elihoole/asrs-aviation-reports · Datasets at Hugging Face

1688277

201909

0001-0600

0.0

Dawn

Air Carrier

B737-700

Part 121

IFR

Passenger

Parked

N

Y

Scheduled Maintenance

Work Cards; Installation; Inspection

Escape Slide

Air Cruiser

X

Improperly Operated

Hangar / Base

Door Area

Air Carrier

Technician

Maintenance Airframe; Maintenance Powerplant

Communication Breakdown

Party1 Ground Personnel; Party2 Ground Personnel

1688277

Aircraft Equipment Problem Critical; Deviation / Discrepancy - Procedural Maintenance; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Attendant

Aircraft In Service At Gate; Pre-flight

General Maintenance Action; General Flight Cancelled / Delayed

Aircraft; Procedure; Manuals; Human Factors

Procedure

I installed [Company 1] emergency evacuation slides on aircraft in the service aft and service forward position. I was notified on my drive home by the dayshift supervisor that the inflight crew found the gurt bars were the wrong length and would not attach. Not being familiar with the [Company 1] slides; I did not know the gurt bars are a different length and position specific. I assumed they could be installed in every position just as the [Company 2] slides/gurt bars can be. I relied on my lead to print MPD25 after I turned in my parts tags and paperwork. I did not realize the [Company 1] have an A or and F in the serial number that notates what position they should be installed in; as there is no documentation of this. I should have checked MPD25 myself before installing the slides. I believe my 'norm' of installing [Company 2] slides that fit in every position and relying on my lead to print MPD25 contributed to my error. In the future I will check MPD25 before installing all parts and I'm truly sorry for this event causing a delay for our passengers.

Technician reported installing emergency evacuation slides in the wrong doors.

1251975

201504

1801-2400

ZZZ.Airport

US

0.0

Air Carrier

Regional Jet 700 ER/LR (CRJ700)

2.0

Part 121

Passenger

Taxi

Aircraft X

General Seating Area

Air Carrier

Captain

Flight Crew Air Transport Pilot (ATP)

Situational Awareness

1251975

Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Other / Unknown

Person Flight Crew

Aircraft In Service At Gate

Flight Crew Took Evasive Action

Procedure

The flight attendant informed a passenger he would have to gate check his bag and he responded he didn't want to check it because it was 'full of batteries.' She asked him to stand aside with the bag in question and informed me. I called Operations multiple times to get more information to make a decision on how to proceed. I asked to see a battery; and it took a little while as somebody had already taken the questionable bag into C4. There were 8 batteries each the size of a small brick; for video equipment. These batteries did not have exposed posts; they had small receptacle holes the camera leads fit in to. They were not taped over. The passenger claimed that they were not charged up. It was found that they did not meet the requirements of 49 CFR 175.10; which states only two larger-type lithium ion batteries of max size 100 up to 160 Watt-hours; if properly prepared and approved by the air carrier; may be in carry on luggage. It does not mention their state of charge. However; there were 8 batteries; and rated at 190 Wh. I did not let them onboard; and the passenger stayed behind with them.The passenger explained to me that he did not understand why I denied them aboard; as he travels like this all the time as do plenty of other people in his profession. He also tried to explain that only when they are charging or under a load could they pose a fire risk; thus his are not charged. Since he had never been stopped or heard of others stopped over the years by TSA; or inquired at the ticket counter about batteries with his video equipment; he assumed it was fine. I think this situation demonstrates some confusion and a lack of information about lithium batteries as their use has spread. I would have never encountered this situation if the passenger inadvertently did not volunteer the information himself.As [operations] provided me with the latest 49 CFR 175.10 on passengers and lithium batteries; it appears that TSA either is not aware or not enforcing it regarding the batteries they allow through their checkpoints. An agent that night was telling my Flight Attendant that since TSA had already checked the bag; it was good to go. Another agent said this type of luggage is fine. The next day I thought it curious when an agent that was there the night before informed me that the passenger with the video equipment had left that next morning and because TSA had 'checked it' it was all ok. It was not specifically said; but implied that the batteries in question went on the aircraft with him.In light of that fact; I am filling this report for clarification on the latest regulations; to confirm if I did err or not in denying the passenger and his baggage onboard; and to know what to do if this situation comes up again. Operations mentioned they will be looking for information on this issue a little more as well.One suggestion I have is to increase information regarding lithium batteries to flight crews in the form of an email and adding a paragraph in the Manual with guidance about the CFRs of defined limits on number of batteries; their size; packaging and describing what is airline approval (i.e. would it be noted on the passenger count given to the Flight Attendant); carried in the cabin or not; and if it matters if they are charged or not.Ticket counters might have a sign about batteries; or ask about lithium batteries if there is a lot of audio/visual and other electrical equipment. Lastly; it is unclear what TSA's role and responsibility is in this situation. They strictly prohibit any liquid amounts greater than 3.4 oz. in case of a fire/explosive threat. If these type of batteries are indeed deemed a fire threat; it would be surprising if TSA is letting all of them through and we are all unknowingly carrying them onboard our aircraft.

A Regional Jet Captain explains his rationale for rejecting a passenger and his carryon luggage consisting of eight large lithium ion camera batteries.

1288355

201508

1801-2400

ZZZZ.ARTCC

FO

35000.0

VMC

Night

Center ZZZZ

Air Carrier

B767 Undifferentiated or Other Model

3.0

Part 121

IFR

Passenger

FMS Or FMC

Cruise

Class A ZZZ

Aircraft X

Flight Deck

Air Carrier

Pilot Flying; Captain

Flight Crew Last 90 Days 160; Flight Crew Total 22000; Flight Crew Type 9000

Troubleshooting; Workload; Physiological - Other

1288355

Deviation / Discrepancy - Procedural Hazardous Material Violation; Flight Deck / Cabin / Aircraft Event Illness / Injury

Person Flight Attendant

In-flight

Flight Crew Returned To Departure Airport; Flight Crew Took Evasive Action; General Physical Injury / Incapacitation

Aircraft; Environment - Non Weather Related; Procedure

Environment - Non Weather Related

We received a call from Business Class galley Flight Attendants (FAs) reporting that she was feeling light headed and dizzy. 10 minutes later all 3 FAs in the Business Class galley called to report light headedness; difficulty breathing; and slight headache. Recirc fans were turned off to increase fresh air to cabin. Only those 3 fwd FAs were affected; the 3 working in Coach were not. Symptoms went away within a few minutes. Approximately 10 minutes after that a 4th FA who had come fwd to assist in the Business class section called to report that he too now had a headache. Contact made with Dispatch; [medical services]; and [maintenance] at this point. While conversing with Dispatch we received another call from fwd galley to report all 4 of them now had all previous symptoms return. Decision to descend and divert was made at that point. Made immediate descent to FL240 to further lower cabin altitude and original plan was [a] diversion. After level at FL240 for 10 minutes Purser called to inform us that all symptoms had gone away. I also had them use portable O2 starting just prior to descent. At that point decision was made in conjunction with Dispatch to continue to ZZZ. Upon arrival we were met by emergency medical personnel who checked all crew members vitals. At no point during the time that the FAs were showing symptoms did either of us in the cockpit feel any of the same symptoms. I had the relief pilot check them and several passengers to see if they were ok. Problem seemed to be located in the fwd galley only. We did have a shipment in the fwd cargo compartment which contained 44 lbs of dry ice which the emergency crews were notified about. After arrival police also met the aircraft and wanted statements from all of us. I refused for us and recommended the same to the FAs.

A B767 returned to the departure airport after the business class flight attendants became light headed. Coach flight attendants were unaffected. Forty four pounds of dry ice were in the forward cargo hold.

1573288

201808

0.0

Air Carrier

Commercial Fixed Wing

2.0

Part 121

IFR

Passenger

Parked

Gate / Ramp / Line

Air Carrier

Ramp

Communication Breakdown

Party1 Ground Personnel; Party2 Ground Personnel

1573288

Deviation / Discrepancy - Procedural Hazardous Material Violation; Deviation / Discrepancy - Procedural Published Material / Policy

Person Ground Personnel

Pre-flight

General None Reported / Taken

Human Factors; Procedure

Procedure

On the [load plan] item 1 only showed the mail as 'live animals-other' and it weighed 893 lbs. Also; on the [load plan] was a 16 lb dog and a quickpack of dry ice. I needed to plan the item 1 mail and the dog in the forward pits and the dry ice in the aft pit. Not knowing what type of animals were in the item 1 mail; I was unable to calculate the air space for the 16 lb dog. I explained this to the [Loading Supervisor] and she had the Ramp Lead call me. The Ramp Lead advised me item 1 mail was fish. Also; item 4 was listed as 'tropical fish.' With that information; the air space was okay.

Ramp load agent reported HAZMAT cargo incorrectly assigned to live animal cargo compartment.

1307497

201510

0601-1200

ZZZ.Airport

US

Daylight

Center ZZZ

Air Carrier

B757-200

2.0

Part 121

IFR

Passenger

Cruise

Class A ZZZ

Turbine Engine

X

Malfunctioning

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Not Flying

Flight Crew Air Transport Pilot (ATP)

1307497

Aircraft Equipment Problem Less Severe

Person Flight Crew

In-flight

Flight Crew Landed As Precaution; Flight Crew Returned To Departure Airport

Aircraft

Shortly after reaching cruise altitude the right engine displayed indication of high vibration. We followed the checklist procedure; which resulted in operating the engine at a reduced power setting to keep the vibration within limits. We [advised] Center and got clearance to return to ZZZ. We landed uneventfully; however the aircraft was overweight. We then taxied to the gate and entered the engine problem and overweight landing in the maintenance logbook.I think the event was well handled by all - the pilots; flight attendants; ATC; dispatch; airport personnel; and maintenance.

B757-200 Captain reported returning to departure airport after noting high vibration on the right engine.

1494780

201711

0601-1200

ZZZ.Airport

US

0.0

VMC

50

Daylight

12000

50

CTAF ZZZ

Personal

RV-3

Part 91

None

Training

Takeoff / Launch

Aircraft X

Flight Deck

Personal

Pilot Flying; Single Pilot

Flight Crew Instrument; Flight Crew Multiengine

Flight Crew Last 90 Days 12; Flight Crew Total 2400

Training / Qualification

1494780

Ground Event / Encounter Loss Of Aircraft Control; Ground Excursion Runway

Person Flight Crew

Other takeoff roll

Aircraft Aircraft Damaged

Human Factors; Weather

Ambiguous

Lost control of aircraft on takeoff run and ran off the runway. Damage to landing gear. Runway in use had quartering tail wind.

RV3 pilot reported loss of control on takeoff roll resulting in a runway excursion and damage to the landing gear.

1061777

201301

0001-0600

ZZZ.ARTCC

US

13000.0

Center ZZZ

Personal

PA-44 Seminole/Turbo Seminole

1.0

Part 91

IFR

Descent

Visual Approach

Class E ZZZ

Facility ZZZ.ARTCC

Government

Enroute

Air Traffic Control Fully Certified

Communication Breakdown

Party1 ATC; Party2 ATC; Party2 Flight Crew

1061777

ATC Issue All Types

Person Air Traffic Control

General Declared Emergency

Human Factors; Procedure

Human Factors

A PA44 reported [the airport] in sight; and was given a visual approach clearance into [the airport]. I observed the PA44 descend through 008; and then climb back to 017. The PA44 checked back on and stated that [the airport] was NOTAMed closed. We agreed that neither of us had been made aware of this closure. The PA44 stated that he was in communication with someone at [the airport] on UNICOM frequency; he was declaring an emergency; and would be landing [the airport]. I reported all this information to the FLM. Make sure that appropriate coordination is accomplished when airports are NOTAMed closed.

Enroute Controller issued a Visual Approach clearance to a non-towered airport only to discover that the airport had been NOTAMed closed.

993496

201202

1201-1800

BQK.Airport

GA

250.0

2.0

1000.0

VMC

8

Night

3000

CTAF BQK

Fractional

Medium Transport; Low Wing; 2 Turbojet Eng

2.0

Part 91

IFR

Ferry / Re-Positioning

Final Approach

Visual Approach

Class G ZTL

CTAF BQK

Any Unknown or Unlisted Aircraft Manufacturer

1.0

Landing

Class G ZTL

Aircraft X

Flight Deck

Fractional

Pilot Flying; Captain

Flight Crew Flight Instructor; Flight Crew Instrument; Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP); Flight Crew Flight Engineer

Situational Awareness; Human-Machine Interface; Communication Breakdown; Confusion

Party1 Flight Crew; Party2 Flight Crew

993496

Conflict Airborne Conflict; Deviation / Discrepancy - Procedural Published Material / Policy; Inflight Event / Encounter Other / Unknown

Horizontal 6000; Vertical 300

Person Flight Crew

Taxi

Flight Crew Took Evasive Action; Flight Crew Became Reoriented

Human Factors; Airspace Structure

Human Factors

We did everything right; except one thing; but good 'heads-up' helped get things right: We were on a left base on visual approach to Runway 7. (This runway was chosen due to the calm winds and the precision lighting only on this runway seemed to indicate it was the preferred runway.) We were just switched to CTAF from Center and I heard the pilot not flying (Co-pilot) making the applicable traffic calls. As I turned onto final; I saw the lights at the airport were either not bright enough or not up at all; so I asked the Co-pilot to click on the lights. (I thought he'd done so earlier; but wasn't sure.) He did so; and made another call on CTAF to announce our arrival. As we got closer to the runway; we saw a light approaching from the opposite runway. I first thought it could be a helicopter maneuvering in the airport area (sometimes they don't talk a lot when training in low areas); but as I continued; the light appeared to maintain centerline and continue toward the opposite runway. I then asked the pilot not flying/Co-pilot to confirm we were on CTAF; as I initiated a go-around. He looked down and noted the frequency was set one digit off. After quickly tuning the correct frequency; the pilot not flying made a call that was received with a response that the other white-light-now-identified-as-an-aircraft was breaking off their approach. They then asked if we had been making radio calls. The pilot not flying said we had; but stated we realized we had incorrectly tuned one digit off when we saw their lights and got no response from our calls. We apologized and both aircraft landed uneventfully .What lulled me/us into a false sense of security was the pilot not flying was making all the right calls; and the runway lights even came on when he clicked on the CTAF frequency. Of course; that was coincidental; the other aircraft had clicked-up the lights at the same time! Yes; a mistake was made. Yes; the 'Mark I eyeball' (i.e.; looking outside) still has a place in aviation.

A Captain approaching BQK noticed aircraft lights on the opposite runway and executed a go around only find out that the First Officer was broadcasting CTAF position reports on an incorrect frequency.

1358876

201605

1201-1800

ZZZ.Airport

US

38000.0

VMC

Daylight

Center ZZZ

Air Carrier

Large Transport; Low Wing; 2 Turbojet Eng

2.0

Part 121

IFR

Passenger

Cruise

Class A ZZZ

Aircraft X

Flight Deck

Air Carrier

Pilot Not Flying; Captain

Flight Crew Air Transport Pilot (ATP)

Flight Crew Last 90 Days 28

Communication Breakdown

Party1 Flight Crew; Party2 Dispatch

1358876

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Passenger Misconduct

Person Flight Attendant

In-flight

Flight Crew Diverted; Flight Crew Overcame Equipment Problem

Equipment / Tooling; Aircraft

Equipment / Tooling

We had a Passenger issue in the back of the aircraft; and requested direct to ZZZ. We were given priority handling from ATC. We only had one FMC that had ACARS capability. While I was trying to communicate with our Company via ACARS; my FO; who was flying the aircraft; was unable to get the weather for our arrival; due to a single ACARS setup.I think it could be a continual safety issue; with only a single ACARS setup; in our aircraft when you are in a time sensitive situation; and severely limited to needed information for the safety of the flight. Only one of us could use ACARS at a time.

