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Incidents related to Issue 41 incidents related to this issue.

Issue: programming may be susceptible to error (Issue #170)
Description: Programming methods for the FMS/autopilot may be susceptible to error.

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  2. Accession Number: 362260
    Synopsis: AN ACR FLC ON A B737 CROSS RADDS INTXN TOO HIGH WHEN THE CAPT ENTERS THE WRONG XING POINT INTO THE FMC. NO CONFLICT.
    Narrative: FO WAS OUT OF COCKPIT TO USE BATHROOM. CAPT RECEIVED CLRNC TO CROSS RADDS INTXN AT 15000 FT. CAPT PUT 15000 FT OVER SEI VOR BY MISTAKE INTO THE FMC. AFTER XING RADDS INTXN AT FL230, CTR ASKED IF A CLRNC HAD BEEN ISSUED TO CROSS RADDS INTXN AT 15000 FT. CREW THEN REALIZED THE MISTAKE AND DSNDED. ATC ADVISED THERE WAS NO CONFLICT WITH TFC, BUT WANTED TO SEE IF PAST CTLR HAD ISSUED CLRNC.

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  4. Accession Number: 364000
    Synopsis: FLC OF A B737-400 FAILED TO DSND IN A TIMELY MANNER TO MAKE AN ALT XING RESTR. FMC WAS NOT PROGRAMMED WITH NEW DSCNT ALT.
    Narrative: RECEIVED DSCNT CLRNC TO CROSS JAYBO INTXN AT 15000 FT. I (PNF) READ BACK THAT CLRNC. FMC HAD 15000 FT AT HEDGE INTXN, WHICH IS 9 DME PAST JAYBO INTXN. AS I WAS ABOUT TO BRING THE ERROR TO THE CAPT'S ATTN, HE BROUGHT DOWN 15000 FT TO THE SCRATCH PAD. BEING DUSK, LOOKING INTO THE SUN, AND THE GLARE MAKING VIEWING HIS FMC DIFFICULT, I FAILED TO CONFIRM THE CHANGE. PAST JAYBO, I CHKED THE DSCNT PAGE AND REALIZED THE FMC HAD NOT BEEN CHANGED AND WE HAD MISSED THE RESTR. MY INACTION TO CONFIRM THE PROPER XING RESTR HAD BEEN EXECUTED BY THE PF WAS THE RESULT OF: 1) THE PF WAS COMPETENT AND NOT PRONE TO MAKING SUCH A MAJOR MISTAKE, THEREFORE, LEADING ME IN ASSUMING THE CORRECTION WAS MADE. 2) INTENSE GLARE MAKING VIEWING THE FMC DIFFICULT. 3) SEEING THE PF BRING DOWN 15000 FT TO THE SCRATCH PAD, I WAS CONFIDENT HE WAS AWARE OF THE ERROR IN THE FMC. 4) 15000 FT IS PLAINLY NOTED ON THE ARR AS THE ALT TO EXPECT AT JAYBO, NOT HEDGE. 5) I ASSUMED MY READBACK OF THE PROPER RESTR WAS HEARD BY THE PF, IN ADDITION TO ATC'S INSTRUCTION.

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  6. Accession Number: 364030
    Synopsis: MD88 FLC FAILS TO CATCH THEIR FMS PROGRAM ERROR WHILE ENRTE ON A STAR ARR. ATC CATCHES THE OFF COURSE DEV AND SENDS THEM DIRECT TO THEIR NEXT POINT.
    Narrative: FLT DEPARTED IND VIA THE DAWNN 1 DEP/BWG TRANSITION AND WAS FLT PLANNED TO ATL VIA THE ROME 8 ARR FROM BWG. SHORTLY AFTER PASSING BWG ZME REQUESTED OUR NEXT NAV FIX, WE RESPONDED RMG AND CTR STATED HE SHOWED OUR POS E OF COURSE. WE WERE NOW 20-40 NM S OF BWG HDG 160 DEGS TO RMG. FMS WAS OPERATIONAL AND BEING TRACKED BY AUTOPLT. AT THIS POINT WE DETERMINED THE TRANSITION OVER BWG HAD NOT TAKEN US VIA THE ROME 8 BWG TRANSITION BUT DIRECTLY TO RMG (HDG APPROX 15 DEGS E OF COURSE). AS WE WERE XREFING OUR POS, CTR STATED NO PROB AND JUST PROCEED DIRECT RMG. FLT CONTINUED WITHOUT INCIDENT. 2 POSSIBLE CAUSES WERE DISCUSSED BY FLC. 1) ON INITIAL FMS PROGRAMMING THE ARR TRANSITION WHICH SHARED A COMMON FIX WITH THE DEP TRANSITION ACCEPTED THE COMMON FIX OF BWG BUT WAS ENTERED IN SUCH A MANNER THE FMS TOOK THE ENTRY AS A REQUEST FOR DIRECT BWG-RMG AND NOT THE BWG TRANSITION TO RMG. 2) THE FMS WAS PROGRAMMED AS FLT PLANNED AND A SUBSEQUENT ENTRY CHANGED THE TRANSITION TO A DIRECT LEG. BOTH PLTS HAD REVIEWED THE DATA ENTRY ON PREFLT. RTE AND FLT PLAN WERE VERIFIED. CREW BELIEVES THEY WOULD HAVE NOTICED THE DIFFERENCE IN HEADING/RTE AS CHANGE FROM DEP CHART TO ARR CHART WAS MADE. THIS WAS IN PROCESS OF HAPPENING AFTER PASSING COMMON POINT OF BWG AND ABOUT THE TIME CTR CONTACTED THE FLT.

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  8. Accession Number: 365130
    Synopsis: FLC OF A B767-200 OVERSHOT DSCNT XING ALT DURING A STAR ARR DUE TO THE CAPT SELECTING THE WRONG FMC MODE CTL.
    Narrative: FLT WAS ON BOARD A B767-200 AND WAS CLRED TO DSND VIA THE CIVIT ARR TO LAX. THE CAPT WAS PF. I WAS BUSY WITH COMPANY DUTIES, EG, CALLING COMPANY OPS FOR GATE ASSIGNMENT, ALERTING THE CABIN CREW TO PREPARE FOR ARR. ORIGINALLY, THE CAPT WAS DSNDING USING VNAV AND IT HAD BEEN PERFORMING SATISFACTORY. I RECALL BEING GIVEN AN AIRSPD ASSIGNMENT OF '300 KTS OR GREATER.' I NOTICED THAT HIS AIRSPD BUG DROPPED TO 250 KTS (DUE TO VNAV PREPARING TO DSND BELOW 10000 FT OR POSSIBLY BEING PROGRAMMED TO CROSS BREMR AT 250 KTS AND GREATER THAN OR EQUAL TO 12000 FT. WHEN PAUSING BTWN TASKS, I NOTICED WE WERE 8 NM FROM BREMR AND WERE DSNDING THROUGH APPROX 13300 FT. I NOTICED THAT THE CAPT WAS TRYING TO OVERRIDE THE SPD REDUCTION BY SELECTING 300 KTS ON THE MCP. I ASSUMED THAT HE WAS USING VNAV SPD INTERVENTION. THEREFORE, I ASSUMED THAT THE AUTOPLT WAS GOING TO LEVEL OFF AT 12000 FT TO MAKE THE XING AT BREMR AT OR ABOVE 12000 FT (D40 LAX). AFTER MY INCORRECT ASSUMPTION, I ADVISED THE CAPT THAT WE WERE GOING THROUGH 12000 FT -- A RECHK OF THE SID CONFIRMED THE REQUIREMENT. WE WERE 4 MI FROM BREMR AND DSNDING THROUGH 11700 FT! THE CAPT AND I WERE BOTH PERPLEXED AS TO WHY THE AUTOPLT DID NOT LEVEL OFF AT 12000 FT. IT TURNS OUT THAT THE AUTOPLT WAS DOING EXACTLY AS IT WAS TOLD TO DO. THE CAPT HAD SELECTED FLT LEVEL CHANGE, 10000 FT WAS THE SELECTED ALT -- THE LOWEST ALT ON THE ARR. THE CAPT WAS FIXATING ON HIS AIRSPD, I WAS DISTR BY MISC DUTIES AND FAILED TO XCHK THE AUTOFLT MODE IN USE.

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  10. Accession Number: 365550
    Synopsis: FLC OF A DO328 FAILED TO FOLLOW THEIR FPR DUE TO AN ERROR IN THEIR FMC STORED FLT PLAN RESULTING IN ATC INTERVENTION TO BRING THEM BACK ON COURSE.
    Narrative: I WAS THE CAPT OF FLT FROM GJT TO COS. OUR CLRNC WAS AS FILED WHICH WAS GJT-JNC-HBU J28 DIRECT COS 168 DEG RADIAL AT 38 DME TO COS. WE PROGRAMMED THE FMS WITH A STORED FLT PLAN WHICH WE THOUGHT WAS CORRECT, BUT THE STORED FLT PLAN WAS IN ERROR FROM THE POINT AFTER HBU VOR. THE STORED FLT PLAN WENT FROM HBU DIRECT COS AND NOT J28 TO THE COS 168 DEG RADIAL AT 38 DME. AS WE APCHED THE HBU VOR, I BEGAN TO LOOK UP SOME PERFORMANCE DATA IN THE ACFT'S POH. THE FO WAS THE PF AND HE WAS TRACKING THE FMS COURSE. I WAS BACKING HIM UP USING VOR NAV. AFTER PASSING THE HBU VOR, THE FO TRACKED A COURSE DIRECT TO COS WHICH WAS APPROX THE 050 DEG RADIAL FROM HBU AND NOT THE 080 DEG RADIAL, WHICH WOULD HAVE BEEN J28. I HAD NEGLECTED TO MONITOR THIS BECAUSE I WAS LOOKING UP SOME PERFORMANCE DATA. AFTER ABOUT 30 MI, CTR CAME ON FREQ AND SAID, FLT XX TURN R 20 DEGS -- YOU ARE NOW CLRED J28 TO THE COS 168 DEG RADIAL AT 38 DME COS, WHICH WAS HOW WE WERE CLRED BEFORE. I THEN REALIZED WHAT WAS WRONG AND REPROGRAMMED THE FMS CORRECTLY. ANOTHER CONTRIBUTING FACTOR WAS THAT THE FO WAS NOT MONITORING HIS MOVING MAP DISPLAY CORRECTLY BECAUSE HE HAD THE SCALE DOWN TO LOW SO THAT IT DID NOT SHOW HIS NEXT WAYPOINT WHICH IF HE HAD SEEN IT, HE WOULD HAVE REALIZED HE WAS PROCEEDING DIRECT TO COS AND NOT THE 168 DEG RADIAL AT 38 DME OFF COS FIX.

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  12. Accession Number: 365580
    Synopsis: FLC OF A DHC8 FAILED TO FOLLOW THE DEP TRACK DURING CLBOUT CAUSING ATC TO INTERVENE AND PROVIDE A DIRECT COURSE TO THE NEXT FLT PLAN FIX.
    Narrative: I AM AN INSTRUCTOR PLT (FLT AND SIMULATOR) FOR ACR X. THIS WAS MY FIRST LINE TRIP IN 12 MONTHS AND I WAS FLYING WITH A LINE CHK AIRMAN DUE TO THE FACT I WAS EXPIRED FOR A LINE CHK AND COULD NOT ACT AS PIC. I AM A CAPT AND WAS OCCUPYING THE L SEAT. DURING OUR PREDEP PREPARATION, IT WAS NOT NOTICED THAT ON OUR FLT PLAN (WHICH INVOLVES AT SOME POINT INTERCEPTING THE HAR 039 DEG RADIAL) WAS NOT PROGRAMMED INTO THE KNS 660 RNAV (THE HAR 039 DEG PORTION). WE DEPARTED AND WERE CLRED TO JOIN THE 039 DEG RADIAL. I WAS NAVING USING THE RMI SINCE HE HAD SELECTED THE HAR 039 DEG RADIAL ON HIS HSI. HE NOTICED THIS AND SAW IT WASN'T PROGRAMMED IN THE KNS 660. HE THEN PROGRAMMED IT IN. THE ONLY PROB WAS HE PROGRAMMED HAR 03939 (39 DME). THE AIRWAY IS INTERCEPTED (THE SEG 101 DEG RADIAL) AT 29 DME. HE HAD DIALED IN THE SEG 101 DEG RADIAL BEFORE HE STARTED PROGRAMMING THE KNS 660. WE THEN NOTICED WE HAD FLOWN THROUGH THE COURSE AND WAS TURNING TO INTERCEPT WHEN ZNY ADVISED US WE MISSED THE AIRWAY AND CLRED US TO GO DIRECT FJC VOR. NOTHING FURTHER WAS SAID BY HIM. WE WERE ABOUT THE SEG 101 DEG RADIAL AND 8 DME WHEN WE FLEW THROUGH AIRWAY ABOUT 10 DEGS, SO I DOUBT WE WERE ACTUALLY OFF THE AIRWAY.

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  14. Accession Number: 366334
    Synopsis: B757 ON BORDER 4 SID GOT A MAP SHIFT OF 43 PT 7 MI AT 400 FT. DEP CTLR VECTORED TO COURSE. REVERTED TO MANUAL ON VOR MODE REMAINDER OF FLT. AT CRUISE ALT FOUND HAD USED LATITUDE AND LONGITUDE FOR SNA VERSUS SAN.
    Narrative: BORDER 4 DEP FROM SAN. NORMAL TKOF TILL 400 FT MSL, MAP SHIFT OF 43.7 NM OCCURRED. LOST SITUATIONAL AWARENESS FOLLOWED FLT DIRECTOR. START L TURN AT 4 DME INSTEAD OF 19 DME. DEP CTLR ISSUED RADAR VECTORS. REVERTED TO MANUAL ON VOR MODE AND FLEW TO DEST. AT CRUISE ALT, I DISCOVERED THAT I ENTERED SNA LATITUDE AND LONGITUDE ON THE POS PAGE OF THE FMS INSTEAD OF SAN LATITUDE AND LONGITUDE. ON CLB AT 400 FT, FMS UPDATE WITH VORS CAUSED MAP SHIFT. IN THE FUTURE I WILL BE DOUBLECHKING LATITUDE AND LONGITUDE VERY, VERY CAREFULLY.

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  16. Accession Number: 367311
    Synopsis: FLC DEV FILED BY ATC ON B767 FLC. FO USED THE WRONG SID FOR FMC AND VOR RADIAL INPUT. CAPT FAILED TO CATCH ERROR ON PREFLT. POTENTIAL CONFLICT OCCURRED.
    Narrative: DURING CLBOUT AT JFK A CONFLICT OCCURRED WITH ANOTHER ACFT. WE WERE CLRED TO FLY THE KENNEDY 7 DEP AND THE BREEZY POINT CLB. DURING PREFLT, I CHKED THE RTE IN THE FMC AGAINST THE FLT PLAN AND EVERYTHING MATCHED. THE FLT PLAN STARTED AT ROBBINSVILLE SO I STEPPED THROUGH IT WITH THAT FIRST POINT. THEN I WENT BACK AND CHKED THE DEP IN THE FMC WHICH THE FO HAD BUILT. THE RTE WAS BUILT TO FLY DIRECT CRI THEN OUTBOUND TO A POINT 50 NM ON THE OTHER SIDE OF CRI. I VISUALLY LOOKED AT THE RTE DRAWN AND IT LOOKED CORRECT AS DISPLAYED ON THE HSI. WITH THE KENNEDY VOR DIALED IN AND THE 223 DEG RADIAL SET ON MY VOR TUNER I WAS FINISHED. THE FO STATED HE ALSO HAD THE DEP VOR AND RADIAL SET IN HIS VOR TUNER. I DID NOT NOTICE THAT HE HAD ENTERED 176 DEGS IN THE VOR INSTEAD OF 223 DEGS AND HAD DONE THE SAME IN THE FMC. THE 176 DEG IS USED FOR THE 'CRI.' CLB OUT. ON CLB OUT, FLYING THE BUILT LNAV DEP, WE WERE FLYING OUT THE WRONG RADIAL. ATC ADVISED US TO INCREASE OUR RATE OF CLB AND SHORTLY AFTERWARDS WE HAD AN RA ON THE TCASII. WE HAD VISUAL CONTACT ON THAT ACFT AND PASSED ABOVE THE ACFT. ATC THEN VECTORED US TO THE R TO INTERCEPT THE 223 DEG RADIAL. THE CTLR TOLD US TO CALL NY DEP UPON LNDG. I CALLED THEM AND THEY SAID A PLTDEV WOULD BE FILED. SUPPLEMENTAL INFO FROM ACN 367310: WHEN I WAS PROGRAMMING THE CDU FOR THE BREEZY POINT CLB, I INCORRECTLY PUT THE 176 DEG RADIAL OUT OF CRI INSTEAD OF THE 223 DEG RADIAL. I BACKED UP THE 176 DEG RADIAL ON THE VOR SO THAT THE 2 RADIALS AGREED. WHEN I WAS READING THE BREEZY POINT CLB PROCS I LOOKED DOWN AT THE CANARSIE CLB BY MISTAKE AND USED THE WRONG RADIAL. MY BACKUP WAS THE WRONG RADIAL SO THE WRONG RADIALS MATCHED.

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  18. Accession Number: 367361
    Synopsis: B757 ON BEARR 2 STAR SLC CLRED TO HOLD AT BYI AS PUBLISHED, VERY CLOSE TO THE VOR. FO, PF, ON IOE FLT AND WAS RUSHED IN SETTING UP THE HOLD. IN ERROR HE PROGRAMMED A L TURN VERSUS R TURN AT BYI. IN CHKING THE CHART HE MISREAD BEARR HOLDING PATTERN FOR BYI. ONE TURN IN THE PATTERN AT BYI AND THEN CLRED STAR. NO COMMENT FROM CTLR.
    Narrative: FLT CLRED TO SLC VIA BEARR 2 ARR, BYI TRANSITION AT FL370. APPROX 20 NM W OF BYI, CLRNC RECEIVED TO CROSS POINT 35 MI SE OF BYI AT FL310. THE FO WAS PF AND WAS ON HIS B757 OPERATING EXPERIENCE FLTS. I AM A B757 LINE CHK AIRMAN. WHILE HE WAS PROGRAMMING THE FMC FOR DSCNT, CTR CALLED AND SAID, 'APCH CTL HAS STOPPED ACCEPTING ARRS, MAINTAIN FL370 AND HOLD AT BYI AS PUBLISHED ON THE BEARR 2 ARR, LEG LENGTH OUR OPTION, NO IDEA HOW LONG HOLD WILL BE BUT EFC AC30Z.' AT THIS TIME WE WERE RAPIDLY ACHING BYI, THE HOLDING FIX. FO QUICKLY REPROGRAMMED FMC FOR HOLD AT FL370 AND SLOWED ACFT RAPIDLY TO HOLDING SPD. HE MISREAD THE PUBLISHED DIRECTION OF HOLD, SEEING THE NON STANDARD PATTERN IN THE CTR OF THE CHART AT BEARR INTXN. I FAILED TO CATCH THE ERROR. WE MADE ONE L-HAND PATTERN, WHICH SHOULD HAVE BEEN R-HAND, BEFORE BEING CLRED OUT OF HOLDING TO CONTINUE ON THE ARR. NO COMMENT FROM ATC REGARDING OUR ERROR. JUST TOO MUCH TO DO IN TOO LITTLE TIME, COMPOUNDED BY TURB AND LACK OF EXPERIENCE ON ONE PLT'S PART. IT SEEMS IMPOSSIBLE TO ANTICIPATE EVERYTHING. SUPPLEMENTAL INFO FROM ACN 367360: THE CLOSE PROX OF THE 2 HOLDING PATTERNS MAY HAVE CONTRIBUTED TO FOCUSING ON THE BEARR HOLDING PATTERN.

