Has ATSB gone totally mad?
From a recent ATSB report about an aircraft that did not take off using the centre line of the runway: .
Bombardier DHC-8-315 commenced the take-off roll on runway 01 at Townsville Aerodrome for Cairns, Queensland. During the takeoff, the pilot in command realised that the aircraft was aligned with the left runway edge. The aircraft was manoeuvred to the centre of the runway and the takeoff rejected. It was later determined that the aircraft’s left main wheel had damaged a runway edge light. There were no injuries to the 34 passengers or five crew members and no damage to the aircraft. The operator did not have procedures to assist the crew to ensure that the aircraft was lined up on the runway centreline in preparation for takeoff. Does that mean that legally all aircraft from Cessna 150 to Airbus A380 are required to have a "procedure" to assist a pilot to ensure they are properly lined up? Don't pilots have eyes to assist them to line up? Isn't this just normal pilot competency from the very first solo? Does ATSB now require this "procedure" to be published in the company Ops manual. How much wet nursing are ATSB writers attempting to foist on pilots? Or are the legal eagles in ATSB trying to stamp their authority on Operations Manuals and how bloody ridiculous this all is...:mad: |
OR
The operator did not have procedures to assist the crew to ensure that the aircraft was lined up on the runway centreline in preparation for landing. OR The operator did not have procedures to assist the crew to ensure that the aircraft was taxing on the taxiway centreline. OR The operator did not have procedures to assist the crew to ensure that the microphone switch was off when not transmitting OR The operator did not have procedures to assist the crew to ensure that the gear lever was adequately lubricated before flight. :ugh: |
"Does that mean that legally all aircraft from Cessna 150 to Airbus A380 are required to have a "procedure" to assist a pilot to ensure they are properly lined up?"
No. The report stated this was a 'minor safety issue'. The statement was an observation, not a direction. I just read the report, not too much I can pick to criticise it. |
Procedure for ensuring pilots line up with the centre of the runway:
Having received and acknowledged ATC clearance to enter the runway in use, crews must ensure that the runway cleared for use is the same runway as the one to be entered. Visually aquire runway centre line. This can be determined by a centre line marking, or by finding a position equidistant from each edge of the runway. Line up with the centreline, making sure that the aircraft is aimed along the correct runway heading. Pilots must ensure that the aircraft is not allowed to line up on the runway edge, which may cause damage to runway edge lighting. There, backsides covered; is that better? The usual consultancy fee is required. |
Not withstanding any other regulation, a Pilot in command must not allow an aircraft to commence a take off from a designated runway, unless:
a) The aircraft has a valid take off clearance for that runway, and, b) the centreline of the aircraft is positioned over the centreline of the runway, and, c) the heading of the aircraft is within one degree of the designated runway heading. This is an offence of strict liability. Penalty sixty penalty units or Five years in jail. |
the heading of the aircraft is within one degree of the designated runway heading. Guess I need a few hundred years in jail. Where did u get that tripe from Smellslikefish? |
After this incident, the operator issued a change in procedure for the FO to call 'on centre line' prior to commencing the take off roll. What I find amusing is that I'm pretty sure the crew thought they were on centre line before they commenced the take off roll so even if that procedure had've been in place at the time of this incident, wouldn't they have called 'on centre line' anyway?
These reactive procedures really aren't thought out prior to issue. All is does is add another thing for crews to get wrong in cyclics. Any competent pilot with good situational awareness is going to line up properly on the centre line and check it prior to opening up the levers. |
Originally Posted by Tee Emm
Isn't this just normal pilot competency from the very first solo?
Just wait, CASA will be onto this quick as a flash. Hope all your ops manuals have a section dedicated to lining your acft up on the centreline! :E |
was it an overly enthusiastic rolling takeoff? Perhaps they just got a bit wide from opening the taps a bit early..
|
A pilot at my old operator did the same thing around the same time on the exact runway in a 404. Happens I guess.