Air carrier Captain reported about the limits of single FMC/ACARS operations.

1573208

201808

1201-1800

ZLC.ARTCC

UT

10000.0

Center ZLC

Personal

DA40 Diamond Star

1.0

Part 91

IFR

Cruise

Airway V4

Class E ZLC

Facility ZLC.ARTCC

Government

Enroute

Air Traffic Control Fully Certified

Communication Breakdown; Confusion; Situational Awareness

Party1 ATC; Party2 ATC

1573208

ATC Issue All Types; Deviation / Discrepancy - Procedural Clearance; Inflight Event / Encounter CFTT / CFIT

Person Air Traffic Control

Air Traffic Control Provided Assistance

Human Factors; Procedure

Procedure

Aircraft X was cleared via V4 BYI direct TWF. We descended aircraft to 100 and shipped as per LOA. TWF called and asked if the aircraft was over DRYAD or MALTT or something for the ILS. We said no; that they were on V4 to BYI. They said okay and asked for control. We gave them control. Later; we saw the aircraft was westbound into high MEA. We called and asked what they were doing and thought the controller said they were going to DRYAD and we informed them they were entering high MEA. They asked what altitude they needed and we said 120 (the MEA was 113). They gave us some explanation of what their strip showed (direct MEDEA or something). We again said they were on V4 and our strip showed that. The controller climbed to 120 and gave direct DRYAD. The plane did enter the 113 MEA when they were at 100.It seemed like the TWF Controller didn't have the complete flight plan on their strip. I don't know why that is and what the controller gave the aircraft or was thinking. They should have had the routing.

Salt Lake Center Controller reported an aircraft was allowed to operate below the Minimum En-route Altitude.

1206547

201409

0601-1200

ATL.Airport

GA

Daylight

TRACON A80

Air Carrier

Regional Jet 900 (CRJ900)

2.0

Part 121

IFR

Passenger

FMS Or FMC; Localizer/Glideslope/ILS Runway 9R

Initial Approach

Vectors; STAR KOLTT ONE

Class B ATL

FMS/FMC

X

Design; Improperly Operated

Aircraft X

Flight Deck

Air Carrier

Pilot Flying; Captain

Flight Crew Air Transport Pilot (ATP)

Workload; Human-Machine Interface; Situational Awareness; Time Pressure; Confusion; Communication Breakdown; Distraction

Party1 Flight Crew; Party2 ATC; Party2 Flight Crew

1206547

ATC Issue All Types; Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Clearance; Deviation / Discrepancy - Procedural Published Material / Policy

N

Person Flight Crew

In-flight

Air Traffic Control Issued Advisory / Alert; Air Traffic Control Issued New Clearance; Flight Crew Became Reoriented; Flight Crew FLC Overrode Automation

Aircraft; Airport; Chart Or Publication; Human Factors; Procedure

Human Factors

While on the KOLTT RNAV STAR arrival we had originally expected and configured for runway 8R. When approximately 5 miles from KOLTT we were issued a runway change to ILS PRM 9R. I saw my FO start to input the new approach into the FMS (or so I thought). I also swapped pages in my book and was given a quick briefing change due to this being a low IMC PRM approach. The problem started when the arrival runway was not changed prior to reaching KOLTT causing a course deviation. We had just about reached THUNDR (3 miles past KOLTT) when ATC advised us that we had missed a turn. He then issued vectors for the ILS PRM 9R. The FO finished the programming of the approach at this time and the flight plan executed; however; the transition was not put in correctly giving a discontinuity on the approach. We were both heads down trying to figure out why the approach was not being displayed correctly. At this time we were given direct ANDIY for which was executed and the NAV button pushed; however the FMS did not arm or capture. We were very close to the fix which added to the confusion. As the aircraft started to pass ANDIY I rotated the heading bug around to fly inbound on the approach still fully expected the FMS to capture. It did not and we continued to drift to the south until we were approximately 1 mile south of course at 21 DME when I turned off the autopilot and corrected the approach alignment. The rest of the approach and landing were normal and to SOP. I believe due to the high workload and last minute runway change along with a stick NAV button caused a compounding situation up to and including the course deviation. We can not always anticipate last minute runway changes and must work through them as a crew with good CRM.'While on the KOLTT RNAV STAR arrival we had originally expected and configured for runway 8R. When approximately 5 miles from KOLTT we were issued a runway change to ILS PRM 9R. I saw my FO start to input the new approach into the FMS (or so I thought). I also swapped pages in my book and was given a quick briefing change due to this being a low IMC PRM approach. The problem started when the arrival runway was not changed prior to reaching KOLTT causing a course deviation. We had just about reached THNDR (3 miles past KOLTT) when ATC advised us that we had missed a turn. He then issued vectors for the ILS PRM 9R. The FO finished the programming of the approach at this time and the flight plan executed; however; the transition was not put in correctly giving a discontinuity on the approach. We were both heads down trying to figure out why the approach was not being displayed correctly. At this time we were given direct ANDIY for which was executed and the NAV button pushed; however the FMS did not arm or capture. We were very close to the fix which added to the confusion. As the aircraft started to pass ANDIY I rotated the heading bug around to fly inbound on the approach still fully expected the FMS to capture. It did not and we continued to drift to the south until we were approximately 1 mile south of course at 21 DME when I turned off the autopilot and corrected the approach alignment. The rest of the approach and landing were normal and to SOP. I believe due to the high workload and last minute runway change along with a stick NAV button caused a compounding situation up to and including the course deviation. We can not always anticipate last minute runway changes and must work through them as a crew with good CRM.

A CRJ-900 flight crew just five miles from KOLTT on the KOLTT RNAV STAR--having planned for; programmed and briefed for a landing on Runway 8R--was instead changed to land on Runway 9R. The First Officer was unable to program the substantial changes of routing and approach; causing multiple track deviations and the ultimate disengagement of all auto flight tools to execute a manual approach and landing.

1740233

202004

0601-1200

ZZZ.Airport

US

10000.0

VMC

Daylight

Air Carrier

Q400

2.0

Part 121

IFR

Passenger

Takeoff / Launch

Vectors

Class B ZZZ

Emergency Extension System

X

Improperly Operated

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Not Flying

Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument; Flight Crew Multiengine

Communication Breakdown

Party1 Flight Crew; Party2 Flight Crew

1740233

Aircraft Equipment Problem Critical; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Crew

In-flight

Aircraft Equipment Problem Dissipated; Flight Crew Overcame Equipment Problem

Aircraft; Procedure

Procedure

I was the Captain on flight from ZZZ to ZZZ1. We arrived [at] the airplane for the first flight of the day (for us and the airplane) and began preparing for departure. During my before start flow I discovered the park brake pressure to be zero. This was confirmed by moving the MFD (Multi-Function Display) into reversionary mode to show an actual value which displayed '0'. I called Maintenance Control and advised them of the brake pressure issue. The Controller directed me to FSM [section] Low Park Brake Pressure. We completed procedure; returned to the flight deck; continued with our normal checklists; and departed for ZZZ1.I was [the] PM (Pilot Monitoring) for this flight. When my First Officer called 'Gear Up' I selected the gear up and observed three red gear light indications for the mains and the nose gear and also noticed that the gear were not traveling. My first thought was to look up and I observed the alternate landing gear release door panel to be open. I communicated this to my First Officer but because we were below acceleration height we continued normally. All of the appropriate flows were completed at acceleration height and I instructed my First Officer to continue climbing but level off at 10;000 ft. which was our initially assigned altitude from ATC but also it was a safe altitude to still have the gear down if the checklist wasn't complete yet. I also instructed my First Officer to keep the airspeed below 200 KIAS. I contacted ATC and told them that we needed a level off at 10;000 ft. and they allowed us to do so. I also called the flight attendants and told them we were working on getting the gear up and that there was nothing wrong with the airplane. I completed the Landing Gear Fails To Retract checklist; the gear retracted normally; and we continued to ZZZ1; the landing gear operated and indicated normally for the remainder of the flight and there was no further incident on this flight.Upon landing in ZZZ1 I contacted Maintenance Control again to advise them of what happened and they advised me to make a log entry in the logbook so they could inspect the landing gear.Now I would like to give some further background on the situation. First; we had this airplane the night before from ZZZ1 to ZZZ and the airplane was a RON. The airplane did not fly again till we got back out to the airport to fly back to ZZZ1. Going back to the zero park brake pressure issue; this was not shocking to me because this airplane had documented issues with the park brake pressure from a couple days prior. I will paraphrase the write up by saying that it was noted that the park brake pressure decreased rapidly after engine shutdown. Maintenance had inspected the system for leaks and observed the pressure for two hours and had no findings. When we parked the night before I observed the park brake pressure to be relatively normal immediately following shut down. Now having gotten back out to the airplane and seeing the park brake pressure at zero; I wasn't terribly surprised. If you look at [the] procedure in the FSM you'll notice there's a warning box prior to any items stating the need to brief the ground crew to remain clear of the main landing gear doors. I did so but in doing so I was now physically standing in the flight deck and not sitting in my seat. My First Officer and I briefly went over the procedure before we did anything so we would know what to expect. This is the first time in nearly 4 years of employment that I have had to do this procedure. We were going line by line through the procedure (or so we thought) and we thought we had done everything completely. It's obvious I missed step 3 otherwise I wouldn't be writing this report. The final step is to return the handle to the flight deck; which we did; then we continued with our normal checklists.Everything above considered; I messed up. There were at least two opportunities for me to trap this error and I missed them. I take full responsibility for the situation. To be completely honest; we were a little behind in our duties because of having to complete the park brake pressure procedure. Both my First Officer and I went out to the engine nacelle to complete this procedure since neither one of us had done it before. It was a learning experience for both of us and it was really cool to finally get to do something we learn so much about and get pounded in our heads in ground school. At the point of discovering the park brake pressure we were in the middle of our before start duties. Upon returning to the flight deck we finished the before start flows and checklist. Being that we were a little pressed for time we were under added pressure so I missed the landing gear alternate doors item on the before start checklist. I'm not one to sit here and point fingers and make excuses but being candid; we were more hurried than normal; this was immediately following a relatively short overnight; a morning show (which I'm normally a PM guy and bid away from morning trips; but I was assigned this overnight as part of all of the rescheduling going on); and all of the added stress from everything currently going on in the world. Just a lot of external pressures. I understand it's my job to protect the operation from those pressures but we aren't perfect and this is something I have to take responsibility for. Going forward; this was huge reminder for me regarding the importance of checklist discipline and really making sure that we aren't distracted from the task at hand whether that's reading a procedure line by line that's literally black and white to really making sure I'm paying attention and visually verifying the checklist items as we complete the checklist.I have just a couple recommendations. Firstly; I believe this to be an isolated issue and this was really me just being stupid and missing something easy. I don't believe this to be something that could be systemic so I don't believe major changes to the operation for the whole pilot group are necessary. That being said; I would like to see an additional step added to the end of [the] procedure to verify that the alternate release doors have been closed. I was doing all of the steps with my iPad in hand outside of the airplane. After I read step 7 and we completed it I didn't think any further about the procedure. Granted; had I not overlooked step 3 I wouldn't be writing this report; but it would be nice for there to be a verification/reminder step to double check and make sure those panels got closed after releasing the gear doors. One last recommendation; and this is extremely nit picky; the procedure has us use the pump handle in the flight deck. We did so since that's what the manual instructed us to do but everything we get taught in ground school and the placard inside the right engine nacelle say to use the pump handle that's located in the upper right side nose compartment.

Q400 Captain reported landing gear failed to retract when selected up; caused by the alternate gear release panel cover being open.

1615139

201902

0601-1200

TGI.Airport

VA

0.0

VMC

Dawn

UNICOM TGI

Helicopter

2.0

Part 91

None

Taxi

Direct

Class G TGI

Aircraft X

Flight Deck

First Officer; Pilot Not Flying

Flight Crew Rotorcraft; Flight Crew Multiengine; Flight Crew Instrument; Flight Crew Commercial

Flight Crew Last 90 Days 15; Flight Crew Total 5000; Flight Crew Type 400

1615139

Deviation / Discrepancy - Procedural FAR; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Crew

In-flight

General None Reported / Taken

Airspace Structure; Chart Or Publication; Airport

Chart Or Publication

After landing Runway 2; aircraft air taxed to the departure end of the runway (approach end for Runway 20). After touchdown; First Officer observed that a barge with an estimated 50' crane had been positioned 800' from the approach end and 200' to the right of center line of Runway 20. It was observed that a small orange flag was affixed to the top of the crane. There was no observation of a light. Later in the day; the Duty Officer spoke with the point of contact on Tangier Island and was informed that a light was on the top of the crane and that the crane would be in place for an extended period of time. The First Officer contacted FSS to report the hazard to flight in an attempt to get a NOTAM published. Pilot provided the lat/long and pilots observed estimated height. After multiple conversations and phone calls; the NOTAM was not published. the reason provided was that the crane owner was required to call the FAA and provide identification information for the crane and accurate information regarding the lighting; position; etc. Pilot implemented a conference call with FSS and [company] system command to assist in verification of the hazard. Pilot was unsuccessful in meeting the administrative requirements to have the NOTAM published. The result of the administrative requirements was that no NOTAM was issued; or has been issued at the time of this report. The hazard still exists. The location is such that it presents a serious safety hazard to landing aircraft.

Helicopter pilot reported sighting a 50-foot crane to right of centerline of the approach to runway 20 at Tangier Island airport.

1485972

201709

0601-1200

SCT.TRACON

CA

9000.0

Mixed

10

Daylight

2800

TRACON SCT

Personal

Lancair Legacy

1.0

Part 91

IFR

Personal

Initial Approach

Class E SCT

Aircraft X

Flight Deck

Personal

Pilot Flying; Single Pilot

Flight Crew Commercial; Flight Crew Flight Instructor; Flight Crew Instrument; Flight Crew Multiengine

Flight Crew Last 90 Days 40; Flight Crew Total 2500; Flight Crew Type 700

Communication Breakdown; Confusion; Situational Awareness; Workload

Party1 Flight Crew; Party2 ATC

1485972

ATC Issue All Types; Deviation / Discrepancy - Procedural Clearance; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Crew

In-flight

Air Traffic Control Issued New Clearance; Flight Crew Became Reoriented; Flight Crew Requested ATC Assistance / Clarification

Company Policy; Chart Or Publication; Airspace Structure; Human Factors; Procedure

Company Policy

SoCal approach is using outdated arrival procedures that are only obscurely published; failing to take advantage of modern equipment and databases; and thereby imposing unnecessary workload (and therefore hazard) on arriving aircrew. Furthermore; they are unable or unwilling to tell a pilot as little as 10 minutes before joining an instrument approach which approach will be used. Conversations with other pilots and personal experience from 10 years prior indicate that this is standard procedure for SoCal and has been brought to their attention previously.The arrival procedures in question turn out to be Tower Enroute Control clearances; which are verbally dictated to the aircrew and sometimes changed midway through the arrival (although a STAR exists). The report also documents SoCal's clearance for a 110-degree turn onto final contrary to guidance in FAAH 7110.65 and without any prior warning to the pilot resulting in a serious overshoot of the final approach course.

Reporter explained details of the event.

Lancair pilot reported receiving an IFR clearance via VORs and airways when they were prepared to fly the published STAR. They were issued a VOR Approach which required a steep turn to the IAF which the pilot felt was in violation of ATC procedures.