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  20. Accession Number: 368880
    Synopsis: AN ACR B757 FLC FLEW THE WRONG COURSE ON DEP FROM MIA. ALERT DEP CTLR CORRECTED THEM.
    Narrative: I FLEW LEG AS CAPT. I DID NOT FOLLOW PROPERLY THE VALLY TRANSITION ON THE MIA 7 SID. AFTER TKOF, DEP CTL GAVE US 090 DEG HDG TO INTERCEPT VALLY TRANSITION. I SET 090 DEGS IN HDG WINDOW AND PRESSED HDG SELECT. I ARMED LNAV. HSI/FLT DIRECTOR ENGAGED LNAV A FEW SECONDS LATER. I OBSERVED THAT COURSE LINE ON HSI CONNECTED WITH VALLY INTXN. I FOLLOWED THE FLT DIRECTOR COMMANDS. DEP CTL THEN ASKED FOR VERIFICATION OF OUR HDG. WE REALIZED THEN THAT WE HAD FAILED TO CORRECT THE LNAV RTE TO REFLECT THE SID COURSE FROM VKZ TO VALLY, BUT HAD FLOWN INSTEAD THE MIA DIRECT VALLY COURSE THAT HAD BEEN DOWNLOADED TO THE FMS. CAPT AND FO HAD VERIFIED THAT ACARS PDC MATCHED FLT PLAN AND THAT FLT PLAN FIXES MATCHED FMC DOWNLOADED RTE FIXES. THESE ACTIONS ALONE DID NOT CATCH THE ERROR IN THE LNAV RTE RELATED TO THE SID. I SUSPECT THAT OURS WAS NOT AN UNCOMMON ERROR. PERHAPS PLACING THE SID ABOVE AND ADJACENT TO THE ACARS PDC RTE, INSTEAD OF IN THE TEXT AT THE BOTTOM OF THE MESSAGE, WOULD HELP PREVENT THIS TYPE OF MISTAKE. ALSO, A MESSAGE ADVISING CREWS TO BE ALERT FOR THIS PARTICULAR MISTAKE MIGHT HELP, SINCE THE POTENTIAL ERROR IS BUILT INTO THE DOWNLOADED FMC RTE. OF COURSE, BOTTOM LINE IS THAT MY INADEQUATE ATTN TO DETAIL CAUSED THE DEV. CONTRIBUTING FACTORS WERE FATIGUE FROM SHORT LAYOVER AND PICKUP AND CONFUSION IN THE COCKPIT RELATED TO MAINT AND PAX PROBS, BOTH BEFORE AND AFTER WE LEFT THE GATE.

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  22. Accession Number: 372780
    Synopsis: CL65 ACFT IN CLB, ON SID, DEVIATED FROM THE SID DUE TO MISPROGRAMMED FMC. CTLR INTERVENED AND GAVE A DIRECT CLRNC.
    Narrative: DURING THE PUSHBACK/TAXI OUT PHASE, OUR DEP CLRNC CHANGED FROM MINNEAPOLIS 6 DEP TO THE SNINE ONE DEP. THE FMS WAS RE-PROGRAMMED BY CAPT. THE FIRST FIX SNINE WAS VERIFIED BY MYSELF IN CONJUNCTION WITH ALL THE TAXI AND BEFORE TKOF CHKS I WAS ALSO RESPONSIBLE FOR DURING THIS PHASE OF ACFT MOVEMENT. I WOULD COMPLETE THE VERIFICATION PROCESS OF THE FLT PLAN RTE ONCE AIRBORNE. UPON COMPLETION OF MY CLB CHK, 10000 FT CHK, AND TALKING TO THE PAX, WHICH INDICATED A NON STERILE COCKPIT, I FINISHED THE VERIFICATION. THIS WAS ALMOST SIMULTANEOUS WITH XING SNINE INTXN. I NOTICED WE WERE HEADED FOR GREEN BAY VOR INSTEAD OF GEEZE INTXN. I TOLD THE CAPT AND JUST THEN ZMP VERIFIED OUR RTE OF FLT. THE CAPT ADMITTED THAT GEEZE WAS NOT PROGRAMMED IN THE FMS AND HE WAS WILLING TO CORRECT IT IMMEDIATELY. HOWEVER, CTR CLRED US DIRECT TO GREEN BAY. THERE WAS NO CONFLICT WITH ANOTHER ACFT.

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  24. Accession Number: 373260
    Synopsis: AN ACR MLG FLC CROSSED A DSCNT FIX 3000 FT HIGH. THEY IMPROPERLY ENTERED THE XING FIX IN THE FMC AND DID NOT MONITOR THE ACFT'S PROGRESS.
    Narrative: MISSED ASSIGNED XING RESTR BY APPROX 3000 FT, 'CROSS BLD 16000 FT 25 MI AT 12000 FT.' REASON: ENTERED THE 12000 FT RESTR ON THE FMC AT BLD VERSUS THE BLD 160 DEG/25 MI FIX. FAILED TO XCHK DSCNT/RESTR PROGRESS WITH VOR!

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  26. Accession Number: 373340
    Synopsis: B737 FLC ENTERS WRONG FIX IN FMC. ATC CAUGHT THE ERROR AND GAVE VECTORS TO CORRECT. THEY LEVELED OFF AT CORRECT ALT.
    Narrative: AIRLINE FLT SLC TO LAS, THE CTR GAVE US A FIX OF LAS 240 DEG RADIAL AT 40 DME, 12000 FT. THE CAPT'S LEG, HE MISTAKENLY PUT LAS 240 DEGS/50 DME IN FMC-FIX PAGE. AS WE APCHED THE IMPROPER FIX THE CTLR QUESTIONED OUR POS AND GAVE US A HEADING TO CORRECT OUR POS. WE DID SO AND LEVELED AT 12000 FT. END OF EVENT. PRIMARY CAUSE FOR ERROR WAS NOT DOUBLE-CHKING INPUTS AND BACKING UP WITH CONFIRMATION FROM OTHER PLT. ALSO FATIGUE A MAJOR FACTOR 3RD LEG OF TRIP 10+ HRS OF DUTY GOING INTO DAY 3 OF 4 DAY TRIP. I THINK THE INDUSTRY, FAA, ACR, SHOULD CONSIDER LOWER DUTY DAY PERIOD REQUIREMENTS AS WE FLY NIGHT PAIRINGS WHEN THE BODY IS ADJUSTING TO IMPROPER REST.

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  28. Accession Number: 373360
    Synopsis: AN ACR B737 FLC CROSSED AN ASSIGNED XING POINT 1000 FT TOO HIGH. ERROR ADMITTED. NO CONFLICT.
    Narrative: GIVEN 20 MI SE BYI AT FL270 WHILE ON BEARR.BEARR2 ARR. STARTED DSCNT EARLY TO EASILY MAKE RESTR. WHILE DSNDING I WENT OFF TO RETRIEVE ATIS. AFTER RETURN FROM ATIS NOTED WE CROSSED RESTR AT FL280 DSNDING. NO QUERY BY CTR. MY COMMENTARY: THIS RESTR SHOULD BE NOTED ON THE STAR, ESPECIALLY SINCE THIS IS GIVEN EVERY TIME OR SO IT APPEARS. MY FO MENTIONED THAT ALTHOUGH HE ACKNOWLEDGED THE CLRNC HE FIXATED ON THE FMS AND ACTUALLY SHALLOWED THE DSCNT TO MAKE FL270 AT THE NEXT POINT ON THE FMS.

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  30. Accession Number: 373860
    Synopsis: AN ACR B757 FLC MISPROGRAMMED THEIR FMC AND CROSSED A NAV POINT 1000 FT TOO HIGH.
    Narrative: FAILED TO CROSS SAYGE INTXN AT FL190. FMC HAD BEEN PROGRAMMED TO CROSS AT FL200.

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  32. Accession Number: 374080
    Synopsis: A COMMERCIAL FIXED WING LGT ON CLBOUT WAS DIRECTED BY ATC TO THE CORRECT DEP OUTBOUND HDG DUE TO THE FMS BEING LOADED INCORRECTLY.
    Narrative: ATC RADIOED AN INQUIRY ON OUR INTERCEPTING THE DEP OUTBOUND. THE FMS HAD BEEN LOADED WITH THE INCORRECT OUTBOUND COURSE AND THE PF WAS FOLLOWING THAT INFO. ATC VECTORED US BACK TO COURSE AND RAW DATA WAS USED INSTEAD OF FMS DATA.

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  34. Accession Number: 374570
    Synopsis: FLC OF AN MLG UNDERSHOT XING ALT RESTR DURING DSCNT ON A STAR ARR DUE TO IMPROPER PROGRAMMING OF FMC FOR THE RATE OF DSCNT NEEDED FOR XING ALT RESTR.
    Narrative: WE WERE CLRED TO CROSS ARGAL AT 10000 FT BY ZDC. FMS WAS IN PROFILE AND WAS PROGRAMMED TO CROSS ARGAL AT 250 KTS AND 10000 FT. 10000 FT WAS SELECTED AND ARMED IN ALT WINDOW. IMMEDIATE DSCNT SELECTED IN FMS. WE EVENTUALLY LEVELED AT 10000 FT APPROX 5 NM PAST ARGAL.