Interesting that he reported the flap overspeed but not the RTO (well that's how I read it). I also know he got the chop by Sunnies over the incident. Fair? |
so what will the procedure be for unsurfaced runways?
|
"Does that mean that legally all aircraft from Cessna 150 to Airbus A380 are required to have a "procedure" to assist a pilot to ensure they are properly lined up?" No. The report stated this was a 'minor safety issue'. The statement was an observation, not a direction. I just read the report, not too much I can pick to criticise it. Either way, this is totally over the top. A written policy to stop this sort of thing? How are we now to do a rolling takeoff without compromising the RTOW? How about the training departments/Regulators ensure that pilots are trained properly so that this sort of thing doesn't happen instead of making yet another rule? |
I presume the taps weren't opened unless the crew thought they were on the CL.
The "procedure" for lining up had been followed, but the crew member made an error, probably a perceptual error. WHY did the crew member make that error? THAT is the question. The ATSB acknowledges some criticism that their investigation model focusses on "organisational" factors, to the detriment of the acts and omissions of the individual. If the addition of another f:mad:ing procedure is the best recommendation/observation that comes out of this report then I suggest the criticism is valid. :suspect: |
The question was "legally" does every operator have to have a procedure based on the findings of this investigation. My opinion was no. The reason: the ATSB is an independent investigative agency. Industry and government are responsible for policy change, not the ATSB. The ATSB makes findings. My take on the findings in this case were that crew distraction, weather, night, and the unusual arrangement of the runway having Ordinance Loading Areas and associated lighting at the threshold, were the major causal factors, and that not having a procedure was listed as a 'Minor safety issue'. The aircraft operator made a decision implement changes to procedures based on the incident, but that does not mean that all operators are legally required to do so.
|
In what publication does ATSB admit this? Have harped on this for some time. Would be interested to read it.
|
how do we do a formation takeoff then????
|
CX has a requirement to verbalise the RWY and intersection just before you cross the holding point and we are not allowed to cross the red lights until they are switched off even if cleared to line up.
In LWMO we will also tune the ILS and check centered when lined up. Maybe a thread drift here but It's the lights on taxiways you have to watch out for, wrongly identifying sideline blue with centerline GREEN is a biggy!! EDITED BY ME. Oops lah Apron B and C heading east in Bali at night is an example to watch, it has sideline blue BUT only on the south side!!! In the rain at night you have to be very careful not to track the lights under the nose!! |
So was this at night in low visibility? If at night, does the runway have centreline lights? I can't imagine any pilot lining up on the runway edge line during the day.
|
Maybe a thread drift here but It's the lights on taxiways you have to watch out for, wrongly identifying sideline blue with centerline white is a biggy!! Apron B and C heading east in Bali at night is an example to watch, it has sideline blue BUT only on the south side!!! In the rain at night you have to be very careful not to track the lights under the nose!! |
Townsville has ORP's either side of the runway threshold, I doubt these are lit. They effectively double the width of the runway at the threshold. It would be easy to mistake them for being on the runway, particularly as the whole aircraft would be on a sealed surface for the first 100 or so meters.
|
I must say that one of my beefs with a typical ATSB statement is the over-use of the term "is consistent with".
Ex: A smoking hole was discovered in the ground which was consistent with witness reports of an aircraft in a vertical dive. CAVOK was forecast which is consistent with a witness report there was no cloud in the area. Shortly after take off the captain threw up all over his first officer which is consistent with witness reports that he had been pissed as a newt that night. |
In what publication does ATSB admit this? They note the criticism (and specifically that it has been made by CASA) and then reject it :} |
Red Jet, good pickup!! I've edited the reply.:{
With regards to Apron B maybe a bit more explanation might help. We pushed back at night in heavy rain from Apron B and were left by the tug at about 70 deg to the taxiway. The FO looking through his wet side window mis identified the blue sideline lights for green centerline and began to turn directly toward the nice row of lights!! I corrected him in plenty of time before we got bogged. So, what I'm trying to say is this, if there is only 1 row of lights be sure you carefully observe which colour they are. Anyway I guess it was a bit of thread drift as the Dash in TSV was on the runway. :ok: |
if there is only 1 row of lights be sure you carefully observe which colour they are. Sorry if I came across as a smartarse. The small inconvenience and slight embarrassment that may arise from "loosing the plot" temporarily, bringing the aircraft to a complete stop and ask someone for help - absolutely PALES INTO INSIGNIFICANCE to the potential consequences of taxiing on with an uneasy feeling in your tummy, while hoping that you pick up something you should recognize soon.Someone just buried a 732 on its arse in a ditch over in Africa while trying to reverse taxi out of a blind spot after a wrong turn. Anyways - back to the thread. |
|
Good stuff! Somebody finally taking the bull by the horns with some good education material. Well done, that man. :D
|
Horatio, would really like to check out the report. Pse to give a link.
|
|
"line it up with the nosewheel on the centerline" |
ATSB Report
Title: Analysis, Causality and Proof in Safety Investgations
Report #:AR 2007-053 |
IMHO, limiting line-up checklists (or 'checks below the line') to calling a maximum of two essential items would go a long way to reducing the recurring problem of crews rushing or otherwise becoming distracted at such a critical time, when attention should be outside the cockpit. Lights, strobes and transponders are hardly items requiring checklists or responses. If CASA got out of the business of approving checklists maybe the local industry could follow world's best practice and move in this direction.
|
If CASA got out of the business of approving checklists maybe the local industry could follow world's best practice and move in this direction. Remember the Jetstar A320 missed approach in Melbourne. The AFM, with which compliance is legally required. See CASR Part 21 and CAR 138, where "flight manual" means the AFM, part of the aircraft certification package. I constantly marvel at the CASA ability to not understand the ramifications of their own legislation. CASA have no power to direct amendment to an AFM, unless it is an Australian type certified aircraft ---- which excludes all but a handful of the aircraft on the Australian Civil Register. Tootle pip!! |
Sled del,
CASA have no power to direct amendment to an AFM Operators make changes to checklists for good reasons. Normally, it's because the procedures created in an office somewhere in the US or Toulouse can't and don't work in every possible operating scenario of the aircraft in the world. Besides, the AFM procedures are just that: procedures. They are not multi-crew checklists. Get into the real world, Sledled. In fact, my Boeing's AFM says: "these procedures are for guidance only in identifying acceptable operating procedures and are not to be considered mandatory or in any way construed as prohibiting an operator from developing their own equivalent procedures". It is an entirely different issue that the JQ changes were not appropriate. That should have been picked up internally. |
i read somewhere that just before taxying to the runway the PIC commented to the FO that " i have reached my limits"
|
To say that one must follow the AFM verbatim regardless is ridiculous. Have your ever heard of the term "No Technical Objection"? CAR 138 Pilot to comply with requirements, etc of aircraft’s flight manual, etc (1) If a flight manual has been issued for an Australian aircraft, the pilot in command of the aircraft must comply with a requirement, instruction, procedure or limitation concerning the operation of the aircraft that is set out in the manual. Penalty: 50 penalty units. This Manual shall not supersede or countermand any Regulations, Orders or Instructions issued by the Civil Aviation Safety Authority. Compliance only with the terms of this Manual shall not absolve any personnel from the responsibility of abiding by such Regulations, Orders and Instructions. You really need to carry a silk around in the flight bag these days to attempt to make sense of anything. |
Brian...
CAR 138 Pilot to comply with requirements, etc of aircraft’s flight manual, etc (1) If a flight manual has been issued for an Australian aircraft, the pilot in command of the aircraft must comply with a requirement, instruction, procedure or limitation concerning the operation of the aircraft that is set out in the manual... Unless the original certification basis is Australian, then CASA does not have the power to approve the checklist, because it forms part of the aircraft certification documentation. So CASA can only 'accept' the checklist, OR an amendment to it if an OEM letter of NTO has been issued. Perhaps you need to sort out/discriminate between CAR 138 and CAR 215(b)? I think you'll find that if the NTO to amend a checklist is necessary to comply with CAR 215(b), then CAR 138 would be satisfied. :ok: I'm not a lawyer, so maybe the legally qualified might like to add their 2-bob's worth here. Good suggestion re the flight bag 'silk'...maybe an APP for iPad perhaps, now it's apparently been accepted by the FAA as an EFB? :D Maybe CASA-acceptance of the iPad as an EFB will follow in about 50 or 60 years?? :8 On second thoughts though, and from its past track record, perhaps that's going to be a bit too tight as a timeframe? :zzz: |
Correct rmcdonal, additionally it was dark, pissing rain and inexperienced f/o. Very easy to make the same mistake.