1274123

201506

BHB.Airport

ME

250.0

VMC

10

Daylight

18000

CTAF BHB

Sail Plane

1.0

Part 91

None

Passenger

Landing

Visual Approach

Class E BHB

Air Taxi

Small Transport; Low Wing; 2 Turboprop Eng

Part 135

IFR

Passenger

Landing

Visual Approach

Class E BHB

Aircraft X

Flight Deck

Personal

Single Pilot; Pilot Flying

Flight Crew Flight Instructor; Flight Crew Commercial; Flight Crew Glider

Flight Crew Last 90 Days 34; Flight Crew Total 3738; Flight Crew Type 3738

Communication Breakdown; Situational Awareness

Party1 Flight Crew; Party2 Flight Crew

1274123

Conflict NMAC; Deviation / Discrepancy - Procedural Published Material / Policy

Vertical 200

Person Flight Crew

In-flight

Flight Crew Took Evasive Action

Human Factors; Procedure

Human Factors

Over the numbers at approximately 250 feet; I noticed a [air taxi turbo prop] come out from under my nose. I then extended my touchdown point beyond the [other aircraft] to avoid wake turbulence. Our speeds were providing separation. Completed landing; exited at midpoint; and tried a radio call to the [aircraft]; no response. Called CTAF for a radio check for my radio...was working fine. Contributing Factors:1. Straight-in approach does not work safely at uncontrolled airports and is not approved.2. No radio contact with CTAF? Wrong frequency or whatever..Flying a pattern at an uncontrolled airport will allow all other Aircraft to see that someone is coming in Silent/off frequency or just not talking.

The pilot of a sailplane experienced a near-mid-air-collision with an air taxi's turbo prop aircraft while operating at a non-towered airport.

1619748

201902

0001-0600

ZZZ.Airport

US

0.0

Air Carrier

Widebody; Low Wing; 2 Turbojet Eng

2.0

Part 121

IFR

Passenger

Parked

Gate / Ramp / Line

Other Cargo compartment loading

Other / Unknown

Communication Breakdown

Party1 Ground Personnel; Party2 Ground Personnel

1619748

Deviation / Discrepancy - Procedural Hazardous Material Violation

Person Ground Personnel

Routine Inspection

General Maintenance Action; General Work Refused

Human Factors; Procedure

Procedure

Dangerous goods (RMD) on pallet PMC was not indicated on the loading instruction; pallet had a DG label on it. Load Control notified; they could not find out what the DG was. Due lack of info pallet was offloaded. As pallet was already loaded other cargo had to be offloaded then affected pallet offloaded and aircraft reloaded Nine minute delay due to this.

Airline Safety Personnel reported the removal of Hazmat shipment due to insufficient required Dangerous Goods documentation upon loading.

1502686

201712

1201-1800

LAX.Airport

CA

12000.0

Daylight

TRACON SCT

Air Carrier

A321

2.0

Part 121

IFR

Passenger

FMS Or FMC

Climb

SID DOTSS2

Class E SCT

UAV - Unpiloted Aerial Vehicle

Class E SCT

Aircraft X

Flight Deck

Air Carrier

Pilot Flying; First Officer

Flight Crew Air Transport Pilot (ATP)

Distraction

1502686

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Not Flying

Flight Crew Air Transport Pilot (ATP)

1502692.0

ATC Issue All Types; Deviation / Discrepancy - Procedural Clearance

Person Flight Crew

In-flight

Air Traffic Control Issued New Clearance; Flight Crew Requested ATC Assistance / Clarification

Airspace Structure; Human Factors; Environment - Non Weather Related

Ambiguous

Departing LAX; DOTSS 2 departure assigned 5000 ft. We were give several turns and then direct PEVEE climbing to 9000 ft then 12000 ft then issued 'climb via SID' then FL230. While in the turn to PEVEE the preceding aircraft reported sighting a drone at 13000 ft. We wanted to clarify the climb via instruction and get a vector left to avoid the area of the drone sighting. Once the Captain was able to finally ask for clarification the controller issued a climb to FL230 and stated 'you're not going to make that climb restriction here's the number to call for a pilot deviation.' We were still at 12000 ft and approximately 17 NM from the 15000 ft or above restriction at DOTSS when he made that pronouncement. We ended up crossing DOTSS at approximately 17000 ft.After speaking with a supervisor at the SoCal ATC faculty; it seems the controller was a bit task saturated with the drone in the area and coordinating with other aircraft. He also stated there was no violation.

[Report narrative contained no additional information.]

A321 flight crew reported being distracted by reports of a drone on departure from LAX.

1606328

201812

0601-1200

ZZZ.Airport

US

0.0

Air Carrier

B787-800

2.0

Part 121

IFR

Passenger

Taxi

Aircraft X

Flight Deck

Air Carrier

First Officer; Relief Pilot

Flight Crew Air Transport Pilot (ATP); Flight Crew Multiengine; Flight Crew Instrument

Confusion

1606328

Deviation / Discrepancy - Procedural Published Material / Policy; Ground Event / Encounter Other / Unknown; Ground Incursion Taxiway

Person Flight Crew

Taxi

Air Traffic Control Provided Assistance; Flight Crew Requested ATC Assistance / Clarification; General Maintenance Action

Procedure; Airport; Human Factors

Procedure

This was the second leg on the first day of a domestic two day that I was assigned in R.O. (Relief Officer). There are several items we noted that need to be addressed for safely handling this type aircraft at ZZZ.We landed on runway XX after sunset and taxied via [route] to gate. There are numerous notes and cautions on the ZZZ 10-9 page regarding taxiway restrictions for a large aircraft's wingspan; all of which applied to us. We briefed each note; along with our expected taxi route after landing and were well prepared for the instructions issued by Ground. There are notes in the ZZZ company pages that mention taxi lines in the ramp area that apply to the 757 only as opposed to narrow body. No mention of any other widebody restrictions. Thankfully this was only slightly confusing and did not apply to our gate area. As we approached taxiway X; we were cleared in the ramp via XY. The ramp is well lit and we clearly saw the lead in lines to the gate. What we did not notice was how close the taxiway edge lights on the east side of X are to the taxiway centerline. There is no depiction anywhere of the ramp taxi lines of various colors and their proximity to the movement area. What we realized the next morning was where we turned in at XY put our engine nacelles uncomfortably close to those aforementioned edge lights.The next morning; we were unsure; based on all the ZZZ wingspan restrictions; how we would be routed for takeoff; so we queried Clearance about their intentions. The controller was very helpful and had a clear understanding of the limitations imposed by our wingspan. When it came time to pushback our clearance from Ramp was to 'pushback [color] line for a [taxiway] exit.' Our tug driver told us he could not push us to remain on the ramp; because our wing would overlap X taxiway. There are no notes or depictions of a ramp taxi line or color (other than [a couple] spots); so we were a little unsure what he meant. We coordinated with Ramp and then Ground to pushback facing north on taxiway X. We did not enter the movement area until cleared by Ground. The tug driver was extremely professional; taking no risks with us. During the push we saw the north/south blue taxi line on the east side of the ramp he had spoken of and we both agreed with his assessment that our right wing would have impeded X. We had some confusion about the Ground frequency; which delayed us several minutes; but was eventually cleared up.Our taxi to takeoff was uneventful; although the stop signs and hold lines for the east-west vehicle crossing midway on [one of them] are too close to the taxiway to provide clearance for our wingspan. We had to stop for a truck to back up away from us.Takeoff was uneventful; however; the [company] FMC database does not include the EO (Engine Out) SIDS. We therefore we put [the SID] in the fix page to help in case of need.Suggestions: The company and ZZZ airport need to address these issues if this aircraft type is going to be safely serving ZZZ in the future.1) Add the EO SIDS to the FMC database2) Have Company evaluate the 787 operations at ZZZ; especially the possibility of the wings extending over the movement line when on the ramp taxi lines and the proximity of the taxiway edge lights on X.3) Add depictions of the ramp taxi lines. Currently there are none. Ramp issues clearances to ramp lines based on color and those of us who are unfamiliar are left confused. Not good.4) Clear up the ZZZ [company] page notes regarding ramp restrictions by A/C (aircraft) type. As currently written; they are confusing for any pilot not operating a 757 or a narrowbody.5) The Standard Taxi instructions on ZZZ pages have the departure and arrival instructions joined together in the same boxes. The paragraphs should start in bold font to highlight the different procedures. We missed the 'Arrival aircraft...' procedures during our approach briefing. Thankfully they did not apply to us for this flight.

B787 flight crew reported company and airport procedures/manuals require updating for new widebody aircraft.

1285935

201508

1201-1800

MGY.Airport

OH

0.0

VMC

10

Daylight

12000

UNICOM MGY

FBO

Skyhawk 172/Cutlass 172

1.0

Part 91

None

Training

Takeoff / Launch

None

Class G MGY

UNICOM MGY

Cessna Citation Undifferentiated or Other Model

Takeoff / Launch

Class G MGY

Aircraft X

Flight Deck

FBO

Instructor; Pilot Not Flying

Flight Crew Commercial; Flight Crew Flight Instructor

Flight Crew Last 90 Days 90; Flight Crew Total 475; Flight Crew Type 300

Situational Awareness

1285935

Conflict Ground Conflict; Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Crew

Taxi

Flight Crew Took Evasive Action

Human Factors

My student and I were about to depart from Runway 2 at MGY. We observed a Mooney land and clear the runway. Once the Mooney was clear [of] the runway on a taxiway my student and I checked the traffic pattern for traffic. Observing no traffic we called on the Unicom that we were departing Runway 2. As we lined up on the runway I observed a Citation 10 moving toward the runway at the far end of the runway on a perpendicular taxiway. I told my student to stop as the jet turned on the runway and faced toward us. I immediately instructed my student to turn around and clear the runway. Not long after I had turned around the jet departed on the opposite Runway 20. There is no reason that jet could not have taken off with the flow of traffic; I have noticed a recent increase of private jets departing and landing on runways at uncontrolled airports based not on the flow of traffic and/or the prevailing winds but on which runway will expedite their arrivals and departures.

C172 Instructor Pilot reported observing a Citation taking off against the flow of traffic at MGY; a non-Tower airport. Reporter stated he has noticed an increase in this kind of activity from private jets.

1008150

201205

0001-0600

ZZZ.TRACON

US

500.0

Marginal

Night

TRACON ZZZ

Air Carrier

A319

2.0

Part 121

IFR

Passenger

Climb

Class B ZZZ

Gear Extend/Retract Mechanism

X

Malfunctioning

Aircraft X

Flight Deck

Air Carrier

First Officer; Pilot Flying

Flight Crew Last 90 Days 150; Flight Crew Total 15000; Flight Crew Type 1500

Troubleshooting; Training / Qualification; Workload; Communication Breakdown; Situational Awareness

Party1 Flight Crew; Party2 Dispatch

1008150

Aircraft Equipment Problem Critical

Automation Aircraft Other Automation; Person Flight Crew

In-flight

Flight Crew FLC complied w / Automation / Advisory; Flight Crew Returned To Departure Airport; Flight Crew Took Evasive Action; General Maintenance Action

Aircraft

Upon gear retraction; received a L/G Shock Absorber fault followed by L/G doors not closed and L/G not uplocked. I continued to fly the airplane while the Captain worked the ECAM. We were given delay vectors while the Captain tried to establish communications with Dispatch and ATC. The Captain was unable to establish communications on several voice frequencies that he was directed to use by Dispatch. Being unable to communicate by voice. The Captain was forced to use the ACARS unit alone for communication. This greatly impeded our ability to effectively handle the situation and added to the time it took to work the problem. We asked for a hold while we completed the checklist which directed us to 'land at nearest suitable airport.' We made the decision to return to the departure airport but were asked via ACARS to take the airplane to a nearby airport which we declined to do. After completing the checklists and coordinating with Dispatch; Maintenance; flilght attendants and the passengers; control of the airplane was handed off to the Captain and we completed and ILS approach. Landing and taxi in were normal.

An A319 ECAM alerted L/G SHOCK ABSORBER; L/G DOORS NOT CLOSED; and L/G NOT UPLOCKED so the crew complied with the ECAM and returned to the departure airport.

1051073

201211

0601-1200

ZZZ.Airport

US

0.0

VMC

Daylight

Air Carrier

B737-300

2.0

Part 121

Passenger

Parked

Y

N

Unscheduled Maintenance

Mach Trim

Boeing

X

Malfunctioning

Aircraft X

Flight Deck

Air Carrier

First Officer

Flight Crew Last 90 Days 240

Confusion; Communication Breakdown; Situational Awareness

Party1 Flight Crew; Party2 Maintenance; Party2 Flight Crew

1051073

Aircraft X

Flight Deck

Air Carrier

Captain

Flight Crew Last 90 Days 187; Flight Crew Type 9600

Training / Qualification; Situational Awareness; Confusion; Communication Breakdown

Party1 Flight Crew; Party2 Maintenance

1051694.0

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural MEL / CDL; Deviation / Discrepancy - Procedural Published Material / Policy

N

Person Flight Crew

Other After Pushback

General Flight Cancelled / Delayed; General Maintenance Action

Aircraft; Human Factors; MEL; Procedure

MEL

We originated the flight which had MEL 22-5-01 for a single channel Mach Trim System failure. During the Before Taxi Checklist when Recall was pressed; the Mach Trim Fail and Master Caution lights did not illuminate. We discussed the MEL and it was incorrectly concluded that the indications were correct for our condition. We continued the flight and landed. During the Before Taxi Checklist; we began to second guess our initial interpretation and decided that we should clarify with Maintenance before continuing. The Captain called Maintenance Control and from what I understood of the conversation; Maintenance and Dispatch agreed that the indications were correct for our condition. At one point the call was disconnected and when the Captain called back; a second Maintenance Controller told us that the indications were correct and that we were good to go. We accepted this and did not return to the gate but continued the flight. During this flight; after re-reading the MEL; we again began to second guess the interpretation and decided to call Maintenance again once on the ground to confirm. In this conversation; Maintenance agreed that we should be observing [seeing] the Mach Trim Fail; Flight Control; and Master Caution lights during the recall test. Contract Maintenance was called; we incurred a significant delay; and the MEL was changed to 22-5-02 for both channels of the Mach Trim System. Part B of the MEL 22-5-01 calls for pressing and releasing the Recall annunciator on the glare shield and observing the Mach Trim Fail light; Flight Control annunciator and the Master Caution lights illuminating. After pushback during the Before Taxi Checklist; these lights did not illuminate. Initially; it was wrongly concluded that the Recall Test and illumination of these lights is performed only during the initial MEL procedure to verify that the remaining channel is operating and that after deactivating the failed channel; the illumination of these lights is inhibited. The call to Maintenance Control reinforced this misinterpretation. Additionally; we had both seen the wording of other MELs that specifically state that the system will be tested before each takeoff. MEL 22-5-01 does not specifically state that the Recall Test will be performed before every takeoff which contributed to our misinterpretation. However; Part 'B' of MEL 22-5-01 is an (O) Procedure which should have been understood to mean the Recall Test must be done for each flight. At the least; as soon as there was a question about the MEL on the originating flight; a call should have been placed to Maintenance at that time while at a Base with Company Maintenance and more options available to us. As a pilot; we are the last line of defense in preventing mistakes such as this and we failed at that in this case. We are conditioned to want to believe that Maintenance wouldn't make a mistake and tell us wrong. But in this case; we should have questioned Maintenance more as to why there was an (O) Procedure from the start; and returned to the gate to have someone confirm that the indications were correct for our condition before departing for flight. Additionally; the wording that the Recall Test will be performed before each flight could be added to the MEL which would leave less chance for misinterpretation.