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  36. Accession Number: 374700
    Synopsis: FLC OF MDT NEGLECTS TO UPDATE FMS FLT PLAN RESULTING IN HDG DEV TO WRONG VOR. RADAR CTLR CAUGHT THE ERROR.
    Narrative: DURING PREPARATIONS FOR A FLT FROM CVG TO SYR, THE FMS WAS INITIALIZED AND THE COMPANY-STORED FLT PLAN WAS PULLED UP AND WAS CHKED AGAINST OUR FLT RELEASE ROUTING AND ATC CLRNC. WE BOTH LOOKED AT THE RTES, BELIEVED THEY MATCHED AND ACTIVATED/EXECUTED THE FMS FLT PLAN. I WAS THE PNF. DURING CRUISE CLB, PASSING APPROX FL230 AND APPROX 10 NM N OF THE FFO VOR, THE ZID CTLR ASKED IF WE 'WERE NAVING TO ROD.' I RESPONDED 'AFFIRMATIVE.' THE CTLR REPLIED, 'NEGATIVE, NEGATIVE, TURN R TO 060 DEGS.' WE COMPLIED AND CONTINUED CLBING WHILE RECHKING OUR ROUTING. ROD WAS NOT ON IT. THE RTE READ IN PART: FFO DIRECT DJB. THE FMS WAS PROGRAMMED TO FLY FFO DIRECT ROD DIRECT DJB. IN RETROSPECT, WE DID REMEMBER NOTING THE DIFFERENCE ON THE GND BUT, PROBABLY DUE TO TYPICAL INTERRUPTIONS, NEITHER OF US DELETED THE UNWANTED FIX. WE DID NOT OBSERVE ANY CONFLICTING TFC NOR DID ATC ISSUE ANY. OUR TCASII DISPLAY DID NOT SHOW POTENTIAL CONFLICTING TFC WITHIN 40 NM (THE LONGEST RANGE THAT CAN BE DISPLAYED). OUR CLB WAS NOT STOPPED. AFTER A SHORT WHILE THE CTLR ASKED FOR OUR ATC RTE CLRNC. I COMPLIED AND READ IT TO HIM. HE THEN GAVE US A SHORT LECTURE ON BEING SURE TO CHK ISSUED CLRNCS MORE CAREFULLY AND THAT THE CTR HAD HAD SEVERAL PREVIOUS INSTANCES OF COMPANY ACFT DEVIATING FROM ATC ROUTING IN THE SAME AREA. HE STATED HE KNEW WE HAD BEEN BRIEFED BY OUR COMPANY ON THIS PROB BECAUSE OF CONTACTS WITH OUR CHIEF PLT. I REPLIED THAT WE HAD INDEED BEEN BRIEFED BUT THAT SOMEHOW THE ERROR SLIPPED THROUGH. HE THEN CLRED US DIRECT TO DJB AND ON COURSE AND HANDED US OFF. ALL COMS WERE CALM AND CORDIAL. I BELIEVE SEVERAL INTERRUPTIONS WITH GND SVCING TASKS DURING THE FMS SETUP CONTRIBUTED TO THE PROGRAMMING OVERSIGHT. THIS IS THE FIRST TIME IN MY 2 YRS OF FMS OP THAT I HAVE HAD A PROB WITH A NAV EXCURSION OF THIS KIND. OTHER THAN MORE VIGILANCE BY CREWS, THE ONLY WAY THIS PROB MIGHT BE AVOIDED IN THE FUTURE IS TO HAVE COMPANY MORE VIGOROUSLY UPDATE 'PROB' FMS FLT PLANS, ESPECIALLY WHEN THE DATABASE DOES NOT MATCH SCHEDULED BUT DIFFERENT ROUTINGS OVER EXTENDED PERIODS OF TIME.

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  38. Accession Number: 375010
    Synopsis: AN ACR FLC IN AN MLG ENTERED THE NEXT WAYPOINT INTO THE FMC INCORRECTLY AND DID NOT VERIFY THE ENTRY. LATER, A CTLR QUESTIONED THEIR RTE OF FLT AND THEY THEN NOTED THE ERROR.
    Narrative: COPLT WAS FLYING. WE WERE CLRED DIRECT LFK. I READ BACK THEN ENTERED IN FMC. 1 OF 2 THINGS THEN HAPPENED, 1) I SELECTED WRONG FIX, OR 2) FMC UPDATED JUST PRIOR TO MY SELECTING LFK CAUSING MOTLY INTXN TO JUMP TO THE LINE I SELECTED. FAILURE BY EITHER MYSELF OR THE COPLT TO VERIFY WHERE WE WERE GOING RESULTED IN ANOTHER CALL FROM A DIFFERENT CTLR THAT WE WERE CLRED DIRECT LUFKIN. COPLT AND I THEN SAW WE WERE HEADED DIRECT TO MOTLY INTXN. WE ENTERED DIRECT LUFKIN INTO FMC AND PROCEEDED ON COURSE. THERE WAS NEVER ANY TFC CONFLICT. COMPLACENCY, HOW OFTEN DO WE HAVE TO HEAR ABOUT IT? THIS KIND OF FAILURE TO VERIFY NAV POS IN MOUNTAINOUS TERRAIN COULD BE FATAL. I'VE LEARNED MY LESSON. SET IT, VERIFY IT AND VERIFY IT AGAIN AND QUESTION IT IF IT DOESN'T MAKE SENSE.

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  40. Accession Number: 375574
    Synopsis: MLG ACFT ON STAR WITH XING RESTR WAS RECLRED DIRECT TO ANOTHER FIX. NEXT CTLR CLRNC REVERTED BACK TO THE ORIGINAL CLRNC, BUT FLC HAD ALREADY SET IN THE NEW FIX ON THE FMC, SO CTLR CLRED THEM TO A POINT CLOSE TO THE ORIGINAL XING FIX. FLC ERRONEOUSLY SET IN WRONG ALT.
    Narrative: ON THE SINCA 3 ARR INTO ATL WE HAD PROGRAMMED THE FMC TO CROSS CANUK AT 250 KTS AND 12000 FT. WE WERE SUBSEQUENTLY CLRED DIRECT TO HUSKY INTXN WITH NO ALT OR AIRSPD RESTR. THE NEXT CTLR TOLD US TO CROSS CANUK AT 250 KTS AND 12000 FT. WE TOLD HER WE WERE DIRECT TO HUSKY, SO SHE THEN RECLRED US TO CROSS 40 MI SE OF ATL AT 12000 FT AND 250 KTS. WE PROGRAMMED THE FMC TO CROSS 11 MI SE OF HUSKY (45 MI SE OF ATL) AT 250 KTS AND 11000 FT. WE SET OUR MCP TO 11000 FT. I BELIEVE WE READ BACK 11000 FT BUT I AM NOT SURE. THE CTLR CAUGHT OUR DSCNT THROUGH 12000 FT AND WE CLBED IMMEDIATELY BACK TO 12000 FT. END OF EVENT. I FEEL IT WAS NOT NECESSARY TO AMEND THE ORIGINAL SINCA ARR IN THE FIRST PLACE (ATC COM GAP BTWN CTLRS). HOWEVER, OUR INATTN TO THE ALT WAS CAUSED BY: 1) FAILURE TO MONITOR THE ACFT BY FOCUSING ENTIRELY ON THE FMC, 2) NOT DOUBLECHKING THE PUBLISHED ARR PLATE FOR CONTINUITY, AND 3) AUTOMATIC AIRPLANE COMPLACENCY.

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  42. Accession Number: 379070
    Synopsis: A B737-300 DSNDING IN ZNY AIRSPACE, RECEIVES CLRNC TO CROSS HAYED AT FL180. THE FO DOESN'T PROGRAM THE FMS PROPERLY AND CANCELS THE DSCNT. ACFT CROSSED HAYED AT FL250.
    Narrative: WE WERE GIVEN A CLRNC TO DSND FROM FL370 TO FL280 AND CROSS HAYED INTXN AT FL180. I HAD THE FMC PROGRAMMED TO CROSS HAYED AT FL180 AND I STARTED THE DSCNT. I RESET FL180 IN THE CRUISE PAGE, WHICH WAS MY MISTAKE BECAUSE THIS DELETES ANY RESTRS. ALSO, AS I WAS DSNDING, I WAS THINKING MY ALT WAS FL280 AND NOT FL180 -- MY MISTAKE AGAIN. BY THE TIME I REALIZED THE MISTAKE, IT WAS TOO LATE FOR THE XING RESTR. CONSEQUENTLY, WE WERE HIGH ON OUR HAYED XING OF FL180. ATC ASKED IF WE WERE GIVEN A XING RESTR. WX WAS VFR.

