 |
37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Air carrier flight crew misunderstands revised segment of pre departure clearance departing iad and has track deviation.
| Attributes | |
| ACN | 786803 |
| Time | |
| Date | 200805 |
| Local Time Of Day | 1801 To 2400 |
| Place | |
| Locale Reference | navaid : hnn.vortac |
| State Reference | VA |
| Altitude | msl single value : 38000 |
| Environment | |
| Light | Daylight |
| Aircraft 1 | |
| Controlling Facilities | artcc : zid.artcc |
| Operator | common carrier : air carrier |
| Make Model Name | Medium Large Transport |
| Operating Under FAR Part | Part 121 |
| Navigation In Use | other |
| Flight Phase | cruise : level |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | flight crew : captain oversight : pic |
| ASRS Report | 786803 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | flight crew : first officer |
| ASRS Report | 786802 |
| Events | |
| Anomaly | non adherence : clearance other spatial deviation |
| Independent Detector | other controllera |
| Resolutory Action | controller : issued advisory |
| Consequence | faa : reviewed incident with flight crew |
| Supplementary | |
| Problem Areas | Flight Crew Human Performance ATC Human Performance |
| Primary Problem | Flight Crew Human Performance |
Narrative:
Flight plan clearance read 'iad ldn J134 flm KK57I -- ZZZ.' pre departure clearance clearance read; '******filed clearance **** iad ldn J134 flm **** ZZZ **** revised segment **** -blues ldn J134 hnn-.' checked routing on chart and noticed that only fix on J134 after ldn was flm. Discussed revised segment with first officer and mistakenly read the removal of ldn as part of the change. First officer had initially programmed CDU correctly to read; 'hnn direct flm direct KK571.' with thirty plus years of flying I should have known that anything after a change is; 'as filed.' had the pre departure clearance read; 'blues ldn J134;' it would have reduced the potential for misinterpretation.
Original NASA ASRS Text
Title: ACR FLT CREW MISUNDERSTANDS REVISED SEGMENT OF PDC DEPARTING IAD AND HAS TRACK DEV.
Narrative: FLT PLAN CLEARANCE READ 'IAD LDN J134 FLM KK57I -- ZZZ.' PDC CLEARANCE READ; '******FILED CLEARANCE **** IAD LDN J134 FLM **** ZZZ **** REVISED SEGMENT **** -BLUES LDN J134 HNN-.' CHECKED ROUTING ON CHART AND NOTICED THAT ONLY FIX ON J134 AFTER LDN WAS FLM. DISCUSSED REVISED SEGMENT WITH FO AND MISTAKENLY READ THE REMOVAL OF LDN AS PART OF THE CHANGE. FO HAD INITIALLY PROGRAMMED CDU CORRECTLY TO READ; 'HNN DIRECT FLM DIRECT KK571.' WITH THIRTY PLUS YEARS OF FLYING I SHOULD HAVE KNOWN THAT ANYTHING AFTER A CHANGE IS; 'AS FILED.' HAD THE PDC READ; 'BLUES LDN J134;' IT WOULD HAVE REDUCED THE POTENTIAL FOR MISINTERPRETATION.
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.