Serious incident Boeing 737-800 , Saturday 5 February 2011

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Date:	Saturday 5 February 2011
Time:	11:25
Type:	Boeing 737-800
Owner/operator:
Registration:
MSN:
Engine model:	CFMI CFM56-7B
Fatalities:	Fatalities: 0 / Occupants:
Other fatalities:	0
Aircraft damage:	None
Category:	Serious incident
Location:	Stockholm-Arlanda Airport (ARN/ESSA) - Sweden
Phase:	Take off
Nature:	Passenger - Scheduled
Departure airport:	Stockholm-Arlanda Airport (ARN/ESSA)
Destination airport:
Investigating agency:	SHK
Confidence Rating:	Information verified through data from accident investigation authorities

Narrative:
A foreign aircraft was cleared to taxi from parking position 66 to the holding point for runway 19R, following a non-standard taxi route. When the aircraft was supposed to turn off taxiway D to proceed north onto taxiway Y, it instead continued straight ahead along the line the pilots were following. The aircraft entered an access taxiway called Y3, which leads onto runway 01L — the same physical runway used as runway 19R.

At the same time, another aircraft (a Boeing 737-800) was taking off from runway 19R as the first aircraft passed the holding point at taxiway Y3, creating a conflict situation between the two aircraft.

The taxiing error became serious because there were no surface markings indicating to the pilots that they had reached a runway holding position on the relevant access taxiway.

The following factors contributed to the incident:

* The taxi clearance did not follow the published standard route.
* There was no holding point marking at taxiway Y3.
* An old, no-longer-valid surface marking (yellow painted lines) near the RGL lighting was mistaken for the holding point marking for Y3.
* The holding point marking did not correspond to the pilots’ taxi chart, which was based on the AIP.

Accident investigation: