Narrative:

I was the PF as first officer on a flight to gatwick; from the USA. Descending through approximately FL130; I simultaneously called for the descent and approach checklists. We completed the descent checklist; but I don't recall completing the approach checklist. On the initial approach for ILS DME runway 26L; we were instructed by gatwick director to maintain 2000 ft in accordance with the published approach. We were in IMC throughout the initial approach. At the may fix we started a descent from 4000 ft to 2000 ft. Prior to intercepting final; I noticed we were descending past 1900 ft. I checked the MCP altitude window; which was set to 2000 ft; rechked our pitch mode; and then queried the captain as to why we were descending below the assigned altitude. As we descended below 1800 ft on the first officer altimeter; we discovered that the first officer altimeter was set to 1001 hpa (qnh) while the captain's altimeter was still set to 1013 (qne). With the #1 autoplt selected; the aircraft was descending to 2000 ft in reference to the captain's altimeter. The captain selected vertical speed climb; reset his altimeter to qnh of 1001 and then selected flch for 2000 ft. The aircraft descended to approximately 1700 ft before climbing back to 2000 ft. The remainder of the approach and landing proceeded without incident. Human performance considerations: this altitude deviation occurred because we failed to execute the approach checklist and did not reset and xchk our altimeters to qnh at the transition level. As the PF; I should have immediately disconnected the autoplt and leveled off or climbed to the assigned altitude before attempting to determine the cause of the altitude discrepancy/deviation. Fatigue was a factor in that we did not ensure checklist items were completed; and were slow to recognize the altitude deviation and take corrective action. Supplemental information from acn 804047: during approach to lgw; on vectors to intercept final approach course; we were given a descent from FL60 to 3000 ft with a transition level of FL40. While in descent to 3000 ft; failed to reset altimeter to qnh 1001MB. Upon leveloff at 3000 ft; given further descent to 2000 ft and to intercept final approach cse. Intercepted facility and descended to 2000 ft. We were then advised by approach control; to monitor altitude of 2000 ft; and immediately afterward; told to check altimeter setting of 1001MB. Noticed we were approximately 300 ft low (1001MB versus 1013MB) and initiated climb back to 2000 ft. Were told to switch to tower approximately 30 seconds later; the remainder of approach was uneventful. Events that caused problem: 4TH day of 6 day international trip. Fatigue from flying all night during normal sleep cycle. PF not calling for approach checklist. Failure of pm not backing up PF by inquiring about approach checklist. Relief pilot failing to notice approach checklist not initiated and not backing up transition level. Non standard transition level altitude (FL40). PF (copilot) having relatively few hours (400) in type and at airline. Coupled with low repetition rate (legs) from being in an international category as a new hire. This was the copilot's first FMS aircraft and he admitted to not being confident in using the FMS and MCP. How to prevent this from recurring: resetting altimeter immediately when given descent from fl to lower altitude. Better monitoring; situational awareness; of approach phase by all crew members. New hires not being put into international category until given at least 300 hours in similar domestic category. This is especially true for pilots that have not flown an FMS/glass cockpit aircraft. These pilots need more repetitions utilizing the electronic navigation equipment in use today.

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Original NASA ASRS Text

Title: B767 RPTS ALTDEV ARRIVING EGKK DUE TO ALTIMETER NOT RESET AT TRANSITION LEVEL.

