JAL 767 crew mistook Changi taxiway for runway

[Hogger60]

From Flight Global

By: GREG WALDRON
SINGAPORE

Source: a day ago'

Japan Airlines (JAL) has suspended the crew of a Boeing 767-300ER that mistakenly commenced their takeoff run on a taxiway at Singapore’s Changi International airport.

The incident occurred while the aircraft was operating flight JL38 to Tokyo Haneda at roughly 02:30 on 12 July, says JAL in an email to Flightglobal.

The carrier only learned of the incident on 23 July when it was contacted by Singapore authorities.

It adds that immediately after starting the takeoff run, the crew realised their error and aborted the takeoff. The aircraft was subsequently directed to the runway and departed without further incident.

There were 10 crew and 198 passengers aboard the aircraft during the incident.

Flightglobal’s Ascend Fleets database shows that the aircraft involved bears registration JA606J. It was delivered in 2003 and is powered by General Electric CF6 engines.

[_Phoenix]

Incredible!
I was just curious how is it possible. From a satelitte imagine of the airport, the rwy 02C looks like 02R, then taxiway becomes 02C, just trying to find a plausible excuse...

[Airbubba]

Did they follow the greens to line up on EP instead of 20C perhaps? :confused:

SIN is a great airport but I hate that maze near the departure end of 20C with A6, A7, EP, EN etc. As with interstate highways, limited access is a good thing in my opinion.

[pattern_is_full]

Well, 20R and 20C are on opposite sides of the terminal, so probably no confusion there. But as Airbubba says, it is a rat's nest of taxiways.

And the main cross taxiway NC2 from the W to the E doesn't actually link up with 20C, so one has to make an extra jog right-left-right to reach the runway.

An eerie resemblance (but with a better outcome) to Singapore 006 in Taipei - big jet, creeping along in the dark, makes a right turn, gets take-off clearance - and the crew thinks they're on the runway.

[Airbubba]

Another account of the miscue:

JAL jet mistakenly accelerated on taxiway at Singapore airport

Jul 29, 2015

A Japan Airlines aircraft nearly tried to take off from a taxiway at Singapore’s Changi Airport on July 12 as pilots mistakenly thought the Boeing 767 jet was on a runway, an act that could have led to a crash with other planes, JAL said Tuesday.

The aircraft, JAL flight 38 bound for Tokyo’s Haneda airport, gathered speed to take off for a few seconds in the early hours of the day, although the act was prohibited.

The incident did not cause any injuries to the 208 passengers and crew members on board. There were no other aircraft on the taxiway at the time.

The 58-year-old captain and a 50-year-old copilot of the aircraft failed to report the incident to JAL. The airline learned of it following a report from Singaporean authorities, the company said.

JAL suspended the two from working aboard aircraft and is considering punishing them, the company said, adding that the pilots did not think the incident was something worth reporting.

On July 12, the plane received clearance for takeoff from the airport traffic controller when it was running near the end of a taxiway, located parallel to a runway, about 25 minutes behind schedule, according to JAL.

The pilots misunderstood that they were at the end of a runway, and ran for a few seconds using takeoff thrust. But since the captain realized that the plane was running on the taxiway and after receiving an order to stop from the controller, the aircraft put on the brakes, JAL said.

JAL jet mistakenly accelerated on taxiway at Singapore airport | The Japan Times (http://www.japantimes.co.jp/news/2015/07/29/national/jal-jet-briefly-takeoff-thrust-singapore-taxiway-controllers-acted-crew-grounded/#.Vbmz8TZRFLg)

[Sqwak7700]

Good to see the captain realized his mistake but chose to continue until the controller intervened. He was just testing the controller, no Asian face saving here.

Reminds me of that recent article about Asian carriers under reporting safety incidents.

[CaptainProp]

.....and never reported it to the company. Company found out when the authorities got in touch.

[bud leon]

Yes, every incident that happens in Asia is due to inferior cultural attributes, while every incident that happens in the west is due to a complex nexus of multiple factors.

The racism on this forum is ignorant and tedious.

[MrSnuggles]

bud leon

The racism on this forum is ignorant and tedious.

Sometimes I tend to agree with you. The First Air accident far north in Canada, where the Capt disregarded the FO and FO didn't take matters into his own hands. What would the repercussions (spelling?) be if that was an Asian crew? Hmmm?

Besides, this isn't the first wrong runway/taxiway incident at Changi.

[ManaAdaSystem]

JAL suspended the two from working aboard aircraft and is considering punishing them, the company said, adding that the pilots did not think the incident was something worth reporting.

If the first action from the company is punishment, are they really surprised this event was not reported?
I'm sure the JAL OMA has the words "non punitive" in it, but if the culture is one of punishment, the pilots will try to bury most incidents if they think they can get away with it.
A lot of airlines operate like this.

[Ranger One]

If the first action from the company is punishment, are they really surprised this event was not reported?
I'm sure the JAL OMA has the words "non punitive" in it, but if the culture is one of punishment, the pilots will try to bury most incidents if they think they can get away with it.
A lot of airlines operate like this.

My first reaction was that any punishment would principally be FOR not reporting it, and rightly. Mistaking a taxiway for a runway... well that's not good but... there but for the grace of God...

But when the first your employer hears about the incident is from an overseas authority... that's the worst possible look.

R1

[Greenlights]

Pay to fly?

[gcal]

Surely rather than suspending the crew there should be an non disciplinary investigation.
I would suspect any company that did not have a frank and honest open police of admitting mistakes.
A company which first seeks to blame is not a healthy one.

[ramble on]

There should be on every taxiway, large brightly painted taxiway identification letters/numbers on all taxiway centrelines approaching, through and immediately after all corners and every X distance on straight ways.

Auckland New Zealand and Bangkok Thailand do it well.

Best practice and all that.

[gcal]

Reading it again and not knowing the system at JAL I wonder if they were suspended because they didn't report it; rather than because they made a mistake.
I hope JAL has an open and honest, no threat, reporting system.

[Huck]

But when the first your employer hears about the incident is from an overseas authority... that's the worst possible look.



We've been warned at my company - EVERY aborted takeoff, no matter how slow, is now reported by ATC to our FAA inspectors. They look to see if there is a pilot report for each. If there was a maintenance reason for the abort, there better be a write-up in the maintenance log.

[framer]

It seems strange to me that someone would contemplate not putting in a report for an aborted take-off ( no matter how slow) . But I am with an airline that would simply email back saying " received your report. Thank you ." And that would be the last I would hear unless they really needed extra information. If I was likely to be ' punished' I might think about rolling the dice. Very glad I'm not in that type of company.

[ManaAdaSystem]

On the NG it is not uncommon for the spoiler lever to be slightly out of stowed position. This will trigger a take off warning the moment thrust is set. You close the thrust levers, give the spoiler lever a push, then take off.

I would never write a report about this.

[megan]

about 25 minutes behind scheduleWonder if that little factoid (assuming it's correct) had a role to play?

[Airbubba]

On the NG it is not uncommon for the spoiler lever to be slightly out of stowed position. This will trigger a take off warning the moment thrust is set. You close the thrust levers, give the spoiler lever a push, then take off.

I would never write a report about this

This is exactly the kind of stuff Huck is talking about with the feds in the U.S.

If you had a takeoff warning and didn't document it, even though you know what caused it and corrected the problem, you might be hanged these days.

You'd better contact dispatch, maintenance, flight ops, and write it up in the logbook. Then decide whether it is a discrepancy or a comment, close the writeup somehow with corrective action like 'cycled spoiler lever, subsequent operation normal' and get a bunch of codes and employee numbers. And for CYA purposes, within 24 hours file an event report, an ASAP safety report and maybe a NASA form.

And, since you may have rolled a down the runway a little, make sure you have data for takeoff from the next intersection and run the numbers again just to make sure.

Or, roll the dice since you are on the runway at PVG with twenty planes behind you for an afternoon departure.

As Dirty Harry said: "You've got to ask yourself one question: 'Do I feel lucky?' Well, do ya, punk?"

The company 'self-discloses' these events to the FAA and like Huck says, they go through QAR and other data to see if it matches with the logbook and event reporting. Remember when we were told that all this data collection was totally anonymous and would never be used for enforcement or punitive purposes?

[ManaAdaSystem]

Luckily I fly in the normal world, and the two times this happened to me, nothing was reported by anyone. Just the way it should be.
I prefer not to have any sort of STASI reporting non events to anyone.

A take off event on a taxiway is a reportable incident.

[Arfur Dent]

Had a situation once when very new to the 744. Hit the TOGA switches when not quite ( BGS) lined up. Aborted at very low speed due TO config warning. Taxi back to normal TO point and lined up properly. FC pax on flight deck so a little embarrassing but properly sorted with no further probs.:ok:

[Airbubba]

Did they follow the greens to line up on EP instead of 20C perhaps?