  43.  
  44. Accession Number: 380502
    Synopsis: AN ACR B767 FLC USED IMPROPER PROC TO ENTER THE RTE INTO THE FMC AND THEN THIS DATA WAS XCHKED IMPROPERLY. THE ACFT GOT OFF COURSE UNTIL THE ARTCC CTLR GAVE A NEW CLRNC DIRECT TO A WAYPOINT.
    Narrative: EZEIZA CTR ASKED OUR HDG, THEN VECTORED US DIRECT PAGON. ORIGINAL CLRNC READ: UA300 GUA, UA301 PAGON, DIRECT VANAR, PAGON 1 SAEZ. WE THEN REALIZED THAT WE HAD BEEN TRACKING DIRECT EZE AFTER GUA INSTEAD OF UA301 PAGON. POS APPROX 10 NM NE PAGON, 4 NM E OF UA301 TRACK CTRLINE. 10 HRS OF ALL NIGHT FLYING HAD ELAPSED, ALL 3 PLTS WERE AT STATIONS IN COCKPIT. FMC HAD BEEN PROGRAMMED FOR UA301 PAGON, ARRS PAGE: PAGON 1A, ILS 11 ARSOT TRANSITION. ATIS ADVISED ILS RWY 35 IN USE. WHEN ILS RWY 35, EZE TRANSITION WAS SELECTED, THE STAR WAS OMITTED. WHEN IT WAS ACTIVATED NOT ONLY WAS PAGON 1A STAR ERASED, BUT ALSO UA301 PAGON, LEAVING EZE AS THE NEXT WAYPOINT AFTER GUA. WE IMMEDIATELY HEADED DIRECT PAGON AND WHEN IN CONTACT WITH EZEIZA APCH WERE VECTORED AND CLRED DIRECT EZE. IMPROPER PROCS WERE FOLLOWED IN THAT VERIFICATION OF THE NEW APCH SELECTION, ILS RWY 35, EZE TRANSITION, WAS NOT COMPLETED UNTIL AFTER ACTIVATION INSTEAD OF BEFORE EXECUTION. ALSO, THE DISCONTINUITY WHICH RESULTED WAS CLOSED WITHOUT VERIFICATION PRIOR TO EXECUTION. THUS, NONE OF US CAUGHT THE FACT THAT WE WERE TRACKING DIRECT EZE VERSUS DIRECT PAGON AND THAT THE FMC HAD DROPPED UA301 PAGON AND PAGON 1A STAR. OTHER CONTRIBUTING FACTORS: FATIGUE. WE WERE LULLED INTO ACCEPTING EZE AS THE NEXT WAYPOINT. IT MADE SENSE WHEN WE LOOKED AT THE HSI. THE APCH WAS NOT ILS RWY 35, EZE TRANSITION (VERSUS ILS RWY 11). BUT WE HAD NOT YET BEEN CLRED DIRECT EZE.

  45.  
  46. Accession Number: 380906
    Synopsis: ACR MLG FLC FAILS TO MAKE AN ALT XING RESTR. FO, PF, IMPROPERLY PROGRAMMED THE FMC IN THE DSCNT PAGE, USING THE WRONG INTXN. PIC, PNF, WAS USING THE WRONG VOR DME FOR DISTANCE INFO.
    Narrative: (STRUK ARR HOU, HOBBY.) CLRED TO CROSS MARIT AT 10000 FT. 10000 FT RESTR PLACED IN WRONG LINE (WRONG INTXN) -- STRUK. INITIAL DSCNT WAS BEGUN AT AN APPROPRIATE DISTANCE, BUT PNF SWITCHED VOR TO NEXT NAV AID, LOST BACK-UP CHK FOR ALT XING. PF GOT BEHIND ACFT. CTR AND APCH NOTIFIED ASAP AS TO DEV AND VOLUNTEERED TO TURN IF NEEDED. NO COMMENTS MADE BY EITHER CTR OR APCH. ACFT CROSSED MARIT INTXN ABOUT 2500 FT HIGH. HI-TECH EQUIP -- SYS OVERLOAD ON LOW-TECH USER. MUCH OF OUR NEW TECHNOLOGY ACTUALLY GETS IN THE WAY OF GOOD SOLID AVIATING. SUPPLEMENTAL INFO FROM ACN 380988: CTR CTLR ASKED IF WE WOULD MAKE 'MARIT AT TEN.' PNF INITIALLY RESPONDED AFFIRMATIVE AS WE DOUBLE CHKED OUR PROGRESS. I DISCOVERED I HAD ENTERED XING RESTR (10000 FT/250 KTS) IN FMC AT STRUK INTXN VERSUS MARIT. PF (ME) WAS USING LNAV/DSCNT PAGE. PNF HAD SWITCHED VOR TO HOBBY VERSUS TNV AND LOST AWARENESS OF XING PROGRESS. 13TH HR OF LONG DAY CONTRIBUTED. INADEQUATE XCHK BY CREW.

  47.  
  48. Accession Number: 381600
    Synopsis: PIC OF AN A320 FAILS TO PROGRAM HIS FMS PROPERLY AND THE ACFT BYPASSES THE 'CLRED DIRECT TO' WAYPOINT. ZLA CTLR QUESTIONS ROUTING.
    Narrative: ON THE OFFSHORE 3 DEP OUT OF SFO AROUND CYPRS INTXN, ATC CLRED US DIRECT LAX. THE AUTOFLT SYS WAS ENGAGED AND I SELECTED DIRECT ON THE MCDU AND LINE SELECTED 'LAX.' THE ACFT TURNED TO AN APPROPRIATE HDG AND WE CONFIRMED. ABEAM LAX, CTR ASKED IF WE WERE DIRECT JLI, AND I LOOKED AT THE MCDU AND THE NAV DISPLAY AND SAW THAT WE WERE INDEED GOING DIRECT TO JLI. WE WERE SHOWING 12 DME FROM LAX. (JLI WAS OUR NEXT WAYPOINT AFTER LAX.) I DO NOT KNOW HOW JLI GOT TO BE THE 'TO' WAYPOINT BUT I HAVE 3 POSSIBILITIES: 1) I SELECTED JLI RATHER THAN LAX, 2) WE PASSED OVER A WAYPOINT WHEN I PUSHED THE LINE SELECT FOR LAX, THE WAYPOINT SCROLLED, AND JLI WAS SELECTED, OR 3) WE CROSSED OUR LAX WAYPOINT AS ATC ASKED, SO JLI WOULD BE THE NEXT WAYPOINT. I THINK SCENARIO #2 TO BE THE MOST LIKELY. TO PREVENT THIS, I RECOMMEND THE PROC TO BE: 1) PRESS DIRECT, 2) TYPE THE IDENT IN THE SCRATCH PAD, AND 3)LS 1L, THE (DIRECT TO) PROMPT. OBVIOUSLY I SHOULD HAVE XCHKED THE MCDU ALSO TO CONFIRM THE CORRECT WAYPOINT WAS ACTIVE.

  49.  
  50. Accession Number: 381871
    Synopsis: WDB ACFT ON OCEANIC ROUTING WAS OFF COURSE DUE TO WAYPOINT ERROR ENTERED IN THE FMC. RPTR CAPT ELECTED TO GO DIRECT NEXT WAYPOINT, BUT 500 FT OFF ALT. APPARENTLY THEY WERE NOT IN COM WITH OCEANIC.
    Narrative: IN CRUISE ON THE OCEANIC PORTION OF THE FLT, I RETURNED FROM MY REST BREAK AND WAS ADVISED THAT THE RELIEF FO PLOTTED A FIX AND CONFIRMED THAT WE WERE OFF COURSE. I RECHKED HIS WORK AND THE PLOT MADE BY THE OPERATING FO. WE WERE OFF COURSE. BY FLYING TO THE WAYPOINT, WHICH WAS PRESENTLY ACTIVE, WE WOULD BE ON COURSE AND ARRIVE AT THE NEXT WAYPOINT, WHICH WAS AS CLRED AT THE TIME GIVEN IN THE LAST POS RPT. I BELIEVED THE SAFEST COURSE OF ACTION TO BE CONTINUING TO THE WAYPOINT AT AN ALT 500 FT LOWER THAN THE CLRNC ALT AND TO CONTINUE TO MAKE FULL USE OF THE TCASII. AT ALL TIMES WE WERE MONITORING 121.5 AND 131.8 PER OCEANIC PROCS. NO ACFT WERE SIGHTED AND NONE WERE ON THE 2 FREQS. THE WAYPOINT ERROR MUST HAVE BEEN INTRODUCED DURING THE WAYPOINT LOADING. THE ERROR WAS NOT DETECTED BY EITHER MYSELF OR THE OPERATING FO. I LATER FOUND THAT HIS PLOT OF POS, WHICH WOULD HAVE SHOWN THE ERROR EARLIER, WAS IN ERROR SHOWING US TO BE ON COURSE. MY ONLY EXPLANATION FOR THE ERROR GOING UNDETECTED IS OUR EXPECTING TO SEE THE 'NORMAL' NUMBERS. I CHKED THE WAYPOINTS AT LEAST TWICE AND OBSERVED THE FO DOING THE SAME. I HAVE NO OTHER EXPLANATION. THE SHOCK OF THIS TYPE OF ERROR IS DEVASTATING.

  51.  
  52. Accession Number: 382000
    Synopsis: FLC OF A B737 FAILED TO FOLLOW THE ASSIGNED SID TRANSITION DURING CLB DUE TO THE FMC PROGRAMMED WITH THE WRONG TRANSITION.
    Narrative: CLRNC GAVE US THE OASYS 2 DEP DAGGETT TRANSITION. OUR FMC HAD THE GFS TRANSITION. WE DIDN'T NOTICE UNTIL WE HAD ALREADY MADE THE TURN INBOUND TO GFS.

  53.  
  54. Accession Number: 385330
    Synopsis: FLC OF AN ACR MDT FAILED TO FOLLOW FLT PLAN ROUTING DUE TO A MISPROGRAMMED FMS RESULTING IN ATC INTERVENTION AND A VECTOR HEADING TO ASSIGNED COURSE.
    Narrative: ON A SCHEDULED FLT FROM HPN TO CVG FO AND I BOTH CHKED FLT PLAN ON RELEASE (FLT RELEASE) AND COMPARED IT TO FLT PLAN IN THE FMS (CANNED WITH ONCE A MONTH CHANGE). THE FLT PLAN IN THE BOX (FMS) WAS WRONG (J6). WE MODIFIED THE FLT PLAN TO PUT THE ARR FOR CVG IN. HOWEVER, I DID NOT CLR THE OLD FLT PLAN BUT CHOSE TO MODIFY IT. BTWN ETX AND AIR ON J80 ARE 5 INTXNS WITH A TURN AT KIPPI INTXN (SUZIE AND HOUTN INTXNS ARE NEXT EACH OTHER ON J80 AND J6). WE DID NOT TAKE OUT (OR CLR) HOUTN FROM FLT PLAN AND WE CHKED THE COMMERCIAL CHARTS AND MISTAKENLY THOUGHT HOUTN INTXN WAS ON J80 WHEN IT WAS ON J6. ZNY GAVE US A 270 DEG HDG BACK TO J80 ABOUT HALF WAY BTWN ETX AND HOUTN INTXN. NO CONFLICTS NOTED, FMS CORRECTED.

