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  • A320 / C56X, vicinity Geneva Switzerland, 2011 (Synopsis: On 17 August 2012, a Swiss A320 being positioned under radar vectors for arrival at Geneva was inadvertently vectored into conflict with a Cessna Citation already established on the ILS LOC for runway 23 at Geneva. Controller training was in progress and the Instructor had just taken control because of concerns at the actions of the Trainee. An error by the Instructor was recognised and de-confliction instructions were given but a co-ordinated TCAS RA still subsequently occurred. STCA was activated but constraints on access to both visual and aural modes of the system served to diminish its value.)
  • A320 / CRJ2, Port Elizabeth South Africa, 2014 (Synopsis: On 10 July 2014, the crew of a Bombardier CRJ200 on a visual go around from an approach to runway 26 at Port Elizabeth took visual avoiding action overhead of the aerodrome to ensure safe separation from an Airbus A320 which had just taken off. Both aircraft also received TCAS RAs. Minimum achieved separation from radar was 370 metres laterally and 263 feet vertically. The Investigation noted that the go around resulted from the TWR controller, who was supervising a student controller, clearing the A320 to enter the runway and take off when the CRJ200 was on short final to land.)
  • A320 / GLID, vicinity Memmingen Germany, 2015 (Synopsis: On 6 April 2015, the crew of an A320 under radar control in Class E airspace and approaching 4000 feet made a very late sighting of a glider being flown by a student pilot which appeared ahead at a similar altitude. The glider pilot reported having seen a 'cone of light' coming towards him. Both aircraft took avoiding action as practicable and passed within a recorded 450 metres with the A320 passing an estimated 250 feet over the glider. The glider was not fitted with a transponder and was not required to be, and the controller had only secondary radar.)
  • A320/B738, vicinity Delhi India, 2013 (Synopsis: On 2 September 2013, a B737 crew were not instructed to go around from their approach by ATC as it became increasingly obvious that an A320 departing the same runway would not be airborne in time for a landing clearance to be issued. They initiated a go around over the threshold and then twice came into conflict with the A320 as both climbed on similar tracks without ATC de-confliction, initially below the height where TCAS RAs are functional. Investigation attributed the conflict to ATC but the failure to effectively deal with the consequences jointly to ATC and both aircraft crews.)
  • A332 / RJ1H, vicinity Zurich Switzerland, 2004 (Synopsis: On 31 October 2004, a Loss of Separation occurred between an A330-200, on a low go-around from Rwy 14 at Zurich Switzerland, and an Avro RJ100 which had been cleared for take-off on Rwy 10 and was on a convergent flight path.)
  • A343 / B744, en-route, south of Newfoundland Canada, 1998 (Synopsis: On 20 July 1998, after an ATC error south of Newfoundland, an Air France A340 and an Air Canada 747-400 were on directly converging tracks and at the same level. Collision was avoided by the correct actioning of coordinated TCAS RAs by both aircraft.)
  • A343 / GLID, en-route, north of Waldshut-Tiengen southwest Germany, 2012 (Synopsis: On 11 August 2012, the augmenting crew member in the flight deck of an Airbus A340 about to join final approach to Zurich in Class 'C' airspace as cleared suddenly saw a glider on a collision course with the aircraft. The operating crew were alerted and immediately executed a "pronounced avoiding manoeuvre" and the two aircraft passed at approximately the same level with approximately 260 metres separation. The Investigation attributed the conflict to airspace incursion by the glider and issue of a clearance to below MRVA to the A340 and noted the absence of relevant safety nets.)
  • A388/A320, vicinity Frankfurt Germany, 2011 (Synopsis: On 13 December 2011, an Airbus 320 was allowed to depart from runway 25C at Frankfurt on a left turning SID just prior to the touchdown of an A380 on runway 25L. The A380 had then initiated a low go around which put it above, ahead of and parallel to the A320 with a closest proximity of 1nm / 200 ft, in breach of the applicable wake vortex separation minima of 7nm / 1000ft. The Investigation found that there had been no actual encounter with the A380 wake vortices but that systemic ATC operational risk management was inadequate.)
  • AT72 / B732, vicinity Queenstown New Zealand, 1999 (Synopsis: On 26 July 1999, an ATR 72-200 being operated by Mount Cook Airlines on a scheduled passenger flight from Christchurch to Queenstown entered the destination CTR without the required ATC clearance after earlier cancelling IFR and in marginal day VMC due to snow showers, separation was then lost against a Boeing 737-200 being operated IFR by Air New Zealand on a scheduled passenger flight from Auckland to Queenstown which was manoeuvring visually (circling) after making an offset VOR/DME approach in accordance with a valid ATC clearance.)
  • AT72 / JS32, en-route, north east of Jonkoping Sweden, 2012 (Synopsis: On 20 June 2012, an ATR72-200 level at FL140 and a climbing opposite direction Jetstream 32 received and correctly responded to co-ordinated TCAS RAs after ATC error. The controller had not noticed visual MTCD and STCA alerts and had attempted to continue active controlling after a TCAS RA declaration. The Investigation observed that the ineffectiveness of visual conflict alerts had previously featured in a similar event at the same ACC and that the ANSP had advised then that its addition was planned. TCAS RA response controller training was considered to be in need of improvement to make it more effective.)
  • AT72, vicinity Stockholm Bromma Sweden, 2010 (Synopsis: On 21 August 2010 a Golden Air Flyg ATR 72 under ATC control in Class ā€˜Cā€™ airspace was vectored close to three parachutists who had been dropped from a helicopter as part of an air show because of confusion between the ATC unit with responsibility for the incident airspace and the adjacent unit to which that responsibility had been delegated because it was nearest to the air show site. Additional confusion was caused by poor R/T practice by both ATC units and by different portrayal of a holding pattern on charts held by ATC and he flight crew.)
  • B734 / MD81, en-route, Romford UK, 1996 (Synopsis: On 12 November 1996, a B737-400 descended below its assigned level in one of the holding patterns at London Heathrow in day IMC to within 100 feet vertically and between 680 and 820 metres horizontally of a MD-81 at its correct level, 1000 feet below. STCA prompted ATC to intervene and the 737 climbed back to its cleared level. Neither aircraft was fitted with TCAS 2 or saw the other visually.)