer why it was on. He did not know. I disengaged 1/2 bank mode (I think he had originally hit 1/2 bank instead of heading mode.) center then said rather softly; 'climb and maintain FL230.' since we were already in a descent at about FL190; I asked to verify this climb altitude. They said 'affirmative; climb immediately to FL230.' the first officer selected vertical speed mode and started climb. The aircraft climbed slowly from descent. I told first officer to disconnect autoplt and commence climb. He hesitated and then did disconnect but maintained a climb of 800 FPM. I then pulled back on the yoke to get a faster climb while telling first officer to pull back and add power so as to get us climbing faster. ATC then asked why we had not turned as requested 10 mi ago. I said that the heading was selected but not engaged. He then cleared us to kessel VOR and to descend back to 17000 ft. After dealing with the above; I left communication #1 to call in range and brief the passenger/flight attendant. While I came back I heard the now potomac approach controller (while now on the royal 1 arrival) tell us to fly a heading to intercept the 248 degree radial and re-establish ourselves on the arrival; maintain 250 KTS. The first officer selected 250 KTS and pulled back the power and also dialed in the heading and hit 'navigation mode.' the aircraft immediately turned left -- the wrong direction. I told the first officer to reselect heading mode. I oriented myself with the arrival chart and saw the 248 degree radial was on the aml VOR; not kessel VOR. I selected the aml frequency in the first officer's navigation and then told him to arm navigation. Finally we were back on track. I then noticed we were doing 280 KTS. I told him to slow back to 250 KTS. I then dialed his heading to the next part of the arrival and noticed he was now at 210 KTS. I told him to speed back up to our assigned speed and also told him he needed to keep his instrument scan up so as to catch these speed deviations. He said he didn't know why the airplane was not maintaining speed. I told him this is a jet and it doesn't respond the same as the turboprop he used to fly. We landed without further incident. Contributing factors: first officer was 2 weeks new online in the aircraft. This was the 5TH leg of the day. Having to go green needles rattled the first officer. I don't think he totally understood what was going on as we were now filed IFR as '/a.' doing this many short legs in a jet with only 1 FMS is not practical. We need 2 FMS's on board. To have to navigation VOR-to-VOR with no power carrots and no fuel usage information from the FMS is too much on a short flight.
Original NASA ASRS Text
Title: ACR CAPT REPORTS THE ERRORS AND OMISSIONS OF NEW HIRE FO ON FIFTH LEG OF DAY AFTER FMC FAILURE.
Narrative: WE WERE TOLD TO CALL CLRNC 5 MINS PRIOR TO PUSH FOR FLOW TO IAD. 5 MINS PRIOR; FO CALLED AND GOT CLRNC. I TOLD HIM TO CALL RAMP FOR PUSHBACK. WITH A HESITATION; RAMP CLRED US FOR PUSHBACK. WHEN PUSH CREW DISCONNECTED HEADSET HE MISTAKENLY ALSO HIT THE NOSE GEAR DOOR SWITCH. THIS CAUSED A MASTER WARNING AND A 'NOSE GEAR DOOR' AURAL MESSAGE. I CALLED PUSH CREW BACK TO THE AIRPLANE TO HOOK HEADSET BACK UP TO US. I THEN TOLD HIM HE HIT THE WRONG SWITCH AND HE NEEDED TO PUT THE NOSE GEAR SWITCH BACK TO THE OTHER POS. HE THEN PRESSED THE APU SHUTDOWN SWITCH. THE ACFT WENT DARK AS WE HAD NOT YET STARTED AN ENG. I COMPLETELY SHUT DOWN THE ACFT AND RESTARTED THE APU AND THEN CHKED THE FLT PLAN; ETC. RAMP CREW THEN PRESSED THE NOSE GEAR DOOR SWITCH BACK TO PROPER POS. CALLED GND CTL WHO SAID WE MISSED OUR CLRNC TO IAD. AFTER SPEAKING WITH FO; REALIZED HE HAD ORIGINALLY MISTAKENLY CALLED RAMP; NOT CLRNC; 5 MINS PRIOR TO PUSH. THAT