Incident Overview
On 27 February 2018 at 08:54 UTC, an Airbus A320 operating a scheduled flight was on approach to runway 11 at Warsaw Chopin Airport (EPWA) when air traffic control (TWR) instructed the crew to initiate a go-around. The reason for the instruction was that runway 11 was occupied by a duty driver, identified as AGENT 84, who was conducting a runway inspection.
Causes and Contributing Circumstances
The direct cause of the incident was the occupancy of runway 11 by the driver AGENT 84 during the inspection. Several circumstances were noted as contributing to the event:
- Runway 11 had sustained damage, with large pieces of concrete observed on the surface, prompting an urgent need for inspection.
- Communication difficulties arose between TWR, the duty operations manager (DOPL), and AGENT 84 due to high traffic volume and time constraints.
- AGENT 84 was operating under the perception of a real FOD (foreign object debris) threat, which fully focused his attention on providing a detailed description of the concrete defect location.
- Both AGENT 84 and DOPL prioritized the runway surface issue.
- Extended correspondence between DOPL and AGENT 84 on the tower frequency hindered the TWR controller's ability to order AGENT 84 to immediately vacate the runway.
Recommendations
The investigating body proposed the following preventive recommendations, which were accepted by the Polish State Commission for Aircraft Accident Investigation:
- The Head of the Airport Control Department at Warsaw Airport, in cooperation with the Chief of the Chopin Airport Operations Safety Service, will develop uniform procedures for priority/critical runway inspections.
- The Head of the SMS Investigation Department will forward the final report to the Safety Manager and the Chief of the Chopin Airport Operations Safety Service to be used in the process of improving operational procedures, including verification of runway inspection and closure procedures by DOPL.
The Commission did not issue any additional safety recommendations.