37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 780739 |
Time | |
Date | 200804 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : teb.airport |
State Reference | NJ |
Altitude | msl bound lower : 1500 msl bound upper : 1800 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | tracon : n90.tracon |
Operator | general aviation : corporate |
Make Model Name | Challenger CL604 |
Operating Under FAR Part | Part 91 |
Navigation In Use | other |
Flight Phase | climbout : takeoff |
Route In Use | departure sid : teb5 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : corporate |
Function | flight crew : first officer |
Qualification | pilot : multi engine pilot : atp pilot : cfi pilot : commercial pilot : instrument |
Experience | flight time last 90 days : 60 flight time total : 5500 flight time type : 300 |
ASRS Report | 780739 |
Person 2 | |
Affiliation | company : corporate |
Function | oversight : pic |
Events | |
Anomaly | non adherence : published procedure |
Independent Detector | other flight crewa |
Resolutory Action | flight crew : returned to assigned altitude |
Supplementary | |
Problem Areas | Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Narrative:
We had been assigned the teb 5 departure from runway 24 at teb. We briefed the departure as usual -- we fly into teb regularly and were familiar with the procedure. However; at some point I set 2000 ft in the altitude selector instead of 1500 ft. As we were approaching 1500 ft; the captain realized that we were not going to level off on autopilot. He disconnected and attempted to level manually; but without inducing negative G's. As such; we floated above 1500 ft by approximately 300 ft. At the same time we were handed off to departure; making the right turn to 280 degrees and preparing to climb to 2000 ft at the 4.5 DME from teb VOR. Departure assigned us a climb to 8000 ft. He did not indicate that we were off altitude or that there were any traffic conflicts. We did not get any TCAS advisories. The rest of the flight was normal. Clearly there was a breakdown in our pre-departure brief in that we did not discover the altitude selector error until it was almost too late. Contributing factors are likely the rushed nature of the departure as our passenger called unexpectedly for a departure 90 minutes earlier than planned. Also a factor in my mind is the fact that just two days prior we had been in teb and departed the teb 5 off of runway 01; which requires a leveloff at 2000 ft instead of 1500 ft. I am very well aware of the importance the altitudes and routing in the teb 5 SID and the frequency of errors in flying it. Again; we fly into teb regularly and are well versed in the departures. Our procedure is to fly in heading mode and use the autoplt as soon as practical to fly the entire procedure. This typically ensures better accuracy in altitude keeping and allows the flying pilot to maintain better situational awareness instead of concentrating solely on flying the airplane. I can offer no definite explanation for the error. I feel that we typically fly in a very well disciplined and professional manner. This was an unfortunate reminder to pay attention and avoid complacency. My only suggestion regarding the teb departures would be to standardize the initial leveloff altitude for all runways when flying the TEB5 SID.
Original NASA ASRS Text
Title: CL604 CREW DEPARTING TEB EXCEEDS 1500 FOOT ALTITUDE RESTR ON TEB 5 SID.
Narrative: WE HAD BEEN ASSIGNED THE TEB 5 DEP FROM RWY 24 AT TEB. WE BRIEFED THE DEP AS USUAL -- WE FLY INTO TEB REGULARLY AND WERE FAMILIAR WITH THE PROC. HOWEVER; AT SOME POINT I SET 2000 FT IN THE ALTITUDE SELECTOR INSTEAD OF 1500 FT. AS WE WERE APCHING 1500 FT; THE CAPT REALIZED THAT WE WERE NOT GOING TO LEVEL OFF ON AUTOPILOT. HE DISCONNECTED AND ATTEMPTED TO LEVEL MANUALLY; BUT WITHOUT INDUCING NEGATIVE G'S. AS SUCH; WE FLOATED ABOVE 1500 FT BY APPROX 300 FT. AT THE SAME TIME WE WERE HANDED OFF TO DEP; MAKING THE R TURN TO 280 DEGS AND PREPARING TO CLB TO 2000 FT AT THE 4.5 DME FROM TEB VOR. DEP ASSIGNED US A CLB TO 8000 FT. HE DID NOT INDICATE THAT WE WERE OFF ALTITUDE OR THAT THERE WERE ANY TFC CONFLICTS. WE DID NOT GET ANY TCAS ADVISORIES. THE REST OF THE FLT WAS NORMAL. CLRLY THERE WAS A BREAKDOWN IN OUR PRE-DEP BRIEF IN THAT WE DID NOT DISCOVER THE ALTITUDE SELECTOR ERROR UNTIL IT WAS ALMOST TOO LATE. CONTRIBUTING FACTORS ARE LIKELY THE RUSHED NATURE OF THE DEP AS OUR PAX CALLED UNEXPECTEDLY FOR A DEP 90 MINUTES EARLIER THAN PLANNED. ALSO A FACTOR IN MY MIND IS THE FACT THAT JUST TWO DAYS PRIOR WE HAD BEEN IN TEB AND DEPARTED THE TEB 5 OFF OF RWY 01; WHICH REQUIRES A LEVELOFF AT 2000 FT INSTEAD OF 1500 FT. I AM VERY WELL AWARE OF THE IMPORTANCE THE ALTITUDES AND ROUTING IN THE TEB 5 SID AND THE FREQUENCY OF ERRORS IN FLYING IT. AGAIN; WE FLY INTO TEB REGULARLY AND ARE WELL VERSED IN THE DEPS. OUR PROC IS TO FLY IN HDG MODE AND USE THE AUTOPLT AS SOON AS PRACTICAL TO FLY THE ENTIRE PROC. THIS TYPICALLY ENSURES BETTER ACCURACY IN ALTITUDE KEEPING AND ALLOWS THE FLYING PLT TO MAINTAIN BETTER SITUATIONAL AWARENESS INSTEAD OF CONCENTRATING SOLELY ON FLYING THE AIRPLANE. I CAN OFFER NO DEFINITE EXPLANATION FOR THE ERROR. I FEEL THAT WE TYPICALLY FLY IN A VERY WELL DISCIPLINED AND PROFESSIONAL MANNER. THIS WAS AN UNFORTUNATE REMINDER TO PAY ATTENTION AND AVOID COMPLACENCY. MY ONLY SUGGESTION REGARDING THE TEB DEPS WOULD BE TO STANDARDIZE THE INITIAL LEVELOFF ALTITUDE FOR ALL RWYS WHEN FLYING THE TEB5 SID.
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.