ALT OVERSHOOT OCCURS FOR MD88 FLT CREW WHEN LATE CHANGES IN STAR ASSIGNMENT INBOUND TO ATL RESULT IN A BREAKDOWN IN PROGRAMMING SOP.
Synopsis
ALT OVERSHOOT OCCURS FOR MD88 FLT CREW WHEN LATE CHANGES IN STAR ASSIGNMENT INBOUND TO ATL RESULT IN A BREAKDOWN IN PROGRAMMING SOP.
Narrative
ON FLT TO ATL; INITIALLY ASSIGNED THE FALCON1 ARR. DURING DSCNT; WE WERE SWITCHED TO APCH CTL AND TOLD TO EXPECT THE PECHY ARR. AT THIS POINT WE WERE CLRED TO 14000 FT. THE FO WAS FLYING AND BEING FAIRLY NEW TO THE ACFT BEGAN TO DISCUSS SWITCHING TO THE NEW ARR AND BEGAN TO EXPLORE THE FMS. THIS INTERRUPTED MY COMPLETION OF THE DSCNT CHK FOR A FEW MOMENTS. WE LEVELED AT 14000 FT. SHORTLY THEREAFTER WE WERE CLRED DIRECTLY TO THE FIX 'DOEVR' AND NOW CLRED FOR THE PECHY ARR. ABOUT THIS SAME TIME; OR SLIGHTLY THEREAFTER; WE WERE ASKED TO SLOW 20 KTS (WHICH WAS 300) AND DSND TO 11000 FT. AT THIS POINT; I MADE MY FIRST MISTAKE AS THE PLT MONITORING. I ATTEMPTED TO MONITOR THE SELECTION; ACTIVATION; AND EXECUTION OF THE NEW ARR IN THE FMS; THEN COMPLETE THE INTERRUPTED CHKLIST; AND I DID NOT CONFIRM AND POINT AT 11000 FT IN THE ALT WINDOW. THE FO THOUGHT HE HEARD DSND TO 10000 FT AND SET THAT IN THE ALT WINDOW. AS I GOT CAUGHT UP; I LOOKED UP TO SEE US DSNDING THROUGH 11000 FT. I MADE A QUICK CALL TO APCH CTL AND THEY CONFIRMED 11000 FT. THEN I PUSHED THE ALT HOLD BUTTON ON AUTOPLT PANEL AT 100 BELOW 11000 FT. THEN I CLICKED OFF THE AUTOPLT TO CORRECT MANUALLY DUE TO SLOW AUTOPLT RESPONSE. WE DSNDED TO APPROX 300-350 FT BELOW 11000 FT MOMENTARILY AND QUICKLY RETURNED TO 11000 FT. APCH CTL MADE NO COMMENT OF ANY KIND AND GAVE NO AMENDED OR NEW CLRNC. AS FAR AS I KNOW THERE WAS NO CONFLICT OR LOSS OF SEPARATION. AFTER REACHING 11000 FT AGAIN; I TURNED THE AUTOPLT ON AND THE FO RESUMED FLYING. A CLASSIC SET UP OF MULTIPLE TASKS; DSCNT; CHKLISTS; FREQ CHANGES; NEW ARR AND THE SAME TIME AS ALT CHANGES AND SPD CHANGES. THIS TASK SATURATION LED MY FO TO MISUNDERSTAND THE CLRNC (NORMAL CLRNC DSCNT IN ATL IS FROM 12000 FT TO 10000 FT) AND I LET THE TASK SATURATION AFFECT MY NORMAL PROC OF VERIFYING THE ALT WINDOW AND POINTING AT IT. FIRST LESSON IS NEVER MISS BOTH PLTS CONFIRMING AND DOUBLE POINT OF AN ASSIGNED ALT. SECOND LESSON IS WHEN IN DOUBT; LEVEL OFF; THEN QUICKLY CONFIRM CLRNC WITH APCH CTL; IE LEVEL FIRST FOR SAFETY; THEN CONFIRM. ALSO; ABANDON AUTOMATION SOONER. IT IS TOO SLOW FOR THIS TYPE OF QUICK LEVELOFF. LAST LESSON; MAXIMIZE PREPARATION TIME AT CRUISE (IE DISCUSS ARR SWITCH OPTION) ESPECIALLY WHEN A CREW MEMBER IS NEW/LOW TIME ON ACFT.
Source: NASA Aviation Safety Reporting System (public domain). Reports are voluntary submissions and are not verified by NASA.