Narrative: I WAS THE PF AS FO ON A FLT TO GATWICK; FROM THE USA. DSNDING THROUGH APPROX FL130; I SIMULTANEOUSLY CALLED FOR THE DSCNT AND APCH CHKLISTS. WE COMPLETED THE DSCNT CHKLIST; BUT I DON'T RECALL COMPLETING THE APCH CHKLIST. ON THE INITIAL APCH FOR ILS DME RWY 26L; WE WERE INSTRUCTED BY GATWICK DIRECTOR TO MAINTAIN 2000 FT IN ACCORDANCE WITH THE PUBLISHED APCH. WE WERE IN IMC THROUGHOUT THE INITIAL APCH. AT THE MAY FIX WE STARTED A DSCNT FROM 4000 FT TO 2000 FT. PRIOR TO INTERCEPTING FINAL; I NOTICED WE WERE DSNDING PAST 1900 FT. I CHKED THE MCP ALT WINDOW; WHICH WAS SET TO 2000 FT; RECHKED OUR PITCH MODE; AND THEN QUERIED THE CAPT AS TO WHY WE WERE DSNDING BELOW THE ASSIGNED ALT. AS WE DSNDED BELOW 1800 FT ON THE FO ALTIMETER; WE DISCOVERED THAT THE FO ALTIMETER WAS SET TO 1001 HPA (QNH) WHILE THE CAPT'S ALTIMETER WAS STILL SET TO 1013 (QNE). WITH THE #1 AUTOPLT SELECTED; THE ACFT WAS DSNDING TO 2000 FT IN REF TO THE CAPT'S ALTIMETER. THE CAPT SELECTED VERT SPD CLB; RESET HIS ALTIMETER TO QNH OF 1001 AND THEN SELECTED FLCH FOR 2000 FT. THE ACFT DSNDED TO APPROX 1700 FT BEFORE CLBING BACK TO 2000 FT. THE REMAINDER OF THE APCH AND LNDG PROCEEDED WITHOUT INCIDENT. HUMAN PERFORMANCE CONSIDERATIONS: THIS ALTDEV OCCURRED BECAUSE WE FAILED TO EXECUTE THE APCH CHKLIST AND DID NOT RESET AND XCHK OUR ALTIMETERS TO QNH AT THE TRANSITION LEVEL. AS THE PF; I SHOULD HAVE IMMEDIATELY DISCONNECTED THE AUTOPLT AND LEVELED OFF OR CLBED TO THE ASSIGNED ALT BEFORE ATTEMPTING TO DETERMINE THE CAUSE OF THE ALT DISCREPANCY/DEV. FATIGUE WAS A FACTOR IN THAT WE DID NOT ENSURE CHKLIST ITEMS WERE COMPLETED; AND WERE SLOW TO RECOGNIZE THE ALTDEV AND TAKE CORRECTIVE ACTION. SUPPLEMENTAL INFO FROM ACN 804047: DURING APCH TO LGW; ON VECTORS TO INTERCEPT FINAL APCH COURSE; WE WERE GIVEN A DSCNT FROM FL60 TO 3000 FT WITH A TRANSITION LEVEL OF FL40. WHILE IN DSCNT TO 3000 FT; FAILED TO RESET ALTIMETER TO QNH 1001MB. UPON LEVELOFF AT 3000 FT; GIVEN FURTHER DSCNT TO 2000 FT AND TO INTERCEPT FINAL APCH CSE. INTERCEPTED FAC AND DSNDED TO 2000 FT. WE WERE THEN ADVISED BY APCH CTL; TO MONITOR ALT OF 2000 FT; AND IMMEDIATELY AFTERWARD; TOLD TO CHK ALTIMETER SETTING OF 1001MB. NOTICED WE WERE APPROX 300 FT LOW (1001MB VERSUS 1013MB) AND INITIATED CLB BACK TO 2000 FT. WERE TOLD TO SWITCH TO TWR APPROX 30 SECONDS LATER; THE REMAINDER OF APCH WAS UNEVENTFUL. EVENTS THAT CAUSED PROB: 4TH DAY OF 6 DAY INTL TRIP. FATIGUE FROM FLYING ALL NIGHT DURING NORMAL SLEEP CYCLE. PF NOT CALLING FOR APCH CHKLIST. FAILURE OF PM NOT BACKING UP PF BY INQUIRING ABOUT APCH CHKLIST. RELIEF PLT FAILING TO NOTICE APCH CHKLIST NOT INITIATED AND NOT BACKING UP TRANSITION LEVEL. NON STANDARD TRANSITION LEVEL ALT (FL40). PF (COPLT) HAVING RELATIVELY FEW HRS (400) IN TYPE AND AT AIRLINE. COUPLED WITH LOW REPETITION RATE (LEGS) FROM BEING IN AN INTL CATEGORY AS A NEW HIRE. THIS WAS THE COPLT'S FIRST FMS ACFT AND HE ADMITTED TO NOT BEING CONFIDENT IN USING THE FMS AND MCP. HOW TO PREVENT THIS FROM RECURRING: RESETTING ALTIMETER IMMEDIATELY WHEN GIVEN DSCNT FROM FL TO LOWER ALT. BETTER MONITORING; SITUATIONAL AWARENESS; OF APCH PHASE BY ALL CREW MEMBERS. NEW HIRES NOT BEING PUT INTO INTL CATEGORY UNTIL GIVEN AT LEAST 300 HRS IN SIMILAR DOMESTIC CATEGORY. THIS IS ESPECIALLY TRUE FOR PLTS THAT HAVE NOT FLOWN AN FMS/GLASS COCKPIT ACFT. THESE PLTS NEED MORE REPETITIONS UTILIZING THE ELECTRONIC NAV EQUIP IN USE TODAY.

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.