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Air carrier was descended to wrong altitude and not caught until after reaching the assigned altitude.
| Attributes | |
| ACN | 123130 |
| Time | |
| Date | 198909 |
| Day | Wed |
| Local Time Of Day | 1201 To 1800 |
| Place | |
| Locale Reference | atc facility : ffu airport : slc |
| State Reference | UT |
| Altitude | msl bound lower : 12000 msl bound upper : 13000 |
| Environment | |
| Flight Conditions | IMC |
| Light | Daylight |
| Aircraft 1 | |
| Controlling Facilities | tracon : slc |
| Operator | common carrier : air carrier |
| Make Model Name | Medium Large Transport, Low Wing, 2 Turbojet Eng |
| Navigation In Use | Other Other |
| Flight Phase | descent other |
| Route In Use | arrival other |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | government : faa |
| Function | controller : approach |
| Qualification | controller : radar |
| ASRS Report | 123130 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | flight crew : first officer |
| Qualification | pilot : flight engineer pilot : commercial pilot : cfi pilot : atp pilot : instrument |
| Experience | flight time last 90 days : 200 flight time total : 4600 flight time type : 1750 |
| ASRS Report | 123249 |
| Events | |
| Anomaly | other anomaly other |
| Independent Detector | other controllera |
| Resolutory Action | controller : issued new clearance |
| Consequence | faa : reviewed incident with flight crew |
| Supplementary | |
| Primary Problem | ATC Human Performance |
| Air Traffic Incident | Operational Deviation Intra Facility Coordination Failure |
Narrative:
The aircraft was given a heading, a speed restriction and an altitude. The pilot read back the proper heading and speed, but the incorrect altitude. I didn't catch the wrong altitude. I discovered the pilot had leveled at the wrong altitude and told him to correct. Factors contributing to the incident, as I believe, were: 1) traffic was combined, 2) additional coordination with another controller was being done at the time of the pilot's readback, 3) it was the last hour of my shift and I was tired and not performing at peak ability, and 4) WX was full IFR at altitude. Supplemental information from acn 123249: on flight from san to slc, both of us (captain and copilot) heard slc approach clear us from 17000 to 12000'. We then descended to 12000' and remained at 12000' for approximately 3-4 mins. Slc approach then called and said we had been cleared to maintain 13000', not 12000', and to climb and maintain 13000'. We then climbed to 13000' and continued our normal approach to slc.
Original NASA ASRS Text
Title: ACR WAS DESCENDED TO WRONG ALT AND NOT CAUGHT UNTIL AFTER REACHING THE ASSIGNED ALT.
Narrative: THE ACFT WAS GIVEN A HDG, A SPD RESTRICTION AND AN ALT. THE PLT READ BACK THE PROPER HDG AND SPD, BUT THE INCORRECT ALT. I DIDN'T CATCH THE WRONG ALT. I DISCOVERED THE PLT HAD LEVELED AT THE WRONG ALT AND TOLD HIM TO CORRECT. FACTORS CONTRIBUTING TO THE INCIDENT, AS I BELIEVE, WERE: 1) TFC WAS COMBINED, 2) ADDITIONAL COORD WITH ANOTHER CTLR WAS BEING DONE AT THE TIME OF THE PLT'S READBACK, 3) IT WAS THE LAST HR OF MY SHIFT AND I WAS TIRED AND NOT PERFORMING AT PEAK ABILITY, AND 4) WX WAS FULL IFR AT ALT. SUPPLEMENTAL INFO FROM ACN 123249: ON FLT FROM SAN TO SLC, BOTH OF US (CAPT AND COPLT) HEARD SLC APCH CLR US FROM 17000 TO 12000'. WE THEN DSNDED TO 12000' AND REMAINED AT 12000' FOR APPROX 3-4 MINS. SLC APCH THEN CALLED AND SAID WE HAD BEEN CLRED TO MAINTAIN 13000', NOT 12000', AND TO CLB AND MAINTAIN 13000'. WE THEN CLBED TO 13000' AND CONTINUED OUR NORMAL APCH TO SLC.
Data retrieved from NASA's ASRS site as of August 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.