|
Brian A & Siuya,
You have indeed got it right. Along with a good slice of CASA FOIs, the full ramifications of the legislative changes in mid-1998 still have not filtered through our old mate Bloggs cranium, and he is far from alone. In his defense, individual pilots should not need to know about this sort of stuff, you "should" be able to depend on CASA to get it right ---- and company manuals being "legal". As is traditional, when CASRs 21 to 35 were put in place, the necessary transitional amendments to existing CARs were either incomplete, incorrect or non-existent. Large slabs of the CASA AOCM make interesting reading, the many inconsistencies (not limited to CAR 138 v 215 v 232) are clear, if, and only if, you understand the significance of the 1998 changes. The Australian arrogance shines through in the said AOCM. Of course we know better than the manufacturers. I love the bit that says words to the effect that changes should not be made to CASA approved flight check systems ( the manufacturers --- [they really mean TC holder] ) on a new type until "---- adequate experience has been gained - for example, the aircraft has been in service for 300-400 hours". So, we are so smart that after 3-400 hours, we know better than a TC holder, whose accumulated fleet experience is in the thousands, or tens of thousands of hours, not forgetting all the development, experience and test work that formed the basis of the aircraft certification, including the AFM, in the first place. Bloggs, my dear fellow, I know the legal requirements for processing a change to an AFM all too well. Boeing's "no technical objection" is but a small part of the story ----- and if you understand the implication of the Australian aviation law framework, as it is, and not how you (and many others) think it is, you would understand the "nto" is not sufficient, any longer. This is not necessarily so in other countries --- it all depends on the legal framework under which the NAA works. In my personal opinion, as a pilot, the A320 matter was not caused by the procedural change, but non-the-less a change was made to the G/A procedure without the approval of the TC holder -- not legally possible under current Australian law. And not very smart. Tootle pip!! |
AFM Operating procedures
Folks,
You seem to searching for roadblocks, consistent with the behaviour you so readily accuse your regulator of demonstrating. CAR 138 says comply with the AFM. No sweat, my FAR/JAR 25 AFMs contain Operating Procedures included in accordance with Section 25-1581 et seq. I note that AC 25-1581-1 includes generic guidance about Operating Procedures (beginning on page 8): http://www.airweb.faa.gov/Regulatory...C25-1581-1.pdf which results in the Disclaimer referred to by my good friend Bloggs. It is an explicit permission to vary the "guidance" when and if appropriate. If I was to develop my own procedures in the light of operational experience, I would be complying with the AFM and certainly not in any way interfering with the certification basis of the aircraft. The regulations recognise that there is some risk in me doing things on my own, so CAR 232 regulates my activity in that regard (as do FARs 121-141 and 121-315 in the US). The Australian Regulator regulates the use of Australian aircraft in accordance with Australian law. What it takes to convince the regulator to approve the necessary changes is a function of the extant institutional timidity. There is no regulatory requirement for NTOs - they are merely means of transferring the risk back to the manufacturer. And the OEM just has deeper pockets - not necessarily more or better knowledge - just ask Bloggs about MDD/Boeing and his beloved B717! :mad: Stay Alive, |
Procedures in AFM
The Airbus AFM and FCOM both contain passages similar to the one Bloggs posted above.
Airbus AFMs do not contain Standard Operating (Normal) Procedures for the Go-Around. By varying the Go-Around SOP an operator is NOT rendering invalid the certification basis for the aircraft. It is not illegal to do what what Jetstar did. It is done by many other operators around the world frequently. The absence of process surrounding the change is another matter completely. Mr Sandilands and others take note. |
All times are GMT. The time now is 13:55. |
Copyright © 2024 MH Sub I, LLC dba Internet Brands. All rights reserved. Use of this site indicates your consent to the Terms of Use.