ASN Wikibase Occurrence # 192781
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Date: | Thursday 14 April 2016 |
Time: | 08:47 |
Type: | Airbus A319-111 |
Owner/operator: | easyJet |
Registration: | G-EZFJ |
MSN: | 4040 |
Year of manufacture: | 2009 |
Engine model: | CFM CFM56-5B5/3 |
Fatalities: | Fatalities: 0 / Occupants: 163 |
Aircraft damage: | None |
Category: | Serious incident |
Location: | Malaga Airport (AGP) -
Spain
|
Phase: | Take off |
Nature: | Passenger - Scheduled |
Departure airport: | Malaga Airport (AGP) |
Destination airport: | Liverpool International Airport (LPL) |
Investigating agency: | AAIB |
Confidence Rating: | Accident investigation report completed and information captured |
Narrative:The aircraft was on scheduled flight, U27180, from Malaga Airport, Spain to Liverpool International Airport. The flight crew consisted of the commander who was a Line Training Captain and a co-pilot who was under training. At the time, runway 31 was in use and the wind was from 300° varying between 270° and 340° at 5 kt. The commander was the Pilot Flying (PF) and the co-pilot the Pilot Monitoring (PM) for the sector.
While calculating the takeoff performance figures using the Electronic Flight Bag (EFB), the co-pilot asked the commander if he could use the Multiple Runway Computation (MRC) function in case the departure runway changed to runway 13. Although it is not part of the line training syllabus, and as it was a training flight, the commander felt it would be beneficial for the co-pilot to look at this function. The operator’s SOPs allow either the single runway calculation or MRC to be used, with the choice given to the crew.
After the performance figures had been calculated by the co-pilot, the commander cross-checked the ‘Critical Data Entry’ as PF in accordance with the operator’s SOPs. He checked the aircraft configuration and that Runway 31 was displayed in the drop-down box on the top right of the EFB page. He also checked that the runway length was correct; the takeoff speeds displayed on the EFB were then entered in the Flight Management Guidance Computer (FMGC). While he recognised the speeds were lower than his previous experience and the thrust reduction altitude was lower, he accepted the figures. He did this as he assumed that the operator had changed some of the aircraft’s performance algorithms, as part of a number of other recent operational changes, which may not have been publicised to flight crew at the time. The subsequent takeoff was normal.
In the cruise, as a result of the commander’s pre-takeoff observation regarding the speeds, he decided to check the calculations. He checked the co-pilot’s EFB and noticed that with MRC selected, although runway 31 was displayed with correct runway length and the correct engine out procedure, the takeoff performance figures displayed on the same screen were for runway 13. The runway 13 selection was in a small drop-down menu on the screen in a different place to where the runway was normally verified. He believes this was not noticed due to the subtle icon selection, the small text size and because the runway selection was normally verified in a different location on the screen.
Conclusion
The flight crew took off from Runway 31 using the takeoff performance data for Runway 13 at Malaga Airport. This incorrect data was provided by the EFB which contained an anomaly that allowed detailed runway information for one runway to be displayed alongside takeoff performance data for another runway. The flight crew, operator and manufacturer were unaware of the anomaly at the time of the event.
The operator has disabled the MRC function and other affected operators have since been informed of this anomaly with a recommendation to disable the MRC function. The L6.x versions of the software do not exhibit this MRC function anomaly.
Accident investigation:
|
| |
Investigating agency: | AAIB |
Report number: | EW/C2016/04/01 |
Status: | Investigation completed |
Duration: | |
Download report: | Final report |
|
Sources:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/582345/AAIB_Bulletin_1-2017.pdf Revision history:
Date/time | Contributor | Updates |
12-Jan-2017 19:31 |
harro |
Added |
12-Jan-2017 19:45 |
harro |
Updated [Narrative] |
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