I misread and misunderstood MEL 22-5-01. This resulted in me not complying with the MEL procedures on [several] flights. The MEL states; 'All (M) Procedures listed in section must be accomplished by a qualified Mechanic.' I mistakenly understood this to mean that the procedure was accomplished once by the Mechanic at the time of deactivation and deferral of the Mach Trim channel. I mistakenly believed the light for that channel to be inhibited. We did not get a Mach Trim Fail light on Recalls. In the first leg; I believed it prudent to confirm my interpretation of the MEL. We talked to Maintenance Control; explained our indications; and asked if we should be getting a Mach Trim Fail light. He believed our indications were correct and we were good to go. In the next leg; I reread the MEL and concluded I may have misread/misinterpreted the procedure; and again contacted Maintenance Control to seek clarification. A different Maintenance Controller informed me we should get the Mach Trim light on Recall. I had misunderstood the procedure. The light not illuminating also indicated MEL 22-5-02 (both channels failed) was the correct MEL for the condition. Maintenance then applied the correct MELMy knowledge of the symbols; terminology; and procedures written in MELs was very weak. I did not really even perceive or comprehend the significance of the (M)/(O) symbology. I had previously just read each step and ensured it was accomplished (in this case by the Mechanic). I have now read the explanation of MEL item information section in the Performance computer to ensure my level of knowledge is good and I fully understand why I made this mistake. I see now that I began to doubt myself; however; I padlocked onto my original thought process and could not escape that train of thought. Some MELs indicate; 'The crew will before each flight [perform test]' Perhaps such language could have helped make this more obvious; however; sound knowledge on my part would have prevented this mistake. I also now recognize that I should have stopped at the first sign of doubt.

A Captain and First Officer report about the misinterpretation and confusion they and Maintenance Control had with a previous MEL 22-5-01 deferral for a Mach Trim System failure on their B737-300 aircraft. The aircraft had flown with a dual channel Mach Trim failure but had been deferred as a single channel failure.

1186662

201407

0001-0600

HCF.TRACON

HI

5000.0

TRACON HCF; Tower NGF

Military

Military Transport

2.0

Part 91

IFR

Tactical

Initial Climb

Visual Approach

Class E HCF

TRACON HCF; Tower NGF

Military

2.0

Part 91

IFR

Tactical

Final Approach

Visual Approach

Class E HCF

Facility HCF.TRACON

Government

Approach

Air Traffic Control Fully Certified

Air Traffic Control Time Certified In Pos 1 (yrs) 15

Communication Breakdown; Confusion

Party1 ATC; Party2 ATC

1186662

ATC Issue All Types; Airspace Violation All Types; Conflict Airborne Conflict; Deviation / Discrepancy - Procedural Published Material / Policy

Person Air Traffic Control

In-flight

Air Traffic Control Separated Traffic

Human Factors; Procedure

Procedure

I had just taken over R3; and the Controller who I relieved apologized for 'what was about to happen.' I knew immediately; that I'd be writing a report; as soon as I heard that; and I'm correct. This is RIMPAC. There are numerous military aircraft all over; and I was given a briefing that NGF Approach would be open 24/7. This is NEVER the case. Maybe they are a VFR Tower only 24/7; but they are NEVER an Approach 24/7. NGF Approach NEEDS TO BE OPEN DURING RIMPAC. Of course; NGF Approach was closed. That is a problem all by itself. NGF Approach needs to be open. I had four aircraft inbound to NGF; and NGF is only a VFR Tower. Based on our rules at ATC; we can only allow one-in and one-out of NGF. An aircraft must report arrival or cancellation before we can clear in another aircraft; or release a different aircraft. Those are the rules. That's all we can do. But; NGF Tower released Aircraft X head on into my Aircraft Y. They are both IFR. I do not believe I lost separation. My D-Side said she did not give NGF Tower permission to release Aircraft X; but NGF Tower released Aircraft X. Thankfully; a disaster was averted. Luckily; there was not a mid-air. There could have been because this was the ultimate worst case scenario. NGF Tower releasing an IFR aircraft head-on into my arrival on a visual approach. I asked the supervisor to find out what happened. This is ridiculous. NGF Approach NEEDS TO BE OPEN DURING RIMPAC. I told every aircraft inbound and outbound from NGF that they need to call NGF and complain about this situation. I told them that when I complain nothing gets accomplished; but maybe if they complained; something would happen. We need to open NGF Approach. Please do something. Please make RIMPAC safer. Please just do what we were told in the briefing; that NGF Approach will be open 24/7 during RIMPAC.NGF Approach NEEDS TO BE OPEN DURING RIMPAC. Yes; you have my permission to share this and any other report I write.

HCF Approach Controller reports that a Tower departed an aircraft while she had an aircraft inbound to the airport. This is a one in one out situation and the departing aircraft was not released by the Arrival Controller causing a procedural deviation.

1649964

201905

0001-0600

ZZZ.ARTCC

US

Thunderstorm

Center ZZZ

Air Carrier

EMB ERJ 145 ER/LR

2.0

Part 121

IFR

Passenger

Cruise

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Flying

Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument; Flight Crew Multiengine

Situational Awareness

1649964

Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor; Inflight Event / Encounter Fuel Issue; Inflight Event / Encounter Weather / Turbulence

Person Flight Attendant; Person Flight Crew

In-flight

Aircraft Equipment Problem Dissipated; General Maintenance Action

Aircraft

There was weather along the route of flight; and we were given a reroute. The reroute after verifying with the weather radar showed we would be clear of the thunderstorms in the area. In the air; we elected to divert and used a mix of the weather radar and ATC guidance; as well as visual guidance. We were given a direct to ZZZ Airport during the last 20 minutes of the flight which we verified with ATC would clear through the weather. The radar showed no cells or build ups as well. We then encountered a moderate turbulence for no more than 5 seconds and then a bright flash occurred. Afterwards; it was smooth air; however; a strong odor was smelled. The odor was not of electric smell; but of a composite resin type smell. We notified the Flight Attendant who agreed smelled the same in the front of the aircraft. I advised the Flight Attendant to carefully walk through the cabin to see where the smell ends; as well as looking out the exit row to see if there was any signs of abnormalities outside and inside the cabin. He verified there was nothing unusual and the smell only existed in the front portion of the cabin. The smell went away completely after approximately 5 minutes. Because of this; we made a joint crew decision to not elect for an emergency and we found no indications of electrical or any abnormalities as well as no overheated or warm avionics/FMS. We briefed fire procedures just in case to be safe. We also looked at other airports to potentially divert to; but ZZZ was the only one nearby (50 miles away). Furthermore; upon landing and after we exited the runway; we received a FUEL IMBALANCE EICAS message. The aircraft indicated an imbalance of 1;900 lbs on the left wing and 1;300 lbs on the right. Due to the pre-planning for the odor; I was not aware of when the balance started occurring; but I can say it was during the decent as I did not see any imbalance before initiating the descent when verifying numbers for the landing data. All of these items were addressed with Maintenance and written up in the log accordingly.There was no way to avoid this scenario as for a possible lightning strike; we utilized all resources including the weather radar; dispatch for preflight; and ATC. If this was a potential lightning strike; all proper precautions were still utilized for cruise flight. For the imbalance; we did a final fuel check prior to descent. We landed without violating any limitations and were within the proper imbalance at touchdown as the EICAS did not occur until we exited the runway. No suggestions given; just awareness. Safety was maintained the entire time and the crew did an excellent job performing their duties and their teamwork was great.

EMB-145 Captain reported a strong composite resin type odor in cockpit also in passenger cabin. The odor dissipated after approximately five minutes.

1618841

201902

VMC

Air Taxi

Cessna 402/402C/B379 Businessliner/Utiliner

2.0

Part 135

IFR

Passenger

Cruise

Turn/Bank Indicator

X

Malfunctioning

Aircraft X

Flight Deck

Air Taxi

Captain; Pilot Flying

Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument; Flight Crew Multiengine

1618841

Aircraft Equipment Problem Less Severe; Inflight Event / Encounter Weather / Turbulence

Person Flight Crew

In-flight

Air Traffic Control Issued New Clearance; Flight Crew Returned To Departure Airport

Aircraft; Weather

Aircraft

The First Officer/Pilot Monitoring noticed the turn coordinator was unstable and was giving us incorrect indications. After observing erratic indications and taking into consideration the weather that was at our destination; we decided to return to ZZZ. We were VMC and we were halfway to ZZZ1 when the decision to turn back was made. The weather in ZZZ1 was low visibility and so we elected to turn back and remain in VMC. We contacted ATC and got a clearance back to ZZZ. We ended up cancelling a few minutes later. Then; we let [Operations Control] know what the issue and plan was.

C402 Captain reported returning to the departure airport due to a malfunctioning turn coordinator.

1595958

201811

1801-2400

ZHU.ARTCC

TX

4500.0

Center ZHU; TRACON AUS

Pilatus Undifferentiated

1.0

VFR

Descent

Class E ZHU

Facility ZHU.ARTCC

Government

Enroute

Air Traffic Control Fully Certified

Air Traffic Control Time Certified In Pos 1 (yrs) 11

Communication Breakdown; Confusion; Situational Awareness; Workload

Party1 ATC; Party2 ATC

1595958

ATC Issue All Types; Deviation / Discrepancy - Procedural Published Material / Policy; Inflight Event / Encounter Weather / Turbulence

Person Air Traffic Control

In-flight

Air Traffic Control Provided Assistance

Human Factors; Procedure

Procedure

Aircraft X was flying from Austin Approach airspace through San Antonio Approach Control airspace to 8T6 Live Oak County airport in ZHU Houston ARTCC airspace. The aircraft began flashing to ZHU at the boundary of Austin's Approach airspace when it should have flashed to San Antonio Approach. I mistakenly took the handoff at 5;500 MSL when my airspace didn't start until 9;000 MSL and the aircraft was going to fly through San Antonio's Approach airspace for another 65 NM.After noticing that I took the handoff on accident and had track control; I flashed the aircraft to San Antonio Approach quickly. At this time; the aircraft was already about 8 miles into San Antonio's airspace and his route of flight took him through multiple returns of moderate and heavy precipitation as well as beneath a military operating area (RAN1B 060-220) that San Antonio controlled with multiple military aircraft transitioning to and from as well as local practice approach aircraft in the area around. Aircraft X called on my frequency and I shipped him to San Antonio Approach 127.1 frequency for traffic advisories.Not long after San Antonio Approach took the handoff; they began flashing Aircraft X back to me with another 50 miles to fly through weather and below the military operating area. I gave it a few minutes; thinking it may have been a mistake again but as Aircraft X began flying due west to avoid weather (further into San Antonio Approach Control's airspace); they continued to flash the aircraft to me at ZHU sector 56 and 92. The weather was wide spread throughout my airspace and I was having to find new routes of flight for aircraft that would not take them through weather and coordinate the routes with adjacent sectors. As I was working; San Antonio continued to flash the aircraft to my sector which became a distraction for me as I was vigilant and looking for conflicts due to the multiple deviations for weather.I called the Churn Departure/south east MOA sectors and asked that they take the handoff back thinking they may not realize it was flashing but got no answer. I waited and called again and someone answered the line and only responded 'OK' by a controller who did not leave give their initials but turned out to be [initials removed]. They continued to flash the aircraft. I called to ask for the initials of the controller and a different controller answered and after being combative stated his initials were '[initials removed]' and that he had taken a point-out on that aircraft. I tried to explain that the aircraft was going to be in their airspace for a while and it would be better for them to help the pilot with advisories; but they hung up the line. They continued to flash the aircraft; so I took the handoff. The San Antonio Approach Controller switched Aircraft X to me with at least another 48 miles to fly as the aircraft was deviating left and right trying to navigate through the weather. I did my best to advise the aircraft of the weather; however; I had no pilot reports on any of that weather since I had not worked any aircraft in that airspace belonging to San Antonio Approach (000-130 MSL).I was disappointed at the lack of concern the San Antonio controllers had for the VFR pilot trying to navigate through the weather. I reported the incident to my Supervisor and he agreed that the pilot would've been better served by the Approach Controller giving advisories through their airspace. This seems to be a common occurrence for San Antonio Approach Control controllers to handoff aircraft flying through their airspace an access of 50 or 60 miles and them only taking a point out or handing them off. In this case; it was especially unsafe to do so due to the transitioning aircraft; bad weather; and my own workload of having to plan for weather deviations.I would recommend that we express the importance of providing service to aircraft transitioning through our own airspace and ask that the San Antonio controllers work the aircraft that transition their airspace since they would be able to give a better account of the airspace; local traffic and weather they have in their area of responsibility.

ZHU Center Controller reported a procedural problem with AUS Approach Control that continually takes point outs on aircraft that fly long distances in the Approach Control airspace.

1596133

201811

0.0

VMC

Air Carrier

A320

2.0

Part 121

IFR

Passenger

Parked

Hydraulic Lines; Connectors; Fittings

X

Malfunctioning

Gate / Ramp / Line

Flight Deck

Air Carrier

Captain

Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument; Flight Crew Multiengine

Flight Crew Total 10137; Flight Crew Type 9568

Communication Breakdown; Troubleshooting

Party1 Flight Crew; Party2 Maintenance

1596133

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Crew

Pre-flight

General Release Refused / Aircraft Not Accepted

Aircraft; Procedure

Procedure

Crew entered MRM [Maintenance Requirements Manual] to address a puddle of HYD fluid observed during walk-around that was in front of the left landing gear. The gear well was wet with HYD fluid also. Local techs responded and inspected the aircraft. A [release document] was issued which the pilots were somewhat confused by. The sign off was very contradictory. Technical Support Maintenance Control was called and he said most of the fluid was thought to be de-ice fluid from a de-ice of the aircraft overnight. Biggest problem with this is the aircraft was not de-iced overnight and the puddle was an individual puddle on an otherwise dry ramp. The totality of the circumstances strongly pointed to hydraulic fluid; but de-ice fluid is the easy go-to answer during winter ops. Crews really do know the difference.The sign-off was contradictory from start to finish. It is not HYD fluid on ramp. It is de-ice fluid. However; it is leaking HYD fluid and will be fixed within two days. It is dripping but somehow the HYD fluid goes through a molecular change and falls on the ramp as de-ice fluid. Would be interested to see the MX outcome of this event.

Air carrier pilot conducting preflight inspection noticed hydraulic fluid leak around left main gear. Maintenance was called to inspect and provided a contradictory conclusion that the leaking fluid was de-ice fluid.

1765217

202010

1201-1800

ZZZ.Airport

US

0.0

Tower ZZZ

Air Carrier

Commercial Fixed Wing

2.0

Part 121

IFR

Passenger

Takeoff / Launch

Tower ZZZ

Air Carrier

Heavy Transport; Low Wing; 4 Turbojet Eng

3.0

IFR

Taxi

Aircraft X

Flight Deck

Air Carrier

First Officer; Pilot Not Flying

Flight Crew Multiengine; Flight Crew Instrument; Flight Crew Air Transport Pilot (ATP)

Communication Breakdown

Party1 Flight Crew; Party2 ATC

1765217

ATC Issue All Types; Ground Event / Encounter Other / Unknown

Person Flight Crew

In-flight

General None Reported / Taken

Staffing; Airport; Human Factors

Human Factors

Takeoff on Runway XXR full length. At around rotation got a push to the right. Rotated safely and the airplane was climbing normally and no abnormal indications on the ECAM. There was however a heavy aircraft sitting perpendicular waiting to cross Runway XXL. Captain asked if they were cleared to cross that runway because our push to the right seemed to happen around the same time we passed them. Can't really remember what the response was from the Controller.They need to staff the ATC facilities properly. One person handling more than one frequency; or both Ground and Tower. This is not just ZZZ. ZZZ1 is also bad when you add construction to the mix.

Air carrier First Officer reported possible jet blast from a heavy aircraft crossing a parallel runway; while departing.

