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Title: | Near-miss, Infraction of minimum separation between the aircraft SE-KOL and SE-ISV at Stockholm/Arlanda airport, AB County, Sweden, on 28 November 2001 |
Micro summary: | A near-miss occurs when an airplane took off while another was overhead, resulting in a collision risk. |
Event Time: | 2001-11-28 at 1100 UTC |
File Name: | 2001-11-28-SE.pdf |
Publishing Agency: | Swedish Accident Investigation Board (AIB) |
Publishing Country: | Sweden |
Report number: | RL 2002:11e |
Pages: | 25 |
Site of event: | Stockholm/Arlanda airport, AB County, Sweden |
Latitude/Longitude: | 59.39°N 017.55°E |
First Airplane | Second Airplane | ||
Departure: | Stockholm-Arlanda Airport, Marsta, Sweden | Stockholm-Arlanda Airport, Marsta, Sweden | |
Destination: | Kramfors-Sollefteå, Kramfors, Sweden | Stockholm-Arlanda Airport, Marsta, Sweden | |
Airplane Type(s): | Saab SF340A | Beech 300 LW | |
Flight Phase: | Takeoff | Takeoff | |
Registration(s): | SE-ISV | SE-KOL | |
Operator(s): | Skyways Express | WaltAir AB | |
Type of flight: | Revenue | Private | |
Occupants: | 14 | 3 | |
Fatalities: | 0 | 0 | |
Serious Injuries: | 0 | 0 | |
Minor/Non-Injured: | 14 | 3 | |
Other Injuries: | 0 | 0 |
Executive Summary: | The pilots in aircraft SE-KOL, with call sign CBN 12 (Calibration 12), were to carry out a number of calibration flights in connection with the new runway (01R/19L) at Stockholm/Arlanda airport. The calibration flights entailed the performance of takeoffs and landings in both directions for the purpose of testing the ground radar. Before the fourth takeoff, which was to take place on runway 01R, the air traffic controller informed them that a departure was to take place from runway 08 and she would get back to CBN. Sky Express with flight number SKX 303 had lined-up on runway 08 for departure. They received takeoff clearance with a right turn-out, to report when they were at 1,500 feet climbing. After one minute she re-contacted CBN and issued the clearance “after takeoff climb on heading 050 degrees 2,500 feet”. Her thought was that afterwards, when Sky Express had turned-out and cleared the intended flight path of CBN, to issue “takeoff at your discretion” to CBN. However the pilots in CBN took off without having received takeoff clearance according to established phraseology and this resulted in an infraction of minimum separation between the aircraft. The pilots in CBN obtained visual contact with the other aircraft and there was no danger of a collision. The closest they came to each other was 0.23 N.M.2 (425 meters) with a vertical separation of 700 feet (213 meters). This was an unusual type of flight, with takeoff and landing outside the established maneuvering area. A special maneuvering area had not been established for runway 01R/19L. In the investigation SHK has discovered that there was no briefing accomplished with the traffic controller prior to the flights and that the traffic controller did not use the correct phraseology upon dispatching the air traffic control clearance. Furthermore, there was a lack of routines within the aviation company’s operational flight rules, concerning calibration flights. At various airports around the country, minor variations exist in the method of giving clearance for takeoff, when activities outside the maneuvering area are concerned. It has also been shown that some extent of uncertainty is prevalent with pilots, in reference to conduct and phraseology pertaining to operations outside the maneuvering area. The incident was caused by the pilots in aircraft CBN taking off without having received clearance for this and a violation of minimum separation ensued with an oncoming aircraft. Contributory causes may have been that incorrect phraseology was used during clearance issue and inadequate routines for unusual types of flights. |
Learning Keywords: | Operations - Airspace - Air Proximity |
Operations - Airspace - Air Traffic Control |
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