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May 2007 Report Intake
Air Carrier/Air Taxi Pilots 2338
General Aviation Pilots 876
Controllers 148
Cabin/Mechanics/Military/Other 229
TOTAL 3591
ASRS Alerts Issued in May 2007
Subject of Alert No. of Alerts
Aircraft or aircraft equipment 9
Airport facility or procedure 4
ATC procedure or equipment 9
Chart, Publication, or Nav Database 3
Company policy 6
Maintenance procedure 2
Other 1
Total 34
Incidents in ASRS Reorting
331
#2, issued clearance with hold for
release. Aircraft responded that he
was in a hurry and would depart
VFR. Controller acknowledged,
issued instructions to remain
outside of Class B and call
airborne. Aircraft acknowledged.
Aircraft departed, was again told
to remain outside Class B and
ident. After radar identification,
issued clearance, maintain 3,000
feet and fly heading 320 degrees...Aircraft was at 3,500
feet climbing. Controller coordinated with Departure to
go to 4,000 feet (Departure’s airspace), aircraft climbed
to 4,000 feet, next frequency (mine). Aircraft instructed to
climb to 8,000 feet and heading 360 degrees, acknowledged,
aircraft turned, did not climb. Reissued climb to 12,000
feet. Aircraft acknowledged and climbed. Handed off to
Center. Aircraft was observed out of 13,000 feet climbing...
Supervisor asked Center to issue pilot deviation advisory...
Pilot calls later, apologized, won’t happen again, never
happened before, in a hurry, thought VFR would help, did
not know floor of Class B was 3,000 feet where he was...
[The problem is] aircraft violated Class B, violated
clearance at 3,000 feet, missed climb from 4,000 feet,
violated altitude at 12,000 feet. Three pilot deviations, one
missed clearance in 10 minutes. No one should be in that
big of a hurry.
Hurry-Up in the Cockpit (continued)
Attempting to save time, a B737 Captain elected to depart
with the aircraft depressurized.
■ We needed to do a bleeds off takeoff for performance
reasons. As we taxied out, I forgot and shut the APU down.
As Tower cleared us for takeoff, we remembered about the
bleeds off takeoff. Since our APU was shut down, I thought
I would be clever and do an unpressurized takeoff to still
get the performance we needed and not waste any more
time. In our haste we did not get the pressurization panel
configured correctly. This caused us to get an auto fail
light about 2 minutes after takeoff. We applied the QRH
and put the pressurization controller in standby, which
extinguished the auto fail light and returned the panel to
a workable configuration...Upon review of the Operations
Manual, I don’t think I had the option of an unpressurized
takeoff since my APU was operable. In any case, I used bad
judgement by making a split-second decision that caused
us to rush our checklist and preparation leading to our
wrong configuration of the pressurization panel...The few
minutes I saved [were] not worth the problems caused.
Slow down, refer to reference materials if necessary, admit
your mistake, stop and do it correctly.
Hurry-Up in the Maintenance Hangar
Maintenance technicians must often work at night, on
multiple aircraft, under tight deadlines, and sometimes
with limited staffing. The constant pressure to turn
aircraft around quickly can lead to hurry-up errors:
■ During an operations check of the passenger service
unit oxygen masks (drop test) we discovered left-hand
#1 passenger service unit mask was not dropping. After
troubleshooting, we discovered the cannon plug was
damaged. Since we did not have the part in stock and the
aircraft was already late, my manager instructed me to
remove a passenger service unit from another CRJ200 that
was in the hangar and install it on the aircraft in question.
I questioned his instructions, but he told me to complete
the tasks and to hurry. I completed switching the passenger
service units and did an operations check. Sometime later
and upon further review it has come to my attention that
the passenger service unit removed from the other aircraft
was not applicable to the aircraft in question. The result
was the aircraft had to be removed from service as soon as
the discrepancy was discovered, and a new part brought in
to replace the incorrect passenger service unit.
“No One Should Be in
That Big of a Hurry”
And finally, we hear from an ATC Departure controller
frustrated by a pilot in a big hurry.
■ Aircraft called Low Altitude/Clearance Delivery for IFR
clearance as Tower was not yet open. Aircraft was told,
　
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