1790004

202102

0601-1200

ZZZ.Airport

US

0.0

VMC

Daylight

FBO

SR20

1.0

Part 91

Training

Taxi

Aircraft X

Flight Deck

FBO

Pilot Flying; Single Pilot

Flight Crew Instrument; Flight Crew Commercial

Situational Awareness; Training / Qualification

1790004

Deviation / Discrepancy - Procedural Published Material / Policy; Ground Event / Encounter Loss Of Aircraft Control

Person Flight Crew

Taxi

Flight Crew Regained Aircraft Control; Flight Crew Returned To Gate; General Flight Cancelled / Delayed

Human Factors

I was doing my first solo for my CFI training so I was alone in the aircraft in the right seat. I was performing engine start up procedures and had to lean over to the complete left side of the flight deck to crank the ignition switch. As I was leaned over the engine started and my feet slipped off the brake pedals. The plane moved forward and as soon as I could react I moved the throttle to idle and my feet back to the brakes. I then taxied back into the parking spot; shut down the aircraft; and canceled the flight.

SR20 pilot reported momentary loss of control following engine start from the right seat.

1676106

201908

1201-1800

SEA.Airport

WA

1700.0

Daylight

Tower SEA

Air Carrier

Commercial Fixed Wing

2.0

Part 121

IFR

Passenger

FMS Or FMC

Final Approach

Class B SEA

Any Unknown or Unlisted Aircraft Manufacturer

Aircraft X

Flight Deck

Air Carrier

First Officer

Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument

Situational Awareness

1676106

Conflict Airborne Conflict

Person Flight Crew

In-flight

Flight Crew FLC complied w / Automation / Advisory

Procedure; Airport; Airspace Structure; Chart Or Publication

Airspace Structure

On final approach into SEA; we received an RA (Resolution Advisory) from traffic below us in the BFI VFR traffic pattern. Seattle Tower said that they reported the traffic to us but both the Captain and I never heard the call for traffic from Tower. We were established on the localizer and glideslope for the ILS 16R into SEA. The Captain responded to the RA and we continued the approach uneventfully.

Air carrier First Officer reported receiving an RA on final approach for an unidentified VFR target at an adjacent airport.

1774860

202012

0601-1200

Air Carrier

B767-300 and 300 ER

2.0

Part 121

IFR

Passenger

Cruise

Off

Aircraft X

Air Carrier

Flight Attendant (On Duty); Flight Attendant In Charge

Flight Attendant Current

Safety Related Duties; Service

Physiological - Other

1774860

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor; Inflight Event / Encounter Other / Unknown

Person Flight Attendant

In-flight; Routine Inspection

Flight Crew Overcame Equipment Problem

Aircraft

Smell of fumes detected on several occasions including all of last month. Aft smoke detectors go off due to the fumes. Pax (Passengers) complain and makes FAs (Flight Attendants) in the aft sick. We've complained many times and nothing seems to be resolving. Deadhead crew members smell it as well.

B767-300 Flight Attendant reported recurring fume events resulting in passenger complaints and flight attendants experiencing health issues.

1758116

202008

ZZZ.Airport

US

0.0

Air Carrier

Commercial Fixed Wing

Part 121

Aircraft X

General Seating Area

Air Carrier

Flight Attendant (On Duty)

Flight Attendant Current

Boarding; Safety Related Duties

Situational Awareness; Other / Unknown; Confusion; Communication Breakdown

Party1 Flight Attendant; Party2 Flight Crew; Party2 Other

1758116

Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Passenger Misconduct

Person Flight Attendant

In-flight

General None Reported / Taken

Human Factors; Company Policy

Human Factors

On this flight; I feel the safety of passengers and crew were put in jeopardy. A uniformed; non-revenue pilot felt that the company policy that all passengers and crew members must wear a face covering didn't apply to him. He stated that he had a doctor's note stating he didn't have to wear it. The agent spoke with him and the working pilot; and they both decided that he didn't need to wear the mask. I didn't feel safe enough to fly; and removed myself from the flight. I question why; in a pandemic; the Captain has sole authority over this type of safety procedure.All employees need to be aware of company safety procedures.

Flight Attendant reported a non-revenue passenger was allowed to ride on the flight and not required to wear a face mask.

1774753

202011

1201-1800

ZZZ.Airport

US

0.0

Air Carrier

B737 Undifferentiated or Other Model

Part 121

Ferry / Re-Positioning

Parked

Navigational Equipment and Processing

X

Malfunctioning

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Flying

Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument; Flight Crew Multiengine

Flight Crew Last 90 Days 67; Flight Crew Total 3193; Flight Crew Type 3193

Time Pressure; Communication Breakdown

Party1 Flight Crew; Party2 Maintenance

1774753

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy

General None Reported / Taken

Aircraft; Logbook Entry; Human Factors

Human Factors

This was originally scheduled as [Flt Number; Route] However that flight was cancelled due to the inbound aircraft diverting due to a reported autopilot/ILS (Instrument Landing System) failure during an attempt at a Cat 3 Autoland approach. Flight [Number] was rescheduled as a ferry flight [Number] to ZZZ; using the diverted aircraft.The aircraft had some autopilot maintenance done at ZZZ1; and was signed off cleared for flight. Upon arrival at the gate in ZZZ2; the Captain reported that the problems with the autopilot and the ILS were not fixed. Both he and the First Officer stated that the exact same malfunctions occurred on both of the past two flights. They described the Captain's ILS as erratic--intermittent ident; azimuth and glide slope drifting stop to stop and blanking out. The aircraft did not intercept course or glide slope on a Cat 3 approach. On the inbound leg; they described a 30 degree left final approach course LOC (Localizer) intercept where instead of rolling left; the airplane rolled right and turned away from final approach course; prompting the Captain to take over manually. They continued to fly a visual approach due to improved weather conditions since their earlier attempt. The Captain said he had made several ACARS ELB (Aircraft Communications And Reporting System Electronic Logbook) entries at the gate in ZZZ2; but had not received any acknowledgement printouts. Because of this; he had notified ZZZ2 maintenance via radio. The gate agent asked my FO (First Officer) and me how soon we would be ready to push back for ZZZ. We replied that there were open write ups that first had to be worked out or deferred; then released. Shortly after that; a Station Operations Supervisor arrived at the gate and expressed an expectation that we would quick turn the aircraft and depart for ZZZ. There had been no maintenance on the aircraft; nor any service. A Maintenance Supervisor arrived and stated the jet was ok to fly as is; with no open write ups. It was clear that there had been a breakdown in communication between the previous crew and the ZZZ2 Station in regards to the status of this aircraft. They became pushy about getting us off the gate. I was clear that this could not happen until these known; reported discrepancies were written up and resolved. I asked about aircraft servicing (fuel) and catering (food and water). The Pilot Mobile app showed that we had crew meals on this flight. (Both of us require Special Meals due to dietary restrictions.) The Operations Supervisor then went on a tirade about no catering at ZZZ2 and how everyone knows that. Her vehement response surprised both of us; as there was no context or cause for it. The maintenance supervisor continued to insist the aircraft had been fixed in ZZZ1 and was good to fly. I called Dispatch to see if we could get some help from [Maintenance Control]. The controller noted there were no open ELB write ups and therefore no reason to delay departure. No one seemed to register that the previous crew had reported multiple malfunctions of navigation equipment on an evening where IMC (Instrument Meteorological Conditions) was a huge factor. So I said to [Maintenance Control]; with the ZZZ2 Maintenance Supervisor and Operations Supervisor within earshot; that I would have to refuse the aircraft unless they properly documented these discrepancies; and either fixed them or legally deferred them. Meanwhile; the First Officer had called the [Flight Manager]. He recommended that we stand our ground on the maintenance issues; continue to be professional; and if we refused the aircraft to follow protocol. We had showed up at the airport slightly hungry; expecting that our crew meals would be boarded as listed. This was becoming a safety of flight problem; as the airport had few options for food at all; and the ones available were in the process of closing down. It was clear that if we were to have any food and water for the 5+10 red eye flight to ZZZ; we wouldhave to stop what we were doing and go find it. I called Dispatch back and tried again to explain the legal operational aspects of why it was important to document these inbound discrepancies. He got a different [Maintenance Controller] on the line and we had a better discussion. The new controller called the previous Captain for a personal debriefing of the inbound flight. That; in turn; got the requisite ELB documentation generated and the maintenance process started. Troubleshooting revealed the problem was not the autopilot but a failed relay in the localizer antenna switch. Once we were confident that our [Company] procedures had been followed; we began preflighting the aircraft for ferry to ZZZ. We were running a little short of time (appx 1 hr before a CCO (Crew Critical Off) time); but not so much as to cause undue hurry. During this time; several of the ZZZ2 station personnel were hovering around us; looking over our shoulders as though we needed close supervision to do our jobs. It was a distraction and a bit creepy. Before closing the door; the Ops supervisor reappeared in the jetway; blamed me for the delay; berating me for threatening to refuse the aircraft over crew meals and bottled water; and for not knowing there is no catering in ZZZ2. Ironically; even though we pushed back with 30 minute's; cushion; we nearly went over our CCO time while waiting at the hold short for the final weight numbers from Station Operations. We lifted off and had an otherwise uneventful flight to ZZZ.

B737 Captain reported lack of proper aircraft maintenance action following previous crew report of navigation equipment malfunctioning.

1746738

202006

1201-1800

ZZZ.TRACON

US

5150.0

VMC

Daylight

TRACON ZZZ

Air Carrier

Commercial Fixed Wing

2.0

Part 121

IFR

Passenger

Initial Approach

Class B ZZZ

Aircraft X

Flight Deck

Air Carrier

Captain; Check Pilot; Pilot Flying

Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP); Flight Crew Flight Instructor; Flight Crew Instrument

Training / Qualification; Distraction; Situational Awareness

1746738

Aircraft X

Flight Deck

Air Carrier

Pilot Not Flying; First Officer

Flight Crew Instrument; Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP)

Communication Breakdown; Confusion; Situational Awareness; Training / Qualification

Party1 Flight Crew; Party2 Flight Crew

1747003.0

Deviation - Altitude Excursion From Assigned Altitude; Deviation - Speed All Types; Deviation / Discrepancy - Procedural Clearance; Inflight Event / Encounter Unstabilized Approach

Person Flight Crew

In-flight

Air Traffic Control Issued New Clearance; Flight Crew Returned To Clearance

Human Factors; Company Policy; Procedure

Company Policy

As a line check airman; I was teaching and providing operating experience to a First Officer (FO) transitioning back to the Aircraft X type; after flying another aircraft type. I was the pilot flying and the trainee FO was in the pilot monitoring role. During our arrival into ZZZ; we received a STAR change from the ZZZZZ arrival to the ZZZZZ1 arrival due to East flow in ZZZ. This clearance was initially given without a runway transition; so we followed company procedure and put in the ZZZZZ1 arrival with XR Transition per the approach notes. At this time; we both mentioned that XR was closed; but decided to follow company procedure with the intention of changing the runway later.The FMS and Automation systems from the trainee's previous aircraft had an auto-throttle and VNAV system. The Aircraft X type does not have these systems; so the descent needs to be manually managed with the thrust levers and vertical speed. The difficulty was compounded because we were using a single FMS Aircraft X type which is physically located in the 4 o'clock position from the Captain; making it nearly impossible to monitor the flight instruments and FMS simultaneously. I was teaching some techniques to manage the altitude and speed adjustments during the RNAV star. When the PM checked in with approach control; we were assigned Runway Y as anticipated. We tuned in the localizer frequencies and briefed the changes for runway Y; but neglected to reprogram the FMS due to the high workload of managing the STAR restrictions.During the downwind portion of the STAR; ZZZ Approach assigned us to descend to expedite descent to 5;000 MSL. I aggressively descended the aircraft; and when approaching 5;400 MSL ATC told us to climb and maintain 6;000 MSL. I climbed the aircraft back up using the autopilot; but was confused and distracted by this unusual change of altitude.ATC gave us a vector for the base to runway Y. I was verbally instructing the FO how to sequence the FMS for the approach and made a quick visual check to make sure it was done correctly (not realizing the waypoints were still programmed for runway XR). I also coached the FO to change the Navigation mode on the FO's Navigation display for greater situational awareness and in case the FMS is improperly programmed.ATC gave us an intercept vector over the ZZZZZ2 intersection and cleared us to intercept the Localizer. I intended to initially track inbound on the FMS and switch to the ILS when within 18 NM. I had a mental red flag and thought 'That's not right' when I heard ZZZZZ2 but saw ZZZZZ3 Intersection on my MFD. The localizer had already passed for the FO's Nav Display; but due to his lack of recent experience and FMS differences from the previous aircraft; he did not mention this to me. I realized we were overshooting and shutoff the autopilot; while turning back toward the south to re-intercept the Runway Y course. As I was doing this; ATC noticed our error and gave us a vector to re-intercept.As I was intercepting and re-stabilizing the aircraft; I let the aircraft drift up and down about 150 feet. I was also initially slow to get the aircraft slowed to an ATC assigned 160 kts because they were querying us about what happened. I reengaged the autopilot; aggressively slowed the aircraft and we were re-established for a stabilized approach. We were very lucky that XR was closed this day; otherwise a serious traffic issue could have occurred.Cause: Poorly positioned Single FMS on Aircraft X type; Loading Arrival and Runway Changes using RNAV STARs; ATC altitude change distraction; low and non-recent experience of FO in training environment; overall decreased currency and proficiency of all pilots due to COVID-19 effects on industry; high workload during RNAV STAR. Neglected to reprogram FMS and verify waypoints for correct runway after ATC assignment; Untimely Teaching; FO not speaking up about localizer movement.I will guard against untimely teaching and focus more on my primary responsibility of flying and monitoring the aircraft; especially close to the terminal area. When training pilots coming from another aircraft; I will start from an assumption that their situational awareness is nil and that they might not have the recency with procedures; Flight Guidance; and FMS to back me up. I will be extra careful to listen and put runway changes into my FMS soon after they are assigned by ATC.

Left seat pilot (PF) Right seat pilot (PM). There was a lack of communication between the check airman and trainee due to the check airman focusing primarily on training instead of flying the airplane. During the departure briefing; as a right seat pilot; I asked to load Runway Y instead of Runway XR although STARS was saying Runway XR. This was because Runway XR was closed according to ATIS. But the left seat pilot replied that we should load the FMS with the runway on STARS and he would correct it when we received our runway assignment. While cruising; left seat (PF) and right seat (PM) executed positive exchange of controls for the arrival briefing. Suddenly things changed by ATC; such as arrival and runway while trying to stay away from weather.Meanwhile; left seat pilot asked for weather related deviation 15 degree to the right. I asked to make sure right or left because there were storm cells to the right. Left seat pilot affirmed and asked again to the right. I requested from ATC 15 degree to the right due to weather. ATC was astounded and repeated the question 'Are you asking for left or right?' I said right; ATC replied standby and 10 seconds after approved weather deviation to the left because of the weather to the right. We then established left deviation from current heading to avoid weather. After left seat pilot finished the arrival briefing; we executed a positive exchange of controls and right seat resumed PM duties. When the left seat then resumed PF duties; the high speed warning occurred 3 times. Both side frequencies and courses were set for Runway Y; but the FMS was still on Runway XR. ATC instructed us to descend and maintain 5;000 feet from 6;000 feet. While we were around 5;300 feet; ATC instructed us to climb and maintain 6;000 feet. PF did not change the altitude. I said again; ATC assigned 6;000 feet. He bugged 6;000 feet and verified but he did not start climbing. I reminded him again that we should climb to 6;000 feet and he finally started climbing. I then verified once more with ATC to ensure assigned 6;000 feet was correct. We got vectors to Runway Y ILS and as a PM; I switched to green needles to make sure all was OK.While left seat was on FMS; I figured out we were going to deviate from Runway Y course and I pushed the TCS and started turning to the right. Simultaneously; left seat pilot kicked the auto pilot off and back to Runway Y course. ATC advised us of a 20 degree deviation while we were around 210 KIAS and asked to reduce speed to 170. I offered gear down; but left seat pilot did not respond. I offered gear down again and ATC then asked to reduce speed to 160 KIAS immediately. Finally; PF asked for gear down and flaps 22. I was almost going to ask to go around; but we corrected and were able to configure the airplane. We made it stable and landed without much hassle.Cause: Lack of crew communication. Mutual errors. Lack of verification when FMS was set up due to changing STARS and runway and fast paced environment. Meanwhile; left seat pilot was talking about topics related to training purposes. As a result; the aircraft automation established us for Runway XR instead of Runway Y.Always take your time. If behind the airplane; ask for help from ATC. If you cannot descend or climb immediately due to lack of crew communication; advise ATC unable. Make sure both pilots are on the same page regardless of their level of experience; seat or check airman status. We are human beings and we may make mistakes; therefore CRM plays a crucial role in the safety of flight instead of being single pilot. It is a gray area and a question between left seat and right seat pilots of what action would be better if STARS is saying a specific runway and that runway is closed. I learned from this event that the crew should be strict about the sterile cockpit rule regardless of it being a training event. Therefore; both crew members can then focus on flying the airplane in order to prevent staying behind the airplane. Finally; the most important thing I have learned from this event is regardless of the other pilot's position/status; do not assume they will do everything correct.