IS WHY RAMP PAUSED AND; PUZZLED; REPLIED 'CLRED TO PUSH' AS THIS WAS RAMP'S SECOND TIME OF CLRING US TO PUSH. AFTER TKOF; DEP CLRED US TO DIRECT VOR. WHILE INPUTTING VOR DIRECT INTO FMS; THE FMS WENT DEAD. WE LOST NAV ON WHITE NEEDLES AND CLB CARROTS FOR N1 REF AND HAD AN FMS RED FLAG. I THEN REQUESTED A HDG FOR VOR AND DEP GAVE A HDG AND TOLD US TO CONTACT ZOB. ON WITH CTR; WE WERE MARKED AS '/A' AS WE LOST THE FMS. THEY GAVE US A HDG DIRECT MGW VOR WHEN ABLE. I GOT OUT THE CHART AND FOUND THE MGW VOR FREQ AND SET OUR RADIOS UP. WHILE AT CRUISE; I LEFT THE RADIO #1 TO THE FO SO I COULD GET ATIS ON RADIO #2. (I HAD TO TURN OFF MONITOR OF RADIO #1 AS FO VOICE WAS TOO LOUD TO GET ATIS WHEN HE XMITTED ON COM #1.) WHILE GETTING ATIS; I SAW FO DIAL ALT TO 17000 FT FROM FL230 AND A HDG BUG MOVE TO ABOUT 30 DEGS L. AFTER I FINISHED WITH ATIS; I WAS BACK ON COM #1 AND BEFORE I COULD TELL FO I WAS BACK; CTR ASKED IF WE WERE IN THE TURN TO THE HDG. I ASKED FO WHAT WE WERE DOING AND HE SAID WE WERE SUPPOSED TO BE TURNING BUT WE WEREN'T. I NOTICED WE WERE IN ROLL MODE AND THE ACFT WAS NOT TURNING. I TOLD HIM TO ENGAGE HDG MODE. HE DID; AND THE AIRPLANE STARTED A VERY SLOW TURN TO THE NEW HDG. I THEN NOTICED THE 1/2 BANK WAS SELECTED AND ASKED FO WHY IT WAS ON. HE DID NOT KNOW. I DISENGAGED 1/2 BANK MODE (I THINK HE HAD ORIGINALLY HIT 1/2 BANK INSTEAD OF HDG MODE.) CTR THEN SAID RATHER SOFTLY; 'CLB AND MAINTAIN FL230.' SINCE WE WERE ALREADY IN A DSCNT AT ABOUT FL190; I ASKED TO VERIFY THIS CLB ALT. THEY SAID 'AFFIRMATIVE; CLB IMMEDIATELY TO FL230.' THE FO SELECTED VERT SPD MODE AND STARTED CLB. THE ACFT CLBED SLOWLY FROM DSCNT. I TOLD FO TO DISCONNECT AUTOPLT AND COMMENCE CLB. HE HESITATED AND THEN DID DISCONNECT BUT MAINTAINED A CLB OF 800 FPM. I THEN PULLED BACK ON THE YOKE TO GET A FASTER CLB WHILE TELLING FO TO PULL BACK AND ADD PWR SO AS TO GET US CLBING FASTER. ATC THEN ASKED WHY WE HAD NOT TURNED AS REQUESTED 10 MI AGO. I SAID THAT THE HDG WAS SELECTED BUT NOT ENGAGED. HE THEN CLRED US TO KESSEL VOR AND TO DSND BACK TO 17000 FT. AFTER DEALING WITH THE ABOVE; I LEFT COM #1 TO CALL IN RANGE AND BRIEF THE PAX/FLT ATTENDANT. WHILE I CAME BACK I HEARD THE NOW POTOMAC APCH CTLR (WHILE NOW ON THE ROYAL 1 ARR) TELL US TO FLY A HDG TO INTERCEPT THE 248 DEG RADIAL AND RE-ESTABLISH OURSELVES ON THE ARR; MAINTAIN 250 KTS. THE FO SELECTED 250 KTS AND PULLED BACK THE PWR AND ALSO DIALED IN THE HDG AND HIT 'NAV MODE.' THE ACFT IMMEDIATELY TURNED L -- THE WRONG DIRECTION. I TOLD THE FO TO RESELECT HDG MODE. I ORIENTED MYSELF WITH THE ARR CHART AND SAW THE 248 DEG RADIAL WAS ON THE AML VOR; NOT KESSEL VOR. I SELECTED THE AML FREQ IN THE FO'S NAV AND THEN TOLD HIM TO ARM NAV. FINALLY WE WERE BACK ON TRACK. I THEN NOTICED WE WERE DOING 280 KTS. I TOLD HIM TO SLOW BACK TO 250 KTS. I THEN DIALED HIS HDG TO THE NEXT PART OF THE ARR AND NOTICED HE WAS NOW AT 210 KTS. I TOLD HIM TO SPD BACK UP TO OUR ASSIGNED SPD AND ALSO TOLD HIM HE NEEDED TO KEEP HIS INST SCAN UP SO AS TO CATCH THESE SPD DEVS. HE SAID HE DIDN'T KNOW WHY THE AIRPLANE WAS NOT MAINTAINING SPD. I TOLD HIM THIS IS A JET AND IT DOESN'T RESPOND THE SAME AS THE TURBOPROP HE USED TO FLY. WE LANDED WITHOUT FURTHER INCIDENT. CONTRIBUTING FACTORS: FO WAS 2 WKS NEW ONLINE IN THE ACFT. THIS WAS THE 5TH LEG OF THE DAY. HAVING TO GO GREEN NEEDLES RATTLED THE FO. I DON'T THINK HE TOTALLY UNDERSTOOD WHAT WAS GOING ON AS WE WERE NOW FILED IFR AS '/A.' DOING THIS MANY SHORT LEGS IN A JET WITH ONLY 1 FMS IS NOT PRACTICAL. WE NEED 2 FMS'S ON BOARD. TO HAVE TO NAV VOR-TO-VOR WITH NO PWR CARROTS AND NO FUEL USAGE INFO FROM THE FMS IS TOO MUCH ON A SHORT FLT.
Data retrieved from NASA's ASRS site as of May 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.