1997-11 · NASA ASRS report 386754
THE CAPT OF A BEECH 1900; BE02; OVERSHOT CLB ALT DURING A MISSED APCH DUE TO A MISUNDERSTANDING OF THE ALT TO WHICH TO CLB.
GIVEN A HOLD AT BURGR L TURNS 7000 FT. WE ENTERED THE HOLD AND WHILE IN THE HOLD WE WERE CLRED FOR THE ILS RWY 18 AT LEB. WE STARTED OUR DSCNT TO 3500 FT. AS WE TURNED INBOUND ON THE APCH WE BECAME ESTABLISHED ON THE LOC AND CONTINUED OUR DSCNT. THE GS STARTED COMING IN AND BECAME CTRED MOMENTARILY; BUT THEN STARTED GIVING US FULL SCALE DEFLECTION UP AND DOWN NEAR BURGR. MY DECISION AT THAT TIME WAS TO GAR AND GO MISSED APCH. I ASKED MY FO TO REVIEW THE MISSED APCH PROC. I THOUGHT HE SAID CLB TO 8000 FT AND R TURN TO IVV NDB. DURING THIS TIME WE CALLED LEB TWR AND TOLD THEM WE WERE GOING MISSED. TWR DID NOT ACKNOWLEDGE US ON THE FIRST CALL. ON THE SECOND CALL TO TWR WE MADE CONTACT; BUT AT THIS TIME WE WERE FLYING THROUGH 7000 FT. WE SHOULD HAVE BEEN AT 4800 FT. TWR THEN CLRED US TO BURGR TO SHOOT THE ILS AGAIN. WE SHOT THE ILS THE SECOND TIME WITH ALL GOOD INDICATIONS. HOW THE PROB AROSE: POOR CRM. IF MY FO READ 8000 FT I SHOULD HAVE QUESTIONED THAT ALT. IF MY FO DIDN'T READ 8000 FT HE SHOULD HAVE QUESTIONED ME. IT WAS DISCOVERED BY ME AND THE CTLR ABOUT THE SAME TIME; I THEN READ THE MISSED APCH AND SAW IT WAS INDEED 4800 FT. CORRECTIVE ACTION: I DON'T BELIEVE WE GOT ALL THE WAY UP TO 8000 FT BUT I DSNDED BACK DOWN ONCE THE ERROR WAS DISCOVERED AND AT THAT TIME THE CTLR GAVE US APCH CLRNC. OTHER CONTRIBUTING FACTORS: STARTED MY DAY AT XA35 (8 HR DAY THUS FAR) FINISHED XL50 LCL. FLEW 4 HRS THAT DAY AT THE TIME OF THE EVENT. 6.3 TOTAL FOR THE DAY. FATIGUE: THIS WAS MY 5TH LEG. 3 MORE AFTER THE EVENT.
Source: NASA Aviation Safety Reporting System (public domain). Reports are voluntary submissions and are not verified by NASA.
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