Looks like my initial hunch was correct:

Incident: JAL B763 at Singapore on Jul 12th 2015, rejected takeoff from taxiway

By Simon Hradecky, created Wednesday, Jul 29th 2015 11:15Z, last updated Wednesday, Jul 29th 2015 11:15Z

A JAL Japan Airlines Boeing 767-300, registration JA606J performing flight JL-38 from Singapore (Singapore) to Tokyo Haneda (Japan) with 198 passengers and 10 crew, had taxied from the gate to depart runway 20C via taxiway WA (parallel to runway 20R), NC2 (North Cross 2) and was turning onto taxiway EP parallel to runway 20L [and parallel to 20C which it is next to, 20L is over on the military side - Airbubba] at about 02:25L (18:25Z Jul 11th) when the crew received takeoff clearance for runway 20C. Tower controller noticed the aircraft was accelerating for takeoff on taxiway EP reaching about 25 knots over ground, instructed the crew to stop and taxi onto runway 20C. The aircraft departed runway 20C about 6 minutes later and reached Tokyo Haneda with a total delay of 20 minutes.

A nice spaghetti bowl taxi diagram in the original article here:

Incident: JAL B763 at Singapore on Jul 12th 2015, rejected takeoff from taxiway (http://avherald.com/h?article=48a008ab)

An eerie resemblance (but with a better outcome) to Singapore 006 in Taipei - big jet, creeping along in the dark, makes a right turn, gets take-off clearance - and the crew thinks they're on the runway.

Another similar incident, with nobody hurt, was Dynasty at ANC. They were cleared to takeoff on the customary runway 32 (now runway 33) at Kilo and they took off on taxiway Kilo instead:

http://www.pprune.org/rumours-news/1600-china-airlines-taxi-way-take-off.html

[JammedStab]

Taxiway Departure Attempt Triggers Changes At JAL, Changi | MRO content from Aviation Week (http://aviationweek.com/mro/taxiway-departure-attempt-triggers-changes-jal-changi?NL=AW-19&Issue=AW-19_20160906_AW-19_326&sfvc4enews=42&cl=article_5&utm_rid=CPEN1000000624045&utm_campaign=6931&utm_medium=email&elq2=69c80e27016a4685ac0b83202d9d5f54)

No more "Follow the Greens" taxi clearances.

[Capn Bloggs]

Report:

http://www.mot.gov.sg/uploadedFiles/Ministry_of_Transport/Content_Blocks/About_MOT/Air_Transport/AAIB/JAL%20B767%20attempted%20take-off%20on%20taxiway%20-%20Final%20Report.pdf

It cannot be over-emphasised that thorough planning for taxi operations is essential for a safe operation.
Pardon? They planned it but got sent another way, which bamboozled the PF/FO. Surely you would be better not planning the taxiout until you get your route from ATC?

No more "Follow the Greens" taxi clearances.

"It is recommended that the ATC consider verbalising the main taxi route in addition to the instruction to “taxi on the greens” in the taxi clearance."

[Offchocks]

Personally I found SIN easy to taxi around with either follow the the greens or a verbal clearance. I can't say the same for JFK.

[Fratemate]

They planned it but got sent another way, which bamboozled the PF/FO. Surely you would be better not planning the taxiout until you get your route from ATC?

I agree but that is not the Japanese way, at least not in ANA or JAL. They insist on briefing the expected taxi route and then get flustered when it changes. I believe every one of their briefings sets them up for a classic confirmation bias trap and it is not unusual to hear them going the way they expected, rather than the way they were instructed. A mate of mine could not get the idiot he was flying with (luckily he's gone now) to listen to what he was trying to tell him. ATC had given contrary taxi instructions to those briefed and although my mate was quite specific in telling the Japanese captain that he was going the wrong way (i.e. the way he'd briefed, rather than the route given by ATC) he continued. My mate actually called and asked for confirmation.......guess where Captain Confirmation Bias went, still ignoring his PM! Funny how a 777 looks coming head on down the same taxiway.

Looking at the green and yellow lines on the report's diagram leads me to think they thought they were turning right onto the runway (as briefed and expected......C B ) but, clearly, they failed to follow their exact progress.

As for not reporting it........I believe ANA and JAL would be similar in their outlook and I would have no hesitation in submitting a report. There would be some form of investigation, as you would expect but I do not believe it would be punitive and I do not ever get the feeling that I'm going to be punished for making a mistake. This has all the marks of face-saving; nothing else, and despite all their talk about cultural changes to rid themselves of such outdated ways of thinking it's a VERY slow process and won't be happening any time soon (measured in centuries).