Narrative:

Aircraft departed mia for valencia, venezuela (svva), with an intermediate stop in maracaibo, venezuela (svmc), and arrived svva with freight bound for mia as well as valencia. Most svva freight on board the aircraft was positioned in the main cargo hold with 1560 pounds in the rear belly. Upon arrival svva, airline cargo reps and ground personnel advised the captain and flight crew that all freight on our aircraft, including that just picked up in svmc, was to be downloaded in svva in order to make room for a vip shipment of manufactured goods from svva to mia. Within the past week the company had initiated a new pallet, net and cargo inspection program that required the captain to confirm the airworthiness of these items before they entered the aircraft. To that end, the company had issued all mia based capts a manual describing inspection procedures and limitations for cargo nets and each of the 9 different types of pallets carried on board its aircraft. Via the voice mail system, capts were informed that they were to carry this manual with them on every flight. On this day, the captain had left his manual at home, confessed to me that he had never read it, and did not know how to conduct a net, pallet or freight inspection. Indeed, other than the publication of the manual and stern admonishments via voice mail and telephone to interpret conservatively the limitations contained therein, neither capts nor flcs had received any formal training regarding the airworthiness of freight, pallets, nets or containers. Previously, this company's flight crew had been instructed to leave such matters to the concern of 'trained ground handling personnel.' later, ground crew personnel gave me a list of pallets and weights indicating that upon departure for mia there would be no belly freight on board the aircraft. After reducing the runway limited maximum takeoff weight by 6300 pounds due to a deferred maintenance item (dmi) on the anti-skid system, specifying the location of all pallets to be loaded on the aircraft, calculating the weight and balance, center of gravity, and stabilizer trim setting, I prepareda takeoff bug card for a packs off takeoff. This day, the so, new to his job and our company, was distraction by a quantity gauge dmi/MEL item requirement to fuel one of the main tanks to a known quantity. And, this was the very day flcs had first been instructed to 'visually confirm the placement of all pallets and the activation of all locks.' so, when I heard freight being loaded into the main cargo area, I went back to supervise until the so finished his other duties. Once there, I found that the ground crew had a) loaded the wrong pallet into position 12, and B) on the next pallet they had installed one of the nets that were supposed to have been discarded. I remained in the main cargo area as each pallet was loaded, instructing the ground crew to double-net some pallets and replace the nets on others. When the so appeared topside, I suggested he monitor the exterior of the aircraft, check his doors, complete his fuel calculations, paperwork, and preflight checks. I would finish what I had started in the main cargo bay. Upon arrival in mia as the first officer and so prepared to depart the aircraft, we were greeted in the main entrance by inspectors from the fll FAA FSDO. The captain was already downstairs. The inspectors asked to see the load plan and inquired about the flight's point of departure. Shortly thereafter, I remembered that the aircraft and crew had yet to clear united states customs. When I mentioned this to the inspectors, they returned the flight release to the so and preceded me down the steps exiting the aircraft. The flight crew then cleared customs and went their separate ways. The training department rep disclosed that on dec/xa/97 a company aircraft, the same as that one occupied by the author of this report, had arrived mia with a flight release/weight and balance report indicating no cargo in the aft belly. However, during their inspection the FAA reps rptedly found 2300 pounds of freight marked vln (svva/valencia) stored in the aft belly compartment. To the inspectors, it appeared this freight had arrived with the aircraft. If that were the case, then thewtof this freight had not been included in takeoff, center of gravity, or landing weight calculations. In their report, the inspectors surmised that the ground crew in svva had simply forgotten to remove freight intended for their airport. But the weight of the freight they found in the aft belly was dramatically different from that which had left mia for vln (800 pounds heavier). Alternatively, it may be surmised that in their haste to quick-turn the aircraft, mia ground crew may have loaded the aft belly prior to the FAA inspector's opportunity to observe its contents after arrival in mia. Contributing factors/recommendations: the captain was new to the company and apparently to the business of hauling freight. The flight engineer was new to the company and his job. While the first officer had nearly 7 yrs experience in this type aircraft and with this company, 2 new procedures had only recently been hastily implemented. To exacerbate matters, the captain forgot to bring the only reference available for one of those new procedures -- the pallet, net, and cargo inspection airworthiness inspection manual. Additionally, the captain knew nothing of the information the new manual contained. Between their normal post- and preflight activities, the company's new and hastily implemented loading and inspection procedures, the complexities of 2 different MEL items, and the captain's unfamiliarity with the demands of freight-oriented ground operations (as indicated by his choice to be absent while most of the loading was taking place), this flight crew was clearly overburdened on the ground in svva that day. Whether or not they actually returned to mia with freight in the aft belly, or whether that freight was hastily loaded for a return trip prior to the FAA inspection has not been determined. But considering all of the factors which may have led to just such an incident, and considering the serious consequences that could have resulted from that type of mistake, the FAA should consider requiring the placement of a trained and certified load master on transport category cargo-only aircraft. Callback conversation with reporter revealed the following information: the reporter stated that the FAA has not contacted him again. The company, however, has had to bring about certain changes in their operations after a short, enforced closure. This event had triggered some needed changes. The company has required the new position of a ramp supervisor at mainland airports. The flcs still supervise at foreign airports. They have an improved net and pallet inspection policy. Although the captain is still responsible for the loading they now have the first officer sign a form verifying the status of the aircraft being correct and as depicted on the weight and balance form and as used for takeoff computations. The first officer has been approached to sign this form or 'quit.' 'another form of company imposed duress.' the first officer feels that this is a breach of aviation safety issues as he now has too little time for proper flight planning and getting ready for flight. Another suggestion added was that there be 2 ramp supervisors working the loading. After is it loaded they draw straws and the short straw goes with the aircraft, a 50/50 chance of going.