  55.  
  56. Accession Number: 385590
    Synopsis: MDT ACFT IN CRUISE HAD WRONG ROUTING SET IN FMS AND OVER FIX TURNED TO WRONG TRACK. ATC INTERVENED AND ASSIGNED CORRECT RTE.
    Narrative: FLT PLAN RTE CALLED FOR CENCE TWO ARR BUT IT WAS NOT PROGRAMMED INTO THE FMS. INSTEAD FREDDY INTXN WAS THE NEXT FIX PROGRAMMED AFTER FDY VOR. WE DEPARTED FDY ON A SW HEADING TO FREDDY WHEN ATC POINTED OUT OUR ERROR AND GAVE US A L TURN TO INTERCEPT THE CENCE TWO ARR.

  57.  
  58. Accession Number: 386030
    Synopsis: B737-400 ACFT CLRED FOR ARR ROUTING, FLC FAILED TO INSERT AN ARR FIX IN FMC AND ACFT WAS 35 MI OFF COURSE WHEN CTLR INTERVENED WITH HDG VECTOR.
    Narrative: WE WERE CLRED DIRECT TO CRG THEN LLAKE 2 ARR INTO WEST PALM BEACH, FL. UPON SELECTING THE ARR IN THE FMC, WE FAILED TO NOTICE THAT INPIN INTXN WAS NOT LOADED. WHEN CTLR QUERIED US AFTER PASSING CRG (GOING DIRECT TO LLAKE INSTEAD OF INPIN) WE WERE ABOUT 35 MI E OF COURSE. HE GAVE US A VECTOR TO REJOIN THE ARR. WHEN WE ASKED, THE CTLR STATED THERE WAS NO CONFLICT.

  59.  
  60. Accession Number: 386850
    Synopsis: CAPT OF A B757 OVERSHOT DSCNT ASSIGNED ALT DUE TO A MISUNDERSTANDING OF THE CORRECT ALT. HOWEVER, AFTER FO REQUESTED CLARIFICATION FROM ATC, THEY WERE RECLRED TO STAY AT THAT ALT.
    Narrative: ON DSCNT INTO MEM PASSING 9200 FT FOR 8000 FT ON THE GILMORE STAR, APCH TOLD US TO LEVEL AT 9000 FT AND MAKE A L 360 DEG TURN TO REJOIN THE ARR. I ACKNOWLEDGED THE NEW CLRNC AND OBSERVED THE CAPT SLEWING THE HDG TO THE L ON THE MCP. I THOUGHT I SAW HIM REACH FOR THE ALT KNOB AND AT THAT TIME WENT HEAD DOWN TO REPROGRAM THE FMS TO INTERCEPT THE ARR UPON THE COMPLETION OF OUR TURN. AFTER ABOUT 90 DEGS OF HDG CHANGE, I LOOKED UP AND SAW THAT WE WERE LEVELING AT 8000 FT. I INFORMED THE CAPT THAT OUR ASSIGNED ALT WAS 9000 FT. I CALLED ATC TO VERIFY AND HE TOLD US TO JUST REMAIN AT 8000 FT NOW. REMAINDER OF FLT WAS UNEVENTFUL. COMPANY PROCS DICTATE THAT THE PF WILL MAKE ALL MCP CHANGES (INCLUDING ALT) WITH THE AUTOPLT ON. I SHOULD HAVE TECHNICALLY VIOLATED THIS POLICY AND SPUN IN 9000 FT. SINCE WE WERE IN A HIGH WORKLOAD, SHORT FUSE SCENARIO, I ALSO COULD HAVE BEEN MORE POSITIVE ABOUT VERIFYING THAT THE CAPT HAD HEARD THE ENTIRE CLRNC (LEVEL AT 9000 FT) AND NOT JUST THE PART ABOUT MAKING THE L 360 DEG TURN. BOTTOM LINE: SHOULD HAVE TO PUT THE RIGHT ALT IN THE WINDOW.

  61.  
  62. Accession Number: 388890
    Synopsis: AN ACR B737 FLC GOT OFF COURSE WHEN THEY LEFT THE CANNED FLT PLAN IN THE FMS INSTEAD OF THE 'AS CLRED' FLT PLAN.
    Narrative: UPON INITIAL PROGRAMMING OF THE FMS, THE 'COMPANY RTE' STORED IN THE FMS WAS VERIFIED WITH THE 'CANNED RTE' INSTEAD OF THE FILED RTE ON THE FLT RELEASE. THE COMPANY RECENTLY CHANGED FROM USING 'CANNED' FLT PLANS TO FILING INDIVIDUAL FLT PLANS. THE RTES WERE THE SAME UNTIL MEM WHERE THE 'CANNED' RTE WAS MEM J29 PXV AND THE FILED RTE WAS MEM J35 FAM. PASSING MEM AND JOINING J29 THE CTR CTLR ADVISED THAT WE APPEARED E OF COURSE. WE REALIZED THE ERROR, CORRECTED THE FMS ROUTING TO THE FILED ROUTING AND CORRECTED COURSE. FATIGUE CONTRIBUTED. THE PREVIOUS DAY WAS A 13.5 HR DUTY DAY WITH 7.5 BLOCK FLT TIME FOLLOWED BY 10 HRS REST WITH AN XB50 (BODY CLOCK TIME ZONE) RPT. XA00 BODY TIME GET UP.

  63.  
  64. Accession Number: 391630
    Synopsis: B737-300 FLC MISPROGRAMS FMS ON RECEIVING DSCNT CLRNC CHANGE AND HAS AN ALTDEV.
    Narrative: WE WERE FLT PLANNED TO ARRIVE DFW VIA THE BOWIE (UKW) ARR. FMS WAS PROGRAMMED TO CROSS KAJAY INTXN AT THE EXPECTED ALT OF FL240, AND ALSO PROGRAMMED TO CROSS BAMBE INTXN AT 11000 FT. PRIOR TO REACHING THE UKW 287 DEG RADIAL, IN THE VICINITY OF TXO, WE WERE RECLRED DIRECT UKW, WHICH ELIMINATED THE FMS PROGRAMMED DSCNT TO FL240 AT KAJAY. FMS DSCNT PROFILE IS NOW COMPUTED TO CROSS BAMBE AT 11000 FT. WHILE PROCEEDING DIRECT UKW, WE WERE CLRED TO CROSS 40 DME W OF UKW AT FL240, PLT DISCRETION. WE REPROGRAMMED THE FMS WITH A NAV POINT 40 DME W OF UKW, BUT APPARENTLY FAILED TO INCLUDE THE ALT CONSTRAINT OF FL240, SO THE FMS DSCNT PROFILE WAS PREDICATED ON REACHING BAMBE INTXN AT 11000 FT. THE REASON FOR THIS OVERSIGHT IS UNKNOWN, BUT PROBABLE CAUSES ARE CREW INVOLVEMENT WITH ARR PROCS (APCH BRIEFING, CONTACTING COMPANY FOR GATE ASSIGNMENT, ETC) AND DISTR DUE TO A CALL FROM THE LEAD FLT ATTENDANT TO RPT CABIN MAINT DISCREPANCIES OR PAX SPECIAL ASSISTANCE REQUESTS UPON ARR. IN ANY CASE, THE FMS VNAV FUNCTION INITIATED ITS DSCNT ACCORDING TO THE PROFILE FOR MEETING THE BAMBE AT 11000 FT RESTR. WHILE IN THE DSCNT, CTR SUBSEQUENTLY CLRED US TO CROSS BAMBE AT 11000 FT, WHICH LEGALLY CANCELED THE 40 DME AT FL240 RESTR. APCHING THE 40 DME FIX, WE REALIZED WE WERE TOO HIGH TO REALISTICALLY MEET THE PREVIOUS RESTR, AND QUESTIONED OURSELVES AS TO WHY WE WERE IN THAT POS, AND THE MOST LOGICAL REASON WAS THAT WE PROBABLY FAILED TO ENTER THE ALT CONSTRAINT INTO THE FMS AND FAILED TO BACK IT UP WITH RAW DATA NAV DUE TO CREW PREOCCUPATION WITH ANCILLARY DUTIES. LESSON LEARNED IS NOTHING NEW: THE PRIORITIES ARE 1) AVIATE, 2) NAV, 3) COMMUNICATE, AND 4) CHKS.

