FLT CREW MANUALLY ENTERED DEPARTURE FROM CLE. CREW INADVERTENTLY ENTERED SIMILAR FIX RATHER THAN FIX DEPICTED ON DEP.

Date: 2007-10 · Aircraft: Medium Large Transport · Phase: climb

Anomalies: deviation-track-heading-all-types|deviation-discrepancy-procedural-clearance

Synopsis

FLT CREW MANUALLY ENTERED DEPARTURE FROM CLE. CREW INADVERTENTLY ENTERED SIMILAR FIX RATHER THAN FIX DEPICTED ON DEP.

Narrative

THE ORIGINAL CLEARANCE FOR FLIGHT FROM CLE; RECEIVED FROM CLEARANCE DELIVERY ON THE GROUND WAS: 'CLEARED VIA RADAR VECTORS; BRUNZ; OBRLN; FINDLAY (FDY); RICHMOND (RID); THEN AS FILED; CLIMB AND MAINTAIN 5;000 FT...' DURING PREFLIGHT; THE FO OBTAINED CLEARANCE FROM ATC AND PROGRAMMED THE FMS. AFTER THE FMS WAS PROGRAMMED; THE FLIGHT CREW VERIFIED THE FLIGHT PATH; WITH THE FO READING THE WAYPOINTS IN THE FMS AND THE CAPTAIN CONFIRMING THE WAYPOINTS AS THEY WERE READ; REFERRING TO THE OBRLN ONE DEP PROC AND H-7 HIGH ALTITUDE ENRTE CHART. AS AN ADDITIONAL CHECK; THE FLIGHT PLAN DISTANCE IN THE FMS WAS COMPARED TO THE DISTANCE COMPUTED ON THE DISPATCH RELEASE; WHERE THE DIFFERENCE BETWEEN THE TWO DISTANCES WERE MINIMAL. HOWEVER; THE FO ENTERED BRUNS IN ERROR INSTEAD OF BRUNZ IN THE FMS. SINCE THE TWO FIXES ARE PRONOUNCED THE SAME WAY; AND ARE WITHIN 30 MILES OF EACH OTHER; THE CREW DID NOT DETECT THE ERROR UNTIL THE FLIGHT WAS AIRBORNE. THE FLIGHT DEPARTED CLE RWY 24C AND WAS GIVEN AN INITIAL HEADING OF 265 DEGS. IN THE VICINITY OF DJB VOR; THE FLIGHT WAS GIVEN 'DIRECT BRUNZ.' THE FO/PNF STATED; 'BRUNS IS BEHIND US.' CLEVELAND DEPARTURE'S ANSWER WAS; 'RECHECK NAVIGATION; CLEARED DIRECT BRUNZ.' THE CREW THEN COMPARED THE FMS WITH THE OBRLN ONE DEP AGAIN; AT WHICH POINT THE BRUNS/BRUNZ ERROR WAS DISCOVERED AND CORRECTED. CONTRIBUTING FACTORS: 1) CLE RWY 6R/24L IS CURRENTLY CLOSED FOR CONSTRUCTION AND RWY 6C/24C IS USED INSTEAD. WHEN USING RWY 6C/24C; THE OBRLN ONE DEP IS NOT SELECTABLE WHICH REQUIRES THE MANUAL ENTRY OF THE DEPARTURE WAYPOINTS WHEN USING RWY 6C/24C AND INTRODUCES THE POTENTIAL FOR ERROR. WHEN SELECTING THE OBRLN ONE DEP USING RWYS 6R/24L AND 6L/24R; THE POTENTIAL BRUNS/BRUNZ ERROR IS AVOIDED AS THE WHOLE PROCEDURE IS LOADED INSTEAD OF MANUALLY CONSTRUCTING INDIVIDUAL WAYPOINTS FOR THE DEPARTURE. 2) HAVING THE HOMONYMS BRUNS AND BRUNZ IN THE SAME TERMINAL AIRSPACE. BRUNZ A FIX ON THE OBRLN ONE DEP. BRUNS IS THE MISSED APPROACH FIX FOR CLE RNAV (GPS) RWY 10 APPROACH. THEY ARE LOCATED WITHIN 30 MILES OF EACH OTHER. BRUNZ IS LOCATED 32 MILES SOUTHWEST OF CLE; BRUNS IS LOCATED 11 MILES SOUTH OF CLE. 3) THE FO WAS UNFAMILIAR WITH THE DEP FROM CLE AND PRE DEP CLEARANCE WAS NOT AVAILABLE THROUGH ACARS; WHICH IS THE NORMAL MEANS OF OBTAINING CLEARANCE. THIS REQUIRED THE CREW TO OBTAIN CLEARANCE THROUGH CLE CLEARANCE DELIVERY. HAD THE CLEARANCE BEEN RECEIVED THROUGH ACARS; THE FIX BRUNZ WOULD HAVE BEEN SPELLED OUT. A CREW THAT WAS EXPERIENCED WITH THE DEPARTURE AT CLEVELAND MOST LIKELY WOULD HAVE KNOWN THAT BRUNZ WAS THE CORRECT FIX WHEN HEARD OVER THE RADIO. I BELIEVE THE ROOT CAUSE OF THE PROBLEM WAS HAVING TWO FIXES WITH IDENTICAL SOUNDING NAMES IN CLOSE PROXIMITY LOCATED IN THE SAME TERMINAL AIRSPACE. THE SAFEGUARDS THAT WERE USED -- VERIFYING THE WAYPOINTS USING CHARTS; COMPARING FLIGHT PLAN DISTANCES -- WERE NOT SUFFICIENT TOWARD DETECTING AND PREVENTING THE PROBLEM. THE SAFEGUARDS THAT NORMALLY WOULD HAVE BEEN IN PLACE BUT WERE NOT USED -- OBTAINING CLEARANCE THROUGH ACARS (INSTEAD OF VERBALLY THROUGH CLEARANCE DELIVERY); SELECTING THE OBRLN DEP (INSTEAD OF MANUALLY INPUTTING THE WAYPOINTS) -- WOULD HAVE BEEN SUFFICIENT TO PREVENT THE PROBLEM PRIOR TO DEPARTURE.

Source: NASA Aviation Safety Reporting System (public domain). Reports are voluntary submissions and are not verified by NASA.