Google
 

Original NASA ASRS Text

Title: AN LGT IS INSPECTED AT MIA ARPT BY THE FAA AFTER ITS ARR FROM VLA (SVVA). FAA FOUND 2300 LBS OF UNRPTED CARGO IN THE SUPPOSEDLY EMPTY CARGO BIN. FO'S RPT DESCRIBES THE CHAOS ENCOUNTERED IN VLA WHILE CARGO WAS BEING LOADED. RPT DEALS WITH AIRLINE PROCS POLICIES, GND CREW ERRORS, AND CREW OVERLOAD.

Narrative: ACFT DEPARTED MIA FOR VALENCIA, VENEZUELA (SVVA), WITH AN INTERMEDIATE STOP IN MARACAIBO, VENEZUELA (SVMC), AND ARRIVED SVVA WITH FREIGHT BOUND FOR MIA AS WELL AS VALENCIA. MOST SVVA FREIGHT ON BOARD THE ACFT WAS POSITIONED IN THE MAIN CARGO HOLD WITH 1560 LBS IN THE REAR BELLY. UPON ARR SVVA, AIRLINE CARGO REPS AND GND PERSONNEL ADVISED THE CAPT AND FLC THAT ALL FREIGHT ON OUR ACFT, INCLUDING THAT JUST PICKED UP IN SVMC, WAS TO BE DOWNLOADED IN SVVA IN ORDER TO MAKE ROOM FOR A VIP SHIPMENT OF MANUFACTURED GOODS FROM SVVA TO MIA. WITHIN THE PAST WK THE COMPANY HAD INITIATED A NEW PALLET, NET AND CARGO INSPECTION PROGRAM THAT REQUIRED THE CAPT TO CONFIRM THE AIRWORTHINESS OF THESE ITEMS BEFORE THEY ENTERED THE ACFT. TO THAT END, THE COMPANY HAD ISSUED ALL MIA BASED CAPTS A MANUAL DESCRIBING INSPECTION PROCS AND LIMITATIONS FOR CARGO NETS AND EACH OF THE 9 DIFFERENT TYPES OF PALLETS CARRIED ON BOARD ITS ACFT. VIA THE VOICE MAIL SYS, CAPTS WERE INFORMED THAT THEY WERE TO CARRY THIS MANUAL WITH THEM ON EVERY FLT. ON THIS DAY, THE CAPT HAD LEFT HIS MANUAL AT HOME, CONFESSED TO ME THAT HE HAD NEVER READ IT, AND DID NOT KNOW HOW TO CONDUCT A NET, PALLET OR FREIGHT INSPECTION. INDEED, OTHER THAN THE PUB OF THE MANUAL AND STERN ADMONISHMENTS VIA VOICE MAIL AND TELEPHONE TO INTERPRET CONSERVATIVELY THE LIMITATIONS CONTAINED THEREIN, NEITHER CAPTS NOR FLCS HAD RECEIVED ANY FORMAL TRAINING REGARDING THE AIRWORTHINESS OF FREIGHT, PALLETS, NETS OR CONTAINERS. PREVIOUSLY, THIS COMPANY'S FLC HAD BEEN INSTRUCTED TO LEAVE SUCH MATTERS TO THE CONCERN OF 'TRAINED GND HANDLING PERSONNEL.' LATER, GND CREW PERSONNEL GAVE ME A LIST OF PALLETS AND WTS INDICATING THAT UPON DEP FOR MIA THERE WOULD BE NO BELLY FREIGHT ON BOARD THE ACFT. AFTER REDUCING THE RWY LIMITED MAX TKOF WT BY 6300 LBS DUE TO A DEFERRED MAINT ITEM (DMI) ON THE ANTI-SKID SYS, SPECIFYING THE LOCATION OF ALL PALLETS TO BE LOADED ON THE ACFT, CALCULATING THE WT AND BAL, CTR OF GRAVITY, AND STABILIZER TRIM SETTING, I PREPAREDA TKOF BUG CARD FOR A PACKS OFF TKOF. THIS DAY, THE SO, NEW TO HIS JOB AND OUR COMPANY, WAS DISTR BY A QUANTITY GAUGE DMI/MEL ITEM REQUIREMENT TO