Summary
On October 12, 2011, at approximately 21:36 Japan Standard Time, a serious incident occurred at Kansai International Airport involving two Boeing 767-300 aircraft. The departing aircraft, operated by Hawaiian Airlines (registration N588HA), entered Runway 06R after being instructed to hold short, while the arriving aircraft, operated by All Nippon Airways (registration JA8356), was on final approach to the same runway. The arriving aircraft executed a go-around following air traffic control instructions. No injuries were sustained and no damage was inflicted on either aircraft.
Flight History
N588HA, operating as Hawaiian Airlines Flight 450 from Kansai to Honolulu, had been holding short of Runway 06R on Taxiway A14 with 208 persons on board, including two flight crew. JA8356, operating as All Nippon Airways Cargo Flight 8519 from Narita to Kansai, had two persons on board. At 21:31:42, the tower controller instructed N588HA to hold short of Runway 06R, which it read back correctly. At 21:35:29, after the preceding aircraft passed, the controller instructed N588HA to "Hold position" and advised it to expect departure after the next arrival five miles out. N588HA read back "Position and hold." At 21:35:52, N588HA entered the runway. Meanwhile, at 21:34:11, the controller had cleared JA8356 to land on Runway 06R. When N588HA entered the runway, the controller ordered JA8356 to go around, which it did.
Probable Causes
The investigation concluded that the incident occurred because N588HA entered the runway despite being instructed to continue holding short. The flight crew misheard the instruction as a clearance to hold on the runway, and the controller did not request clarification although the readback did not match the phraseology of the original instruction. Contributing factors included the similarity of the instruction wording to U.S. phraseology for holding on the runway, the crew's expectation of a hold-on-runway instruction, the timing of the instruction as an arriving aircraft passed, and the controller's lack of awareness of the U.S. phraseology used in the readback.