  65.  
  66. Accession Number: 392166
    Synopsis: AN L1011 DSNDING IN ZLC AIRSPACE FAILS TO PROGRAM THE COMPUTER ROUTING PROPERLY AND CROSSES THE ASSIGNED WAYPOINT 2000 FT HIGH.
    Narrative: DURING INITIAL FMS LOADING/VERIFICATION OF RTE SPANE-FFU- SLC DID NOT INCLUDE OTHER POINTS ON SID. ENRTE ENTRY OF ADDITIONAL POINTS FOR LNDG TO S AT SLC. BOAGY WAS INSERTED ERRONEOUSLY PRIOR TO SPANE INSTEAD OF AFTER SPANE. WE NOTED DSCNT CLRNC SEEMED SOMEWHAT EARLY FOR XING SPANE AT FL190, BUT DIDN'T PICK UP ON THE FACT THAT RTE WAS BOAGY DIRECT SPANE INSTEAD OF SPANE DIRECT BOAGY. DSCNT OF ABOUT 1000 FPM INITIATED FOR ARR AT FL190 AND 280 KTS PRIOR TO SPANE. CTR CALLED TO QUESTION OUR NAV. NOTED WE WERE N OF COURSE. WENT TO MANUAL NAV, XCHKED DIRECT ON FMS AND REALIZED THE ERROR. CTR ASSIGNED US A HDG FOR VECTORS FOR APCH AND I INITIATED AND EXPEDITED DSCNT WITH SPD BRAKES TO ATTEMPT TO REGAIN ALT COMPLIANCE. FURTHER DSCNT CLRNC TO 17000 FT ALSO ISSUED WITH VECTOR. ALTHOUGH NO MENTION WAS MADE OF ALT OR XING PROB BY CTR, I ASSUME WE WOULD NOT HAVE BEEN IN COMPLIANCE BY SPANE AS WE WERE NEARLY THERE WHEN CORRECTIVE ACTION INITIATED AND VECTOR ISSUED. HDOF TO APCH WAS GIVEN BY CTR, SO NO FOLLOW-UP WAS AVAILABLE FROM ATC AND APCH CONTINUED NORMALLY. TO THE BEST OF MY KNOWLEDGE, THERE WAS NO CONFLICT WITH ANY OTHER TFC. A CLOSER REVIEW OF THE SID OR A FOLLOW-UP ON THE QUESTION OF THE EARLY DSCNT RAISED WOULD HAVE CAUGHT THE PROGRAMMING ERROR. SUPPLEMENTAL INFO FROM ACN 392023: APCHING SLC WE WERE GIVEN CLRNC TO CROSS SPANE AT FL190. WE THOUGHT CLRNC SEEMED 'EARLY' DUE TO DISTANCE TO SPANE. WE BEGAN DSCNT TO REACH SPANE AT FL190 BASED ON BAD DATA. AT ABOUT 5 MI FROM SPANE ATC SAID THEY SHOWED US ABOUT 5 MI N OF ARR TRACK. THIS IS WHEN WE NOTICED PROGRAM ERROR. WE WERE AT FL230. WE IMMEDIATELY WENT TO MANUAL NAV (VOR) AND EXPEDITED DSCNT. WE MISSED OUR SPANE RESTR BY ABOUT 2000 FT. ALTHOUGH BOAGY WAS VERIFIED AS A CORRECT FIX ON THE SPANE 3 ARR WE MISSED THE FACT THAT IT WAS INSERTED IN THE WRONG LOCATION. HAD WE BEEN MORE DILIGENT IN THE RTE CHANGE OR QUESTIONED 'EARLY' DSCNT CLRNC FOR SPANE, THIS ERROR WOULD NOT HAVE OCCURRED.

  67.  
  68. Accession Number: 392704
    Synopsis: B777B DEPARTS LAX, CA, WITH THE FMS NOT PROGRAMMED. DURING CLBOUT IT SUFFERS LOSS OF SEPARATION BECAUSE THE FLC IS BUSY TRYING TO PROGRAM THE FMS PROPERLY. FLC IS DISTRACTED WITH PERSONAL PROBS.
    Narrative: THIS IS A CLASSIC CASE OF HOW TO HAVE AN ACCIDENT WITH THE GLASS COCKPIT. I WAS THE REGULAR PLT, BUT FLYING AS RELIEF. THE COPLT WAS FLYING, LAX TO LHR FLT ON JAN/SAT/98. THE CAPT WAS UNDER STRESS. HE JUST COMMITTED HIS CLOSE RELATIVE TO A MENTAL INSTITUTION. HE STATED HE THOUGHT SOMETHING WAS WRONG WITH HIS HEART. HE TOLD ME TO KEEP AN EYE ON THE COPLT BECAUSE ON PREVIOUS TRIPS HE WOULD LOSE HIS SIT AWARENESS. THERE WAS A LOT OF CONFUSION ON COCKPIT SETUP. TWO MECHS HAD TO CLR TWO STATUS MESSAGES. THE FUELER WAS HAVING TROUBLE BALANCING THE FUEL. THEN THE DATA MODE DEFAULTED TO THE #2 RADIO. BUT FINALLY WE GOT GOING. WE DEPARTED ON THE LOOP DEP OUT OF LAX. THE COPLT MISSED THE L TURN AT 2 MI AND HAD TO BE DIRECTED TO TURN BY THE CAPT. AT THIS POINT THE CAPT REALIZED THAT THE DEP WAS NOT INSTALLED. HE PUT IN LAX AND HIT (NAV) AND ASKED THE COPLT TO FLY THE SID WHILE HE TRIED TO FIGURE OUT WHAT WAS WRONG WITH THE COMPUTER. THE COPLT FLEW STRAIGHT TO THE VOR AND THEN KEPT GOING STRAIGHT. I TOLD HIM HE HAD TO TURN R. HE ASKED IF HE COULD PUT ON THE AUTOPLT, THE CAPT SAID NO, JUST FLY THE PLANE. HE TURNED BACK R AND THEN TURNED OUTBOUND. AT THIS POINT ZLA TOLD US TO CLB TO FL260 AND TFC AT 3 O'CLOCK POS. THE NEXT THING WE GOT WAS TCASII 'DSND NOW.' WE SAW THE OTHER ACFT PASS IN FRONT. THE COPLT DID NOT REACT TO THE TCASII RA AND HAD TO BE TOLD BY BOTH OF US TO DSND. IT APPEARED ZLA WAS NEVER AWARE OF THE CONFLICT. THE PROB WAS THAT THE CAPT INSTALLED LAX AS DEST INSTEAD OF LHR. AS A RESULT, THE PREVIOUS FLT'S INBOUND ARR WAS STILL SHOWING TO LAX. THIS IS WHAT THE COPLT THOUGHT WAS THE OUTBOUND COURSE. THIS PUT HIM S OF THE OUTBOUND RADIAL AND CAUSED THE TFC CONFLICT. WHY ZLA DID NOT CATCH IT IS BEYOND ME. LESSONS: 1) THE PLT WHO INSTALLS INFO INTO THE COMPUTER, MUST HAVE EACH PAGE CHKED BY THE OTHER PLT. 2) THE PF SHOULD ALWAYS BACK UP WITH RAW DATA. 3) DO NOT DO COMPUTER WORK THAT'S COMPLICATED BELOW 18000 FT. 4) IF YOU ARE STRESSED OUT AND NOT FEELING WELL, GO ON SICK LEAVE.

  69.  
  70. Accession Number: 393280
    Synopsis: LGT FO ADMITS TO A NAV ERROR. HE HAD FAILED TO FOLLOW PROC WHEN ENTERING RWY AND DEP PROCS INTO THE FMC AND LATER FOUND, VIA ATC, THAT THE ACFT WAS HEADING TO OTHER PLACES NOT IN CLRNC.
    Narrative: WE WERE GOING FROM SFO-SNA. THE ORIGINAL RTE WAS: OFFSHORE 3 SXC SNA, THAT WAS ENTERED INTO THE FMC. LATER WE WERE GIVEN THE PORTE 2 FLW DEPARTING RWY 10R. ON TAXI OUT GND CTL TOLD US TO EXPECT RWY 10L, EACH TIME WE WOULD CHANGE THE FMC. APCHING RWY 10L WE WERE AGAIN SWITCHED TO RWY 10R, RESELECTING RWY 10R IN THE FMC. ON THE PORTE 2 DEP, BEFORE INTERCEPT OAK 135 DEG RADIAL, WE WERE CLRED DIRECT WAGES. AFTER PASSING WAGES INTXN ZOA ASKED US WHERE WERE WE GOING. WE TURNED UP THE SCALE ON OUR HSI AND REALIZED WE WERE HEADING TO MQO NOT FLW LIKE OUR CLRNC HAD STATED. NO SEPARATION PROB RESULTED FROM THE NAV ERROR. WHAT WE FEEL HAPPENED AFTER SOME INVESTIGATION WAS WHEN I ENTERED THE RWY CHANGES AND THE DEP CHANGE INTO THE FMC, I DID NOT ENTER RWY, SID, TRANSITION LIKE THE FLT MANUAL TELLS US. BUT I WENT L TO R AND ENTERED SID, TRANSITION, RWY, THIS LEFT MQO IN THE LEGS PAGE BUT NOT THE RTE PAGE. THE RTE PAGE WAS CHKED BUT NOT THE LEGS PAGE, THIS ALSO WOULD HAVE CAUSED MY MISTAKE.

  71.  
  72. Accession Number: 394140
    Synopsis: A B737-300 ENTERS A HOLDING PATTERN INCORRECTLY BECAUSE HIS NAV SYS IS IMPROPERLY PROGRAMMED. THIS OCCURS IN ZID AIRSPACE.
    Narrative: LAST MIN HOLDING INSTRUCTIONS ISSUED BY ATC BECAUSE ZOB COULD NOT ACCEPT HDOF. INSTRUCTED TO HOLD AT APE VOR 270 DEG RADIAL, R TURNS, 20 DME LEGS, FL290, EFC XA35Z. CAPT (PF) ENTERED DATA FOR HOLDING INTO FMS WITH FO (PNF) CONCURRING WITH INPUT. PNF USED RAW DATA FOR BACKUP. HOLDING COURSE ENTERED INCORRECTLY, RESULTING IN INCORRECT ENTRY INTO HOLDING AIRSPACE. JUMP SEAT RIDER NOTICED ERROR AND ATC WAS NOTIFIED OF CORRECTION BACK TO HOLDING AIRSPACE. NO CONFLICT, BUT VERY EMBARRASSING. CONTRIBUTING FACTORS: EFC WOULD REQUIRE LNDG SHORT OF DEST DUE TO INSUFFICIENT HOLDING FUEL (MAX TKOF WT LAS- PHL). NO ALTERNATE REQUIRED ON FLT PLAN. WITHOUT ANY PRIOR KNOWLEDGE OF DELAYS AT DEST, FLC BECAME VERY BUSY ALL AT ONCE: 1) CLRED TO A HOLD FIX OFF AIRWAY. 2) MINIMUM FUEL COMPUTATION. 3) FLT ATTENDANT CALLING ON INTERPHONE WITH CABIN PROB. WORKLOAD MGMNT SUFFERED AND THE FMS ERROR WAS NOT CAUGHT IN A TIMELY MANNER. VERY LITTLE TEAM WORK BTWN CAPT AND FO DUE TO EARLIER DISAGREEMENT. JOB WELL DONE BY JUMP SEAT RIDER.