FUEL ONE OF THE MAIN TANKS TO A KNOWN QUANTITY. AND, THIS WAS THE VERY DAY FLCS HAD FIRST BEEN INSTRUCTED TO 'VISUALLY CONFIRM THE PLACEMENT OF ALL PALLETS AND THE ACTIVATION OF ALL LOCKS.' SO, WHEN I HEARD FREIGHT BEING LOADED INTO THE MAIN CARGO AREA, I WENT BACK TO SUPERVISE UNTIL THE SO FINISHED HIS OTHER DUTIES. ONCE THERE, I FOUND THAT THE GND CREW HAD A) LOADED THE WRONG PALLET INTO POS 12, AND B) ON THE NEXT PALLET THEY HAD INSTALLED ONE OF THE NETS THAT WERE SUPPOSED TO HAVE BEEN DISCARDED. I REMAINED IN THE MAIN CARGO AREA AS EACH PALLET WAS LOADED, INSTRUCTING THE GND CREW TO DOUBLE-NET SOME PALLETS AND REPLACE THE NETS ON OTHERS. WHEN THE SO APPEARED TOPSIDE, I SUGGESTED HE MONITOR THE EXTERIOR OF THE ACFT, CHK HIS DOORS, COMPLETE HIS FUEL CALCULATIONS, PAPERWORK, AND PREFLT CHKS. I WOULD FINISH WHAT I HAD STARTED IN THE MAIN CARGO BAY. UPON ARR IN MIA AS THE FO AND SO PREPARED TO DEPART THE ACFT, WE WERE GREETED IN THE MAIN ENTRANCE BY INSPECTORS FROM THE FLL FAA FSDO. THE CAPT WAS ALREADY DOWNSTAIRS. THE INSPECTORS ASKED TO SEE THE LOAD PLAN AND INQUIRED ABOUT THE FLT'S POINT OF DEP. SHORTLY THEREAFTER, I REMEMBERED THAT THE ACFT AND CREW HAD YET TO CLR UNITED STATES CUSTOMS. WHEN I MENTIONED THIS TO THE INSPECTORS, THEY RETURNED THE FLT RELEASE TO THE SO AND PRECEDED ME DOWN THE STEPS EXITING THE ACFT. THE FLC THEN CLRED CUSTOMS AND WENT THEIR SEPARATE WAYS. THE TRAINING DEPT REP DISCLOSED THAT ON DEC/XA/97 A COMPANY ACFT, THE SAME AS THAT ONE OCCUPIED BY THE AUTHOR OF THIS RPT, HAD ARRIVED MIA WITH A FLT RELEASE/WT AND BAL RPT INDICATING NO CARGO IN THE AFT BELLY. HOWEVER, DURING THEIR INSPECTION THE FAA REPS RPTEDLY FOUND 2300 LBS OF FREIGHT MARKED VLN (SVVA/VALENCIA) STORED IN THE AFT BELLY COMPARTMENT. TO THE INSPECTORS, IT APPEARED THIS FREIGHT HAD ARRIVED WITH THE ACFT. IF THAT WERE THE CASE, THEN THEWTOF THIS FREIGHT HAD NOT BEEN INCLUDED IN TKOF, CTR OF GRAVITY, OR LNDG WT CALCULATIONS. IN THEIR RPT, THE INSPECTORS SURMISED THAT THE GND CREW IN SVVA HAD SIMPLY FORGOTTEN TO REMOVE FREIGHT INTENDED FOR THEIR ARPT. BUT THE WT OF THE FREIGHT THEY FOUND IN THE AFT BELLY WAS DRAMATICALLY DIFFERENT FROM THAT WHICH HAD LEFT MIA FOR VLN (800 LBS HEAVIER). ALTERNATIVELY, IT MAY BE SURMISED THAT IN THEIR HASTE TO QUICK-TURN THE ACFT, MIA GND CREW MAY HAVE LOADED THE AFT BELLY PRIOR TO THE FAA INSPECTOR'S OPPORTUNITY TO OBSERVE ITS CONTENTS AFTER ARR IN MIA. CONTRIBUTING FACTORS/RECOMMENDATIONS: THE CAPT WAS NEW TO THE COMPANY AND APPARENTLY