Air carrier flight crew reported experiencing an unstabilized approach and setting up to land on a closed runway with anticipation of changing to landing runway later.

1283239

201507

0601-1200

ZZZ.Airport

US

37000.0

VMC

Center ZZZ

Air Carrier

B737-800

2.0

Part 121

IFR

Passenger

Cruise

Class A ZZZ

Powerplant Fire/Overheat Warning

X

Malfunctioning

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Not Flying

Flight Crew Air Transport Pilot (ATP)

Flight Crew Total 18800

Situational Awareness

1283239

Aircraft X

Flight Deck

Air Carrier

Pilot Flying; First Officer

Flight Crew Air Transport Pilot (ATP)

1283594.0

Aircraft Equipment Problem Less Severe

Automation Aircraft Other Automation; Person Flight Crew

In-flight

Flight Crew Landed As Precaution; Flight Crew Diverted; General Maintenance Action

Aircraft

We were about 130 NM north of ZZZ at FL370; when the right engine overheat light illuminated. Proceeded with Memory Items and QRH. The light went out when the thrust lever was brought almost back to idle. The right engine was never shut down. After this; we started our decent towards ZZZ. Flight attendants were briefed and passengers were informed about our situation and divert to ZZZ. CFR was requested upon arrival as well. We had an uneventful landing on 18L. Upon exiting the runway we stopped and shut down the right engine. CFR inspected the aircraft; and we were told there were no leaks or other abnormalities. We continued to the gate; where all passengers were deplaned.

Maintenance discovered the overheat/fire detection element touching a duct in the engine bay which apparently caused the false overheat indication. From an aircrew standpoint; there was no means to prevent this event. A learning point to pass along however; would be that the crew must always assume the worst case and take the most conservative course of action to ensure the safety of the aircraft and passengers.

B737-800 flight crew experienced a right engine overheat light at FL370. When the thrust lever was reduced to almost idle the light goes out. The crew elected to divert to the nearest suitable airport and the engine was allowed to continue to run.

1021373

201206

EWR.Airport

NJ

0.0

Dawn

Air Carrier

A319

2.0

Passenger

Parked

Aircraft X

Cabin Jumpseat

Air Carrier

Flight Attendant (On Duty)

1021373

Deviation / Discrepancy - Procedural Security; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Attendant; Person Flight Crew

Pre-flight

General None Reported / Taken

Human Factors

When checking in with the gate agent in the morning in Newark; the agent was late and told us he didn't know how to get into [the computer]. Agent let us in the jetway without checking our ID's! Our Purser asked if he wasn't going to check; how did he know we weren't terrorists? He said we didn't look like them. After telling the First Officer; he made a point of making us all come off with our luggage so he could write our names down.

Air carrier Flight Attendant reported lax security procedures by boarding agent at EWR.

1462853

201707

ZZZ.Airport

US

0.0

Air Carrier

Commercial Fixed Wing

2.0

Part 121

IFR

Passenger

Parked

Drinkable/Waste Water Syst

X

Design

Gate / Ramp / Line

Air Carrier

Ramp

Distraction; Physiological - Other; Workload

1462853

Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Other / Unknown; Ground Event / Encounter Other / Unknown

Person Ground Personnel

Aircraft In Service At Gate

General Physical Injury / Incapacitation

Aircraft; Company Policy; Environment - Non Weather Related; Human Factors; Procedure

Environment - Non Weather Related

Working on the ramp has its own set of hazards. During the upload process hot liquids being poured down the drain which therefore pours onto the gate [where] myself and my coworkers are is becoming an issue. Coffee and or hot water gets poured out and it exits around areas we as rampers must service.

A Ramp Agent discussed the physical hazard's ramp workers encounter when hot liquids are poured into aircraft drains while the aircraft are parked at the gate.

1682320

201909

Air Carrier

B737 Undifferentiated or Other Model

2.0

Part 121

IFR

Passenger

Cruise

Aircraft X

General Seating Area

Air Carrier

Flight Attendant (On Duty)

Flight Attendant Current

Service; Safety Related Duties

Physiological - Other; Fatigue

1682320

Flight Deck / Cabin / Aircraft Event Illness / Injury; Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor

Person Flight Attendant

In-flight

General Physical Injury / Incapacitation

Human Factors; Aircraft

Aircraft

In this report you will find my irregularity reports that I have documented concerning toxic air syndrome that I have experienced while on duty at [Company].[Company] Safety Department said that 'the Hepa-Filters on [Company]'s aircraft are changed out on a regular schedule based.'I also understand that these maintenance procedures are codified in [Company] Technical Operations approved FAA Maintenance Manuals. With that said;How can I verify this for transparency; for each aircraft that I am flying on?1. ZZZ-ZZZ1; Flight # XXXX Serious illness work environment safety concern. After two hours of flying on this aircraft I started experiencing chronic symptoms (Listlessness; Headaches; Fatigue;) are just some of the symptoms I was experiencing as well as C-Flight Attendant and the inbound B- Flight Attendant briefly told me of her illnesses she was experiencing as well. I noticed that when we were on the ground and the galley doors were open; the symptoms went away. This continued all day to the point that I thought I was going to have to call scheduling to be pulled. I believe that this aircraft should be examined for whatever made me and my colleagues work environment physically fatigue.2. ZZZ2-ZZZ3; Flight # XXXYThe crew experienced jet fumes from the aircraft on takeoff from ZZZ2. When we landed in ZZZ3; the A and B Flight Attendants brought it to my attention how severely heavy the fumes they experienced on takeoff. These fumes weren't as heavily present in the back of the aircraft as the A and B Flight Attendants were experiencing. These aircraft fumes side effects caused me to experience a slight headache and pain in my eyes.3. Flight # XXXZ; ZZZ4-ZZZ5After 45 minutes into this flight; I started feeling symptoms; headaches; eye pain; feeling if I was going to faint; and nauseous. No; I am not pregnant! I woke up that morning feeling perfectly fine. Like I said before; the symptoms didn't start until 45 minutes after my first departure. The odor didn't appear to be as prevalent to me as it were for the inbound crew. I'm sure that whatever product they use to disinfect the carpet for that aircraft probably contributed to my temporary illness. In between flights I would step off the aircraft to get fresh air; this helped alleviate the symptoms and when my shift was over and I was off the aircraft I noticed the symptoms disappeared; so I know for a fact that the aircraft cabin environment was causing my symptoms.

Flight Attendant reported three prior fume events resulting physiological issues.

1864824

202112

0601-1200

ZZZ.TRACON

US

4000.0

Daylight

Personal

Small Aircraft; Low Wing; 2 Eng; Retractable Gear

1.0

Part 91

IFR

Personal

Initial Climb

SID ZZZ

Aircraft X

Pilot Flying; Single Pilot

Flight Crew Instrument; Flight Crew Multiengine; Flight Crew Flight Instructor; Flight Crew Air Transport Pilot (ATP)

Flight Crew Last 90 Days 125; Flight Crew Total 7500; Flight Crew Type 1300

Confusion; Distraction; Situational Awareness

1864824

Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Published Material / Policy; Deviation / Discrepancy - Procedural Clearance; Inflight Event / Encounter CFTT / CFIT

Automation Air Traffic Control; Person Air Traffic Control

In-flight

Air Traffic Control Issued Advisory / Alert; Air Traffic Control Issued New Clearance; Flight Crew Requested ATC Assistance / Clarification

Human Factors

I departed ZZZ Runway XX on an IFR flight plan via the ZZZ SID. As I was turning left to intercept the ZZZ vortac 114 radial at approximately 3;500 to 4;000 ft.; I was issued the flowing climb instruction; 'expedite thru 6;000 climb and maintain one-one thousand.' I acknowledged this clearance and immediately began an intense visual scan outside the aircraft for traffic because of the Controller's unusual request for an expedited climb. I did not properly include my navigation receiver as part of my scan as I was now concentrating outside the plane where VMC prevailed at that time. Less than a minute later; the Controller issued a 'low altitude alert' to which I responded that I was in VMC and had terrain in sight. I was not aware at this time that I was off course from the radial specified in the SID. Approximately 1 minute later; as I was climbing thru 6;000 ft.; I was subsequently issued a radar Vector to 'ZZZZZ intersection; flight planned route;' Post flight review of 'Flight Aware' tracking showed my flight east of the ZZZ 114 radial and return after the low altitude from the Controller. I should have remained focused on tracking the ZZZ 114 radial after departure and not allowed the unusual expeditious climb request from the Controller distract me away from my primary function of navigating. Also; if the Controller witnessed my flight deviating left off course towards terrain; it would have been better for her to have notified me of a course error rather than issue an expedited climb instruction.

A pilot reported they flew off course while departing on a SID and received a Low Altitude warning and expedited climb instruction from ATC.

1562629

201807

0001-0600

ZZZ.ARTCC

US

10000.0

VMC

Night

A320

Climb; Cruise

Class E ZZZ

Fuel System

X

Malfunctioning

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Flying

Flight Crew Air Transport Pilot (ATP)

1562629

Aircraft Equipment Problem Critical; Deviation / Discrepancy - Procedural MEL / CDL; Deviation / Discrepancy - Procedural Maintenance; Deviation / Discrepancy - Procedural Published Material / Policy; Inflight Event / Encounter Fuel Issue

Person Flight Crew

In-flight

Flight Crew Diverted; Flight Crew Landed As Precaution; General Maintenance Action

Aircraft; Procedure

Procedure

Diverted to [an alternate airport] as the result of fuel valve malfunction (outer to inner tank valves; right wing tank). This [has] been a recurring maintenance issue on this aircraft. It required a repetitive inspection and maintenance action prior to each departure. We had a mechanic assigned to travel with us as contract maintenance was unavailable. Prior to departure our mechanic experienced difficulty accomplishing the prescribed maintenance action per MEL and contacted Maintenance Control. After repeated attempts to secure the fuel valves open; the left valves indicated fully open; but the right valve indicator indicated approximately 1/2 open. Maintenance Control assured us that this was a valid position and met the criteria for the MEL action required as it allowed the fuel in the outer wing tanks to migrate to the inner wing tank; which it did. We strenuously disagreed with this assessment as it was not consistent with the previous 3 legs that we had flown this day. He insisted it was in compliance and we departed. Climbing through 10;000 feet we reviewed the systems pages and discovered that the outer to inner fuel valves had closed and there was now about 200 pounds of fuel in the outer wing tanks. As the flight progressed we noted that the outer tanks were filling at an alarming rate. In about 30 minutes we had 3;000 pounds in the outer wing tanks and felt that if if this continued we would not have enough fuel in the inner tanks to reach [destination] if the valves did not open on schedule as the result of the maintenance action performed before departure. We contacted Dispatch and suggested a diversion to [a nearby alternate]. The Dispatcher concurred and we proceeded to [divert] and landed uneventfully. The maintenance crew that met us upon reviewing the maintenance log and speaking with the Mechanic that was assigned to our trip felt that the procedure that was applied [before departure] was incorrect. [They] produced a printed page from the maintenance manual and applied the procedure with positive results. An entry was made into our logbook reflecting this assessment. We boarded our passengers and continued uneventfully.

A320 Captain reported diverting to an alternate when their fuel system; which was on MEL restrictions; was not performing as expected.

1194903

201408

1801-2400

IAD.Airport

DC

0.0

Night

Air Carrier

EMB ERJ 145 ER/LR

2.0

Part 121

Parked

Company

Air Carrier

Dispatcher

Dispatch Dispatcher

Training / Qualification; Situational Awareness; Communication Breakdown; Workload

Party1 Dispatch; Party2 ATC

1194903

Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Published Material / Policy; Deviation / Discrepancy - Procedural Clearance

Person Air Traffic Control

In-flight

General None Reported / Taken

At 2 hours prior to scheduled departure time; I completed and filed a flight plan for the flight in question. Due to enroute weather; this flight was filed using a Dispatcher created route of: IAD..FLUKY..PAUKI..MOL.J22.... An hour prior to departure time; the Captain informed me that the aircraft was broken. The Coordinator arranged for an aircraft swap. The new aircraft would result in a delay of several hours. Once the swap was inputted into the Sabre System; I regenerated the flight plan; and created an amendment to the release. This flight was subsequently passed down to the late night Dispatcher. During the regeneration of the flight plan; the Dispatcher created route was lost; and replaced with the company default route. The original route was still on file with the FAA. It is not Dispatch policy to generate a new ATC strip for tail swaps. As a result of this; the crew was 'Cleared as Filed.' However; the route on the paperwork did not match the route as seen by ATC.This is an error with several causes: First of all; as a hub coordinator; my time on the dispatch desk is not sufficient to ensure I remain proficient in all the oddities of the flight planning system. This particular scenario is not covered by any manual; and it is up to the Dispatcher to remember that the system behaves as it does. Secondly; the Dispatch workload makes it almost impossible to remember what routes have been assigned to what flights. There are just too many releases per desk. Additionally; knowing this is a potential problem; the company should implement a procedure to prevent this issue. Either require the dispatcher to remove the strip and refile during a tail swap; or require the crew to request a full route clearance when a new release is generated.

Dispatcher reports assigning a weather avoidance route to one of his flights then having send a new release when an aircraft swap is required. The new release defaults to the standard company route but the weather avoidance route remains on file with ATC. The crew is cleared as filed which is not the route on the current release.

1014842

201206

1801-2400

BWI.Airport

MD

0.0

Night

Ground BWI

Air Carrier

Widebody Transport

2.0

Part 121

IFR

Cargo / Freight / Delivery

Taxi

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Flying

Flight Crew Air Transport Pilot (ATP)

Other / Unknown

1014842

No Specific Anomaly Occurred All Types

Person Flight Crew

Taxi

Flight Crew Requested ATC Assistance / Clarification

Airport; Human Factors; Weather

Ambiguous

Due to inoperative APU; started all engines before push back. Rain began during engine start; light to moderate and then somewhat heavy. Push back completed. It was very hard to visually identify the taxi lines. This was my first BWI trip in several years. Ground Control was helpful once we cleared the ramp area; but the taxiway markings at night coupled with significant rain make it almost impossible to see the taxiway lines. (Very similar to SJU and previously reported by this individual) I tried using the EFVS [enhanced night vision system]; but this accomplished little. The problem is poor lighting and taxiway markings/paint that is non-reflective. In my opinion; [this is] unsatisfactory and a very real safety issue. Use reflective paint.

Air Carrier Captain reports difficulty seeing taxiway lines at BWI at night during rain; suggesting the paint is less reflective than normal.