  73.  
  74. Accession Number: 394900
    Synopsis: FLC OF AN MD88 FAILED TO RESET ALTIMETERS DURING DSCNT THROUGH FL180 RESULTING IN OVERSHOOTING STAR XING ALT DUE TO DISTR OF AN ACFT EQUIP PROB. AS THEY WERE CORRECTING BACK TO THE XING ALT, ATC INTERVENED TO INQUIRE ABOUT THEIR ALT.
    Narrative: WE WERE DSNDING ON THE GLEN ROSE 3 ARR INTO DFW. PASSING 20000 FT THE FLT ATTENDANTS CALLED BUT WERE UNABLE TO HEAR US THROUGH THE INTERPHONE. THE CAPT AND I DISCUSSED WHETHER WE SHOULD PUT THIS IN THE LOGBOOK AND IF WE HAD TIME TO CALL AHEAD AND NOTIFY MAINT (WE DID NOT). THE CAPT THEN QUERIED APCH CTL ABOUT THE SPD RESTRS AND APCH SAID WE COULD DELETE ALL RESTRS EXCEPT AT DELMO, THE LAST FIX ON THE ARR. I DELETED ALL PREVIOUS SPDS IN THE FMS BUT ALSO INADVERTENTLY DELETED THE 11000 FT ALT RESTR AT HIRST, WHICH STILL APPLIED. ALTHOUGH THE FMS SHOWED WE WERE ON THE CORRECT DSCNT PROFILE, THIS WAS FOR THE SPD AND ALT AT DELMO, NOT HIRST. THE CAPT NOTICED WE WERE HIGH AND DEPLOYED THE SPD BRAKE. WE LEVELED AT 11000 FT INDICATED AND IMMEDIATELY REALIZED WE HAD BEEN DISTRACTED (BY THE INTERPHONE PROB AND BY TRYING TO MAKE THE 11000 FT ALT AT HIRST WHICH WAS NOT PROPERLY PROGRAMMED IN THE FMS) AND HAD NOT PERFORMED A DSCNT CHK. ALTIMETERS WERE STILL READING 29.92, AND SINCE THE LCL SETTING WAS APPROX 29.62, WE WERE 300 FT LOW. WE INITIATED A CLB AS ATC CALLED TO QUESTION OUR ALT.

  75.  
  76. Accession Number: 395800
    Synopsis: FLC OF BA41 MISPROGRAMS FMS FOR DSCNT INTERCEPT OF FIX, RESULTING IN A HDG DEV WHICH IS DISCOVERED BY ATC.
    Narrative: ATC ISSUES A BARIN TRANSITION INTO DULLES, VA, WITH XING RESTR AT BARIN AT 5000 FT. PF STARTED THE DSCNT, THE PNF HAD SOME PROBS TO PROGRAM THE FMS. PNF TOLD THE PF HE PUT THE BARIN TRANSITION IN THE FMS. AFTER A COUPLE SECONDS THE PF NOTICED SOMETHING WAS WRONG WITH THE FMS AND QUESTIONED THE PNF. AT THIS TIME ZDC TOLD US THAT WE WERE OFF COURSE AND SUGGESTED HDG TO BARIN.

  77.  
  78. Accession Number: 397541
    Synopsis: B737-300 ACFT DIDN'T FOLLOW CORRECT SID PROC. ON THE SID DEPICTION THERE ARE 14 DIFFERENT SID ROUTES WHICH RPTR CAPT BELIEVES CAN BE DEPICTED BETTER AND CLEARER.
    Narrative: WE WERE CLRED VIA THE ARTHUR KILL DEP AND OUR RTE WAS VIA LANNA. WE ERRONEOUSLY REMAINED ON THE 260 DEG HDG INSTEAD OF INTERCEPTING THE SBJ 100 DEG RADIAL. WHEN WE WERE APPROX ABEAM OF SBJ THE CTLR ASKED WHERE WE WERE GOING AND COMMENTED, 'I GUESS THAT STILL ISN'T DEPICTED VERY CLRLY.' IN OUR RUSH TO GET BACK WHERE WE BELONGED WE INITIALLY PROGRAMMED THE MCP/FMS INCORRECTLY AND INITIALLY TURNED L INSTEAD OF R, FURTHER COMPOUNDING THE ERROR. AT THE SAME TIME THE CTLR HANDED US OFF. THIS CREATED A LOT OF CONFUSION FOR US AND THE NEW CTLR. WE ALL RECOGNIZED AND CORRECTED THE ERRORS AT THE SAME TIME. NO TFC CONFLICTS OCCURRED. COMPLACENCY WAS A DEFINITE FACTOR IN THIS ERROR. WE HAD JUST FLOWN THIS SID ON OUR PREVIOUS DEP FROM EWR AND ASSUMED THE PROC WAS THE SAME FOR ALL DEP FIXES. OBVIOUSLY WE DID NOT TEST THIS ASSUMPTION AS WE SHOULD HAVE. ANOTHER FACTOR IS THAT THIS PROC IS VERY POORLY WRITTEN/CHARTED. I BELIEVE THAT THE CONVENTIONAL METHOD OF DEPICTING SID TRANSITIONS SHOULD BE USED (IE, THE ROUTING VIA SBJ TO LANNA SHOULD BE DEPICTED USING A HVY DASHED LINE AND SHOULD BE REFERRED TO AS THE 'LANNA TRANSITION'). THE CLRNC SHOULD ALSO USE THIS PHRASEOLOGY. ALSO, THE COMMERCIAL CHART CATEGORIZES THIS PROC AS A 'VECTOR' PROC. THIS HELPED STRENGTHEN OUR (INCORRECT) BELIEF THAT WE WOULD RECEIVE VECTORS TO LANNA. PERHAPS THIS PROC SHOULD BE SEPARATED INTO TWO PROCS, ONE FOR THE VECTOR FIXES AND ONE FOR THE PLT NAV FIXES. CERTAINLY SOME CHANGES AND IMPROVEMENTS CAN BE MADE TO THE CURRENT CHART AND CLRNC PHRASEOLOGY.

  79.  
  80. Accession Number: 399890
    Synopsis: B767-200 ACFT ON STAR ARRIVAL WAS GIVEN A NEW STAR. FLT CREW PROGRAMMED FMS FOR THE NEW ARRIVAL, BUT DIDN'T MAKE THE CROSSING RESTRICTION ON THE NEW ARRIVAL.
    Narrative: APPROACHING CIVIT INTXN OUR ARRIVAL WAS CHANGED FROM THE CIVET TO THE MITTS ARRIVAL WITH INSTRUCTIONS FOR INTERCEPTING THE RWY 24R LOCALIZER. THE FMS WAS PROGRAMMED (I THOUGHT) FOR THE MITTS AND WE WERE CLRED FOR THAT ARRIVAL. APPROACHING MITTS INTXN, MY CO-PLT ADVISED ME THAT IT LOOKED AS IF THE ACFT WAS NOT PROPERLY DSNDING. I CHECKED THE HSI AT THE SAME TIME AS A FLT ATTENDANT ENTERED THE COCKPIT AND I MISINTERPRETED THE DISPLAY AS BEING OK. IT WASN'T. WE CROSSED MITTS ABOUT 600 FT HIGH. I REESTABLISHED THE CORRECT VERT PATH AND NOTICED THAT THE 'EXEC' LIGHT ON THE FMS WAS ILLUMINATED. THIS ARRIVAL IS A RELATIVELY NEW AND NOT OFTEN USED PROC. THIS INCIDENT RESULTED FROM THE LAST MINUTE CHANGE IN ARRIVAL, A POSSIBLE ERROR IN PROGRAMMING THE FMS, AN INTERRUPTION IN THE COCKPIT, AND MY UNFAMILIARITY WITH THE PROC.

  81.  
  82. Accession Number: 400590
    Synopsis: FLC OF A B757 MISPROGRAMMED THE FMC CAUSING A SLOWER DSCNT ON A STAR ARR THAN REQUIRED BY ATC. ARTCC WAS NOTIFIED OF THE PROB PRIOR TO THE FIX RESULTING IN ATC VECTORING OFF COURSE UNTIL ACFT HAD APPROPRIATELY DSNDED BEFORE THE XING FIX.
    Narrative: RECEIVED CLRNC TO CROSS HAYED INTXN AT FL190. FMS (CDU) ORIGINALLY HAD HAYED AT FL180 PROGRAMMED. PF PUT IN NEW CLRNC IN CDU BUT LINE SELECTED PENNS INTXN INSTEAD OF HAYED. PENNS IS FURTHER AWAY THAN HAYED INTXN. BECAUSE IT WAS A HIGHER ALT AT A FIX FURTHER AWAY FROM ORIGINAL PROGRAMMING, THE BOX (FMC) DELETED THE HAYED AT FL180 RESTR AND NOW COMPUTED PENNS AT FL190 FOR TOP OF DSCNT POINT. ABOUT 10 MI FROM HAYED INTXN, CAPT NOTICED THE ERROR WHILE IN A DSCNT (ACFT PROGRAMMED TO CROSS PENNS AT FL190). IMMEDIATELY CALLED ATC AND ADVISED. WAS GIVEN A TURN OFF AIRWAY TO FACILITATE DSCNT, THEN TURNED BACK TO ORIGINAL COURSE AND RESUMED NORMAL NAV. ERROR WAS MADE BY NOT DOUBLECHKING LINE ENTRY AND NEW XING RESTR AND SECOND ERROR WAS MADE BY NOT CHKING LINE 1R OF CDU ON 'DSCNT PAGE' TO SEE WHAT THE TOP OF DSCNT POINT WAS BEING COMPUTED ON.
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