TO THE BUSINESS OF HAULING FREIGHT. THE FE WAS NEW TO THE COMPANY AND HIS JOB. WHILE THE FO HAD NEARLY 7 YRS EXPERIENCE IN THIS TYPE ACFT AND WITH THIS COMPANY, 2 NEW PROCS HAD ONLY RECENTLY BEEN HASTILY IMPLEMENTED. TO EXACERBATE MATTERS, THE CAPT FORGOT TO BRING THE ONLY REF AVAILABLE FOR ONE OF THOSE NEW PROCS -- THE PALLET, NET, AND CARGO INSPECTION AIRWORTHINESS INSPECTION MANUAL. ADDITIONALLY, THE CAPT KNEW NOTHING OF THE INFO THE NEW MANUAL CONTAINED. BTWN THEIR NORMAL POST- AND PREFLT ACTIVITIES, THE COMPANY'S NEW AND HASTILY IMPLEMENTED LOADING AND INSPECTION PROCS, THE COMPLEXITIES OF 2 DIFFERENT MEL ITEMS, AND THE CAPT'S UNFAMILIARITY WITH THE DEMANDS OF FREIGHT-ORIENTED GND OPS (AS INDICATED BY HIS CHOICE TO BE ABSENT WHILE MOST OF THE LOADING WAS TAKING PLACE), THIS FLC WAS CLRLY OVERBURDENED ON THE GND IN SVVA THAT DAY. WHETHER OR NOT THEY ACTUALLY RETURNED TO MIA WITH FREIGHT IN THE AFT BELLY, OR WHETHER THAT FREIGHT WAS HASTILY LOADED FOR A RETURN TRIP PRIOR TO THE FAA INSPECTION HAS NOT BEEN DETERMINED. BUT CONSIDERING ALL OF THE FACTORS WHICH MAY HAVE LED TO JUST SUCH AN INCIDENT, AND CONSIDERING THE SERIOUS CONSEQUENCES THAT COULD HAVE RESULTED FROM THAT TYPE OF MISTAKE, THE FAA SHOULD CONSIDER REQUIRING THE PLACEMENT OF A TRAINED AND CERTIFIED LOAD MASTER ON TRANSPORT CATEGORY CARGO-ONLY ACFT. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THE RPTR STATED THAT THE FAA HAS NOT CONTACTED HIM AGAIN. THE COMPANY, HOWEVER, HAS HAD TO BRING ABOUT CERTAIN CHANGES IN THEIR OPS AFTER A SHORT, ENFORCED CLOSURE. THIS EVENT HAD TRIGGERED SOME NEEDED CHANGES. THE COMPANY HAS REQUIRED THE NEW POS OF A RAMP SUPVR AT MAINLAND ARPTS. THE FLCS STILL SUPERVISE AT FOREIGN ARPTS. THEY HAVE AN IMPROVED NET AND PALLET INSPECTION POLICY. ALTHOUGH THE CAPT IS STILL RESPONSIBLE FOR THE LOADING THEY NOW HAVE THE FO SIGN A FORM VERIFYING THE STATUS OF THE ACFT BEING CORRECT AND AS DEPICTED ON THE WT AND BAL FORM AND AS USED FOR TKOF COMPUTATIONS. THE FO HAS BEEN APCHED TO SIGN THIS FORM OR 'QUIT.' 'ANOTHER FORM OF COMPANY IMPOSED DURESS.' THE FO FEELS THAT THIS IS A BREACH OF AVIATION SAFETY ISSUES AS HE NOW HAS TOO LITTLE TIME FOR PROPER FLT PLANNING AND GETTING READY FOR FLT. ANOTHER SUGGESTION ADDED WAS THAT THERE BE 2 RAMP SUPVRS WORKING THE LOADING. AFTER IS IT LOADED THEY DRAW STRAWS AND THE SHORT STRAW GOES WITH THE ACFT, A 50/50 CHANCE OF GOING.

Data retrieved from NASA's ASRS site as of July 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.