1118406

201309

0001-0600

PCT.TRACON

VA

2500.0

TRACON PCT

Air Carrier

EMB ERJ 190/195 ER/LR

2.0

Part 121

IFR

Passenger

Final Approach

Visual Approach

Class B DCA

Personal

Amateur/Home Built/Experimental

1.0

Part 91

VFR

None

Class B DCA

Facility PCT.TRACON

Government

Approach; Departure

Air Traffic Control Fully Certified

Situational Awareness

1118406

No Specific Anomaly Occurred All Types

Person Air Traffic Control

General None Reported / Taken

Procedure

I issued Air Carrier X to 'Cross 10 DME at or above 2;500 FT; cleared Mount Vernon Visual Runway One.' This clearance would never have taken the pilot outside of the Class Bravo airspace. A VFR aircraft on the SFRA frequency was flying right below the Class Bravo at 2;400 FT. I issued timely traffic to the Air Carrier X pilot. The pilot received a TCAS RA from the VFR aircraft. I verified with the pilot that the TCAS told him to descend and he said yes. I informed him that he was now outside of the Class Bravo. At the time of the event; I was on position for well over an hour and a half. And there was a Class Bravo airwork plane that was flying East/West lines for the duration of my time on position that made the session very difficult. That is why it was necessary not to have the arrivals into DCA too high at all. And as I stated; I never issued anything that would have taken the aircraft outside of the Bravo and issued a traffic call about the VFR SFRA traffic. No error was made. Expand the Class Bravo 1;500 FT shelf much further south of DCA. The pilots for DCA need to be able to get low enough to make a stabilized approach.

PCT Controller issuing a Visual Approach to DCA noted the aircraft departing the confines of Class B in response to a TCAS RA; the reporter advocated expansion of the existing Class B airspace.

1024130

201207

1801-2400

HNL.Airport

HI

0.0

Tower HCF

Air Carrier

Commercial Fixed Wing

2.0

Part 121

IFR

Final Approach

Visual Approach

Class B HNL

Tower HCF

PA-23 Apache/Geronimo Apache

1.0

Part 91

VFR

Taxi

None

Facility HCF.Tower

Government

Local

Air Traffic Control Fully Certified

Situational Awareness

1024130

Deviation / Discrepancy - Procedural Clearance; Ground Incursion Runway

Person Air Traffic Control

Taxi

Air Traffic Control Issued New Clearance; Flight Crew Executed Go Around / Missed Approach

Airport; Human Factors

Airport

A PA23 arrived on Runway 4L and was instructed to turn right at Taxiway E; hold short of Runway 4R for arriving traffic. Pilot acknowledged. While working other traffic; I turned to scan my traffic and observed the PA23 to have crossed the first hold bar and was holding at the improper hold bar. Simultaneously; my Local Assist was pointing at the aircraft to get my attention. An air carrier was on approximately a 0.75 mile final and was immediately sent around to avoid conflict; then re-sequenced by Approach. Simplify this re-occurring problem by using one hold bar; rather than two.

HCF Controller described a go around event in which traffic instructed to hold short of Runway 4R failed to hold at the correct hold bar; the reporter recommends using only one hold bar reduce confusion.

1435678

201703

ZZZ.Airport

US

Tower ZZZ

Air Carrier

A320

2.0

Part 121

IFR

Passenger

Initial Climb

Class B ZZZ

Air Conditioning and Pressurization Pack

X

Malfunctioning

Aircraft X

Cabin Jumpseat

Air Carrier

Flight Attendant In Charge; Flight Attendant (On Duty)

Flight Attendant Current

Physiological - Other

1435678

Aircraft Equipment Problem Less Severe; Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor

Person Flight Attendant

In-flight

Flight Crew Landed As Precaution; Flight Crew Returned To Departure Airport; General Physical Injury / Incapacitation; General Flight Cancelled / Delayed; General Maintenance Action

Aircraft; Human Factors

Aircraft

Twenty seconds after takeoff the B flight attendant in the AFT galley called and informed me they were smelling a distinct 'dirty sock' smell that they believed to be toxic fumes. I then called the captain; informing them of what the B flight attendant had just told me. The captain said he would call right back. About a minute later the odor had made its way through to the plane and was present in the front galley where it made me light headed and dizzy with a slight headache. The odor was noticeable to the passengers. I called the AFT galley back and they had told me they had donned oxygen. The captain soon called me back and told me we were heading back; that it would not be an emergency landing; and he would make the announcement to the passengers and we should prepare the cabin for landing. At this time said they could also smell the odor. We returned the gate where the AFT doors were disarmed and opened due to the discomfort the B/C flight attendants were experiencing. Burning eyes/skin/metal taste/dizziness. The paramedics were called to the aircraft and the flight crew decided to go to the hospital to be checked out and have their blood tested.

A320 Flight Attendant reported a 'dirty sock' smell in the rear of the aircraft shortly after takeoff. The Captain was informed and the flight returned to the departure airport.

1494172

201710

1201-1800

ZZZ.Airport

US

0.0

VMC

10

Daylight

1200

Ground ZZZ

Personal

RV-12

1.0

Part 91

None

Personal

Taxi

Ground ZZZ

Government

Light Transport; High Wing; 2 Turboprop Eng

Other Fire Fighter

Other Firefighting

Taxi

Aircraft X

Flight Deck

Personal

Single Pilot; Pilot Flying

Flight Crew Private; Flight Crew Instrument

Flight Crew Last 90 Days 27; Flight Crew Total 1157; Flight Crew Type 307

Communication Breakdown

Party1 Flight Crew; Party2 ATC

1494172

ATC Issue All Types; Conflict Ground Conflict; Critical; Ground Event / Encounter Other / Unknown

Person Flight Crew

Taxi

Flight Crew Took Evasive Action

Airport; Procedure

Procedure

I was parked in the transient parking area and called to taxi to run up with the current ATIS. I was cleared by ground control to taxi to run up which took me to the end of [the runway]. I completed my run up and called ground and was cleared to taxi to departure RWY and hold short. Which I did. I switched to the Tower and requested departure. The Tower repeated hold short. I repeated back holding short. A Cessna was turning base to final while I held short. In the minute waiting for the Cessna to land; three firefighting airplanes taxied up next to me. The Cessna landed barely able to squeeze between me holding at the RWY 27 hold line and the taxi lights on the far side of the taxiway. I repeated my question to the tower if I should continue to hold or not? The Tower repeated for me to hold. Note: I did not hear any radio communications between the Tower and firefighting planes so I assumed they were talking on another frequency. They just started scrambling past my plane even though they didn't have enough room to get their big airplanes past my RV12 without their wings passing over the top of my wing. By that time; my little RV12 was bucking and bouncing like a bronco in the turbo prop blast and I just held on praying my plane wouldn't flip over. This repeated three times in rapid succession for each of the three firefighting airplanes. I did not call Tower at that moment because I was too busy trying to keep my plane on the ground using the controls. (Note: my RV12 will fly at 42 kts.)As soon as the last of the firefighting planes had barely lifted off the runway a foot or two feet; the Tower immediately called me and said I was cleared for takeoff. I responded to the Tower with a loud terse statement that 'THAT WAS UNSAFE. MY LITTLE PLANE ALMOST FLIPPED OVER.' The Tower paused for an awkward time then repeated I was cleared for T/O. I taxied into position on [the runway] and could see the heavy [aircraft] had left swirling wing tip vortices that were kicking up dust all the way down the runway. The Tower did NOT mention to me any caution about wake turbulence so I called back to the Tower that I couldn't T/O with the vortices. They were still visibly kicking up dust. After 30 sec to a minute wait; the dust settled and I took off shaken but safe.The unsafe operations: The Tower and Ground Control should never have cleared the much larger firefighting airplanes to taxi so close to me that the wing of the [firefighting aircraft] passed over the top of my wing as it taxied past. Also; the prop blast from the much larger turbo prop airplanes only a few feet away could have flipped my aircraft over resulting in severe damage to my airplane and possibly severe bodily injury to my wife and me.The firefighting airplane pilots also ignored the safety of my airplane. They should have refused to taxi past my small plane since it was obvious they had to be way too close to be safe.

RV-12 pilot reported that when he was lined up for takeoff two firefighting airplanes squeezed by his airplane and took off in front of him causing wake turbulence.

1798401

202103

1201-1800

ZOA.ARTCC

CA

100.0

VMC

10

Dusk

10000

Commercial Operator (UAS)

Autel Robotics Evo II

1.0

Part 107

None

Photo Shoot / Video

Hovering (UAS)

Class G ZOA

Small

Multi-Rotor

Purchased

Number of UAS 1

Commercial Operator (UAS)

Remote PIC (UAS)

Flight Crew Commercial; Flight Crew Instrument; Flight Crew Remote Pilot (UAS); Flight Crew Rotorcraft

Flight Crew Last 90 Days 5; Flight Crew Total 250; Flight Crew Total (UAS) 10; Flight Crew Type (UAS) 10

Situational Awareness; Confusion; Training / Qualification

1798401

Airspace Violation All Types; Deviation / Discrepancy - Procedural FAR; Deviation / Discrepancy - Procedural Published Material / Policy; Deviation / Discrepancy - Procedural Unauthorized Flight Operations (UAS)

Person Other Person

Flight Crew Exited Penetrated Airspace; General Police / Security Involved

Airspace Structure; Chart Or Publication; Human Factors; Software and Automation

Ambiguous

I am reporting this in the interest of flight safety and for the furtherance of drone operations in the NAS (National Airspace System). For experience in the hours to clarify I went to flight school and earned a PPL (Private Pilot License) and have roughly X00 hours flight in helicopters combined with instrument and commercial type training; along with XX hours of fixed wing flight experience. 10 hours in drones however that is measured in flight logs stored within the aircraft flight logs and is subject to some error like all things are. The issue was that I was hired to film [an event] that was not permitted (something I did not know). The other issue was that the area I was operating in [an area] on the San Francisco sectional chart as no flight below 1;000 ft. AGL. I was aware of this area and knew approximately where it was but at the time believed it to be much farther north. The issue with drone operations vs. commercial manned aircraft operations is that the infrastructure is built around manned flight and to precisely pinpoint a physical address on a sectional is quite cumbersome. For the most part a sectional is helpful for areas in general but you could literally find yourself operating inside a hole within several boundaries. This is where applications such as Airmap; B4uFly; and UASidekick can be a huge help in checking and re-checking an area. I do understand the responsibility falls onto the PIC in this case and that I should have been more diligent and this is a lesson learned. But I cannot imagine that professional operators would be pulling out plotters for every address they fly at to pinpoint the coordinates. My concern lies with the applications accuracy not that the developers do not try but 4 of the top applications did not alert me to an airspace issue; this along with my presumed thought that the restriction was much farther north let me to believe I had the all clear. As drone operators the only official source we have is one that is geared towards manned flight and as usage continues to grow my fear is that a more serious incursion is inevitable. Helicopters operators have a chart that is most helpful to them when operating at low level; and this is very helpful as I have used these to navigate Los Angeles and San Francisco class B. Drones are an emerging business and as a responsible operator I am always concerned about flight safety. But usage is only increasing; something as simple as doing a roof inspection of a residential home reduces risk increases productivity and improves the accuracy and level of service. Drones may be small but they are making a huge impact.As drone operators the only official source we have is one that is geared towards manned flight and as usage continues to grow my fear is that a more serious incursion is inevitable. Helicopters operators have a chart that is most helpful to them when operating at low level; and this is very helpful as I have used these to navigate Los Angeles and San Francisco class B. Drones are an emerging business and as a responsible operator I am always concerned about flight safety. But usage is only increasing; something as simple as doing a roof inspection of a residential home reduces risk increases productivity and improves the accuracy and level of service. Drones may be small but they are making a huge impact.

Part 107 pilot was flying in an area they believed to be available for UAS operations. After further review the pilot learned they were in fact in airspace not available to UAS operations which was not noted by any of the UAS apps.

1499986

201711

1201-1800

ZZZ.Airport

US

39000.0

VMC

Daylight

Center ZZZ

Corporate

Citation X (C750)

2.0

Part 91

IFR

Passenger

Cruise

Class A ZZZ

Aircraft X

Flight Deck

Corporate

First Officer; Pilot Not Flying

Flight Crew Air Transport Pilot (ATP)

Situational Awareness

1499986

Aircraft X

Flight Deck

Corporate

Captain; Pilot Flying

Flight Crew Air Transport Pilot (ATP)

Human-Machine Interface; Situational Awareness

1499987.0

Aircraft Equipment Problem Less Severe; Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Clearance; Deviation / Discrepancy - Procedural Published Material / Policy

Automation Aircraft Other Automation; Person Air Traffic Control

In-flight

Air Traffic Control Provided Assistance; Flight Crew Requested ATC Assistance / Clarification; Flight Crew Became Reoriented; Flight Crew FLC Overrode Automation

Chart Or Publication; Procedure; Aircraft

Chart Or Publication

Received clearance from ATC to hold west over ZZZ VOR as published at FL390 with an EFC (Expected Further Clearance) of 5 minutes prior to reaching fix. When entering hold into FMS; we found that the inbound course was already preloaded as 88 degrees (hold west) so assumed that the published hold was already preloaded into FMS. In the FMS; the direction of the hold was right turns. In the 5 minutes of time prior to reaching the holding fix; both pilots attempted to find the published hold on the HI enroute charts in Jeppesen application on our iPads. We were both unable to find the published hold on the electronic enroute charts so we assumed the hold in the FMS was correct. When entering the hold; the FMS directed the autopilot to begin a direct entry to the right but that was incorrect since the published hold was left turns. ATC immediately queried us and gave us radar vectors (right 270 degree turn) and we proceeded on course with no further hold instructions and no further incident. Both pilots went back and looked at the Jeppesen HI enroute chart after we were given the 'corrective radar vector' and we did find the 'published hold' and we confirmed that it did have left turns not right turns as had been initiated by the hold procedure entered into the FMS. Proceeded onto destination uneventfully.Both pilots could have done a better job of locating the 'published hold' on the enroute chart in the 5 minutes of time allotted by ATC and/or we could have queried ATC regarding the details of the 'published hold' when were unable to locate the published hold on the enroute chart prior to reaching the fix.

Reliance upon FMS database for correct holding pattern information without confirmation from available resources or additional query to ATC under time pressure lead to this error. Future events similar to this can be managed with an immediate query to ATC when I doubt of clearance. Both crew members have also spent time refamiliarizing themselves with how to pull information from the available resources and will disseminate this info to fellow departmental pilots.

Cessna 750 flight crew reported that when they received clearance from ATC to hold over a fix; the FMC directed the autopilot to turn in the opposite direction.

1631199

201903

0601-1200

ZZZ.Airport

US

0.0

VMC

Daylight

CLR

Air Carrier

A319

2.0

Part 121

IFR

Passenger

Cruise; Initial Approach

Low

128.0

3.0

Aircraft X

Cabin Jumpseat

Air Carrier

Flight Attendant (On Duty)

Flight Attendant Current

Flight Attendant Airline Total 34; Flight Attendant Number Of Acft Qualified On 7; Flight Attendant Total 34; Flight Attendant Type 25

Safety Related Duties

Physiological - Other

1631199

Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor; Flight Deck / Cabin / Aircraft Event Illness / Injury

N

Person Flight Attendant; Person Flight Crew

In-flight

Flight Crew Landed As Precaution; Flight Crew Overcame Equipment Problem

Aircraft

The fume event was a sudden onset of a toxic acrid mix. A haze developed throughout the cabin and passengers were suddenly turning on air vents with some breathing through clothing to cover their nose and mouth. The haze immediately caused a burning sensation to the eyes; nose and throat. My sinuses also burned and the smell was overwhelming and led to a bad headache dizziness and general nausea feeling that then became a general malaise sick feeling combined with a suffocating reaction that lasted for 10 minutes till landing and then another 10 minutes for taxi in to the gate. The haze did not dissipate until the forward cabin door was opened. There were 2 other FAs sitting in the extra cabin jump seats that were sickened by this event. The pilots were notified on taxi in that we were in the midst of a fume event and they also concurred and filled out a cockpit report that they had dealt with it too. Myself and the rest of the crew did not feel well after this happened for the remainder of the duty day until the following morning.

A319 Flight Attendant reported sudden onset of toxic acrid fumes in the cabin resulting in health issues.

1019646

201206

1801-2400

ZTL.ARTCC

GA

27000.0

Center ZTL

Air Carrier

Regional Jet 200 ER/LR (CRJ200)

2.0

Part 121

IFR

Descent

Class A ZTL

Facility ZTL.ARTCC

Government

Enroute

Air Traffic Control Fully Certified

Communication Breakdown

Party1 ATC; Party2 ATC

1019646

ATC Issue All Types; Deviation / Discrepancy - Procedural Published Material / Policy

Person Air Traffic Control

In-flight

General None Reported / Taken

Human Factors; Procedure

Human Factors

I was working the R-Side at Spartanburg High. I accepted the hand off on a CRJ2 from Sector 50 with the aircraft showing at FL270 descending to FL250 in the Data Block. The SOP between Sector 50 and Sector 32 requires these aircraft to be level at FL250 when they cross the boundary. The aircraft checked on my frequency at FL270 with no clearance for lower. I had to call and get control and expedite the aircraft through FL260 because I had crossing traffic at FL270. The aircraft missed by six miles. 'Dressing up' Data Blocks is rampant at ZTL. I don't know for sure that the Sector 50 Controller did this. Perhaps the pilot of the aircraft missed a clearance. I'm pretty sure the Data Block was dressed up. If so; this is intentional violation of the 7110.65. Why is it any different than intentionally violating separation standards? It can lead quite quickly to a loss of separation.

ZTL Controller voiced concern regarding an adjacent controller allegedly 'dressing-up' a Data Block to indicate procedures were being issued/followed when in fact had not; compromising airspace integrity.

1065464

201202

1201-1800

TEB.Airport

NJ

1500.0

VMC

10

Daylight

TRACON N90

Corporate

Citation II S2/Bravo (C550)

2.0

Part 91

IFR

Passenger

FMS Or FMC

Initial Climb

SID RUUDY FOUR

Class B EWR; Class D TEB

Altitude Hold/Capture

X

Improperly Operated

Aircraft X

Flight Deck

Corporate

First Officer; Pilot Not Flying

Flight Crew Commercial; Flight Crew Instrument; Flight Crew Multiengine

Flight Crew Last 90 Days 150; Flight Crew Total 1100; Flight Crew Type 300

Communication Breakdown; Confusion; Distraction; Troubleshooting; Workload

1065464

Aircraft Equipment Problem Less Severe; Deviation - Altitude Overshoot; Deviation / Discrepancy - Procedural Clearance; Deviation / Discrepancy - Procedural Published Material / Policy

Person Air Traffic Control

In-flight

Air Traffic Control Issued New Clearance; Flight Crew Took Evasive Action; Flight Crew Became Reoriented; Flight Crew Returned To Clearance

Aircraft; Procedure; Human Factors

Ambiguous

The Captain and I took off Runway 24 at TEB via the RUUDY FOUR Departure. On departure; we were having trouble with our FMS and getting our flight director to sync up. Our altitude was set to level off at 1;500 FT. At 500 FT I called the '500 FT for 1;500 FT' callout and verified the 'Alt Select' button was Armed. Shortly after; I put my head down to verify the FMS was flying the correct course to intercept the 260 degree course to WENTZ. While working the FMS; we received a call from ATC to verify our altitude. This was the point that I had realized the altitude did not capture upon reaching 1;500 FT. We deviated above our assigned altitude approximately 600-700 FT prior to immediately taking corrective action (reduced power and pitched down) to return the 1;500 FT. The Captain was under the impression he had engaged the autopilot and the altitude select was armed; however; when attempting to get the flight director to sync up; it inadvertently disengaged the 'alt select arm' button. Due to our flight director issue; I took my eyes of the instruments to attend the FMS and verify we were flying the correct departure routing. In the future; I will back up the flying pilot and personally watch the instruments to ensure we are leveling of at the assigned altitudes.

A CE550 Flight Director failed to sync with the FMS after departing on the TEB Runway 24 RUUDY FOUR and so a distracted crew did not detect the 1;500 FT altitude overshoot until ATC requested an altitude check.

1093770

201306

MRY.Airport

CA

330.0

3.0

2500.0

IMC

Fog; 3

Night

1500

4000

TRACON NCT

Skyhawk 172/Cutlass 172

1.0

Part 91

IFR

Training

Climb

SID MONTEREY NINE

Class C MRY

Aircraft X

Flight Deck

Pilot Flying; Instructor

Flight Crew Flight Instructor; Flight Crew Air Transport Pilot (ATP)

Flight Crew Last 90 Days 40; Flight Crew Total 7150; Flight Crew Type 3500

Human-Machine Interface; Situational Awareness

1093770

Aircraft Equipment Problem Less Severe; Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Clearance

Person Flight Crew

In-flight

Air Traffic Control Issued New Clearance; Aircraft Automation Overrode Flight Crew; Flight Crew Became Reoriented

Human Factors; Aircraft

Ambiguous

Maintain directional control during climbout to 6;000 FT departing MRY. After initially activating flight plan with MRY 9 procedure included; G1000 failed to track after liftoff. I immediately tried to reactivate the flight plan but could not get the GPS to track our course. At this point we were entering IMC (bases 1;500 FT and tops 2;500 FT) so I continued climbout on heading 330 while the student flew and I tried to debug the G1000. At 2;500 FT I reported the tops and clear of clouds. I tried to inform the Controller of the situation with the G1000; however; I do not believe I was successful in clearly communicating what was happening. The Controller unable to understand my problem with G1000 became agitated at repeated calls to adjust heading. Although approach plates were available for the entire route including a return to MRY if required; inability to activate the procedure became a focus and distracted me from attention to student. Although able to maintain situational awareness; workload impaired my timely response to ATC. Traffic avoidance was maintained at all times. This all occurred while in VMC as we were above 2;500 FT. In retrospect when the equipment malfunction occurred I should have immediately gone to the autopilot for heading control which would have reduced my workload significantly and improved my level of responsiveness to ATC. At no time was there any traffic conflict; airspace violation or altitude violation.

C172 instructor pilot reports difficulties with his G1000 departing MRY on the MRY9 departure with a student at the controls; resulting in track deviations.

1580993

201809

1201-1800

DTW.Airport

MI

250.0

Tower DTW

Air Carrier

Regional Jet 900 (CRJ900)

2.0

Part 121

IFR

Passenger

Initial Climb

Class B DTW

Aircraft X

Flight Deck

Air Carrier

Captain; Pilot Flying

Flight Crew Air Transport Pilot (ATP)

Situational Awareness

1580993

ATC Issue All Types; Inflight Event / Encounter Wake Vortex Encounter

Person Flight Crew

In-flight

Air Traffic Control Issued New Clearance; Flight Crew Took Evasive Action; Flight Crew Requested ATC Assistance / Clarification

Environment - Non Weather Related; Procedure

Procedure

Given takeoff clearance from 21R in DTW behind a 757 before the aircraft had finished rotating. I turned on continuous ignition in case of wake turbulence encounter. We got a small jolt of wake turbulence at 200-300 ft AGL. At less than 1000ft; we encountered significant wake turbulence requiring full deflection of roll controls at least 3 times. I saw the 757 had turned left and told the First Officer (FO) to ask for runway heading to get out of the turbulence. When the FO advised the Tower; the reply was 'there is no wake turbulence.' I informed the controller that we had been full deflection on the flight controls to counter the turbulence. He then gave us runway heading. The Tower no longer [provides] wake turbulence separation on 757s. Provide wake turbulence separation on 757s.

CRJ-900 Captain reported encountering wake turbulence departing DTW in trail of a B757.

1438881

201704

ZZZ.Airport

US

0.0

Air Carrier

B787-800

2.0

Part 121

IFR

Passenger

Parked

Company

General Seating Area

Air Carrier

Flight Attendant (On Duty)

Flight Attendant Current

Communication Breakdown

Party1 Ground Personnel; Party2 Flight Attendant

1438881

Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Passenger Misconduct

Y

Person Flight Attendant

In-flight

General None Reported / Taken

Company Policy; Human Factors

Company Policy

I did not witness passenger boarding as I was working in the aft of the cabin. The passenger was boarded with an aisle chair and apparently needed 3 assistants. He was traveling with his wife (?) Mrs. X.After takeoff I noticed Ms. X was feeding him. Later I was told by other crew members that she had changed his diaper on the passenger seat. He was unable to stand or even move himself to a sitting position from laying on the seat. She was unable to move him or help him in the bathroom.This seems an unsafe condition for him to be unable to use a bathroom for a 15 hour flight. It seems unsanitary to change a diaper in the passenger seat. It seems unsanitary and unfair to have other passengers have to share the area with the smells of human urine and feces for such a long flight.In hind sight I wish we had contacted [customer service] during boarding to determine if it was acceptable for him to travel. He needed one or two or more strong people traveling with him to be able to get him in the aisle chair and help him in the bathroom. That might not have worked either.The flight had been delayed and we were hurrying to leave and the passenger's level of disability was unclear to flight attendants. It is difficult to imagine anyone would try to travel in this condition with such insufficient support. Our manual seems unclear to me regarding passenger acceptance in situations like this. This is a difficult problem to resolve in the middle of boarding.

Boeing 787 Flight Attendant reported an adult passenger required a diaper change in his seat. The Flight Attendant questioned whether the passenger should have been boarded under this condition; citing sanitary reasons.

1614309

201901

0601-1200

ZZZ.ARTCC

US

45000.0

VMC

Temperature - Extreme

Dawn

Center ZZZ

Air Taxi

EMB-505 / Phenom 300

2.0

Part 135

IFR

Passenger

Cruise

Aircraft Auto Temperature System

X

Malfunctioning

Aircraft X

Flight Deck

Air Taxi

Pilot Not Flying; First Officer

Flight Crew Flight Instructor; Flight Crew Instrument; Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP)

Flight Crew Last 90 Days 100; Flight Crew Total 5000; Flight Crew Type 500

Troubleshooting

1614309

Aircraft X

Flight Deck

Air Taxi

Pilot Flying; Captain

Flight Crew Air Transport Pilot (ATP); Flight Crew Flight Instructor; Flight Crew Instrument; Flight Crew Multiengine

Troubleshooting

1614316.0

Aircraft Equipment Problem Less Severe; Flight Deck / Cabin / Aircraft Event Other / Unknown; Inflight Event / Encounter Weather / Turbulence

Person Flight Crew

In-flight

Air Traffic Control Issued New Clearance; Flight Crew Diverted; Flight Crew Took Evasive Action; General Maintenance Action

Aircraft; Human Factors

Aircraft

Extreme cold cockpit temperatures were experienced enroute from ZZZ to ZZZ1 airport with two crew and four passengers on board.The crew begin to notice cold cockpit temperatures 30 minutes after departure from ZZZ airport. The crew attempted to warm the cockpit temperature by increasing the controller knob. This had no effect on the actual cockpit temp; a further increase to the temp controller was made. This induced the duct 2 OVERTEMP CAS. The crew followed the checklist for the corresponding CAS massage and the CAS message extinguished. Yet the cockpit temperature continued to decrease. The crew begins to experience adverse effects from the cold temperatures inside the cockpit. Realizing the adverse effects the extreme cold temperatures were having; the crew [notified ATC] and requested an immediate emergency descent to a lower altitude and requested a divert to ZZZ2 airport.The descent; approach and landing at ZZZ2 was safe and uneventful. Heavily corroded TMVs (Temperature Modulating Valves) were found after maintenance was performed the following day.

[Report narrative contained no additional information.]

EMB-505 flight crew reported the loss of temperature control led to a diversion where maintenance found corroded Temperature Modulating Valves.

1163382

201404

1201-1800

ZZZ.Airport

US

0.0

VMC

Daylight

Tower ZZZ

Air Carrier

B767-300 and 300 ER

3.0

Part 121

IFR

Passenger

Takeoff / Launch

Pitot-Static System

X

Malfunctioning

Aircraft X

Flight Deck

Air Carrier

First Officer; Pilot Flying

Flight Crew Total 16000

Confusion

1163382

Aircraft X

Flight Deck

Air Carrier

Pilot Not Flying; Captain

Training / Qualification; Workload; Time Pressure

1163080.0

Aircraft Equipment Problem Critical; Deviation / Discrepancy - Procedural Published Material / Policy

Person Flight Crew

In-flight

Flight Crew FLC complied w / Automation / Advisory; Flight Crew Rejected Takeoff; Flight Crew Returned To Gate; General Maintenance Action

Aircraft; Environment - Non Weather Related; Procedure

Environment - Non Weather Related

I was the pilot flying performing the takeoff. During the takeoff roll the Captain called '80 KTS' and then leaned forward and deactivated the autobrakes from 'RTO' to 'OFF' and stated 'My Aircraft' 'Aborting Takeoff'. The Captain then closed the throttles; moved them into 'REV' and spoilers deployed. I noted 110 KTS on the airspeed ribbon and held the yoke forward; called deployed and no autobrakes. I inform the Tower that we were aborting the takeoff. The Captain stated that during airspeed crosscheck he noted that the standby airspeed indicated had not moved off its parked position of 30 KTS. The deceleration was very gentle and there appeared to be; and felt as if no heavy braking if any braking was taking place. The Captain said that he was not using brakes or very little braking. We rolled to end of the runway and exited.The Tower asked if we needed assistance and the Captain said no. On exiting the runway; I informed Ground that we will be returning to the gate and they too asked if we needed assistance. Again the Captain said no. During this time the Captain had instructed the Relief Pilot to contact the cabin and inform them of the situation and then the Relief Pilot called the company. We taxied in to our gate; and Maintenance came out to inspect the aircraft. A mud wasp was found to have made a nest in the standby pitot tube which result in no airspeed indication from the standby instruments. All of the us: Captain; First Officer and Relief Pilot were into the brake cooling charts I found that each of us had a different opinion as to what our cooling should be. I believed we should enter the chart at 110 KTS but the Captain said it should be at 85-80 KTS; as this was where he believed he began to apply brakes. The aircraft was taken out of service. Maintenance has a procedure for covering the pitot tubes if an aircraft sits for 24 hours or more. This aircraft sat for 8 hours. I believe that practice should be revised to a time less then 24 hours. Also high speed; low speed aborts should be discussed more because we; the cockpit crew; had a disagreement as to whether this was a high speed or low speed abort.

At approximately 75 KTS I glanced at my airspeed indicator; [then] glanced at First Officer's. Looked at center airspeed and it was 30 KTS (no movement). Tapped IFSD (duh moment...). No change. Aborted; used minimal braking to minimize impact on aircraft. Rolled down runway and turned off at last normal landing exit taxiway. [I] directed Relief Pilot to notify flight attendants. After that Relief Pilot made PA to passengers while First Officer and I focused on the aircraft. Post After Landing Checklist and communicating with flight attendants and passengers had Relief Pilot verify abort chart for any actions required. Event was in 'no action' required except for approximately 20-25 minute delay. Not an issue as the aircraft was taken out of service for wasps/bees mud nest in pitot tube. Notified Dispatch at the gate.

A B767 Captain; the pilot not flying; rejected a takeoff at about 100 KTS when he noted the Standby Airspeed Indicator at zero. Upon returning to the gate Maintenance discovered a wasp's nest in the standby pitot tube.