Air Traffic Control Time Certified In Pos 1 (yrs) 7

Troubleshooting; Distraction; Communication Breakdown; Confusion; Situational Awareness

ATC Issue All Types; Airspace Violation All Types; Conflict Airborne Conflict; Deviation / Discrepancy - Procedural Published Material / Policy

When I got in and relieved the mid-shift I noticed 3 high altitude codes in and close to my airspace that nobody new about.  The codes had various altitudes associated with the targets all ranging between 520 and 590 [FL520-590].  We assumed they were bad radar targets but the SOC said they weren't.  When the MOS got in; we confirmed that the codes were; in fact; high altitude balloons.  They claim the area knew about it from the night before; but nobody could find paperwork in the area.  They said they would bring down the paperwork but never did.  I think this is a dangerous situation especially with the number of high-altitude Global Hawks that we have flying around in the same airspace.  Over the next hour or so I observed the balloons float into ZDV and ZLC airspace and called both of those other sectors to tell them about the codes.  Neither ZDV nor ZLC knew about the balloons before my call either.The areas must be kept informed of balloon activity especially due to the fact that we frequently have high-altitude Global Hawk aircraft in the airspace.

ZLA Controller reports of high altitude balloons in which the sectors didn't have any information on. Traffic Management Unit said they knew about them the night before and should have paperwork in the area.


Physiological - Other; Human-Machine Interface; Confusion; Situational Awareness

Flight Crew Last 90 Days 55; Flight Crew Total 25000; Flight Crew Type 16000

Time Pressure; Situational Awareness; Training / Qualification

Deviation / Discrepancy - Procedural Published Material / Policy; Ground Event / Encounter Ground Strike - Aircraft

Flight Crew Took Evasive Action; General Maintenance Action

Chart Or Publication; Procedure; Human Factors

On takeoff roll. Captain called out 'rotate'. I began to rotate and noticed airplane didn't feel ready to fly; so I slowed the rotation rate until I felt the main gear liftoff. I then resumed to rotate to target pitch attitude. At that point I noticed the airspeed was right around V2. Climbed out of terminal area and then reviewed takeoff data. We determined the Captain's airspeed bugs were set lower than the performance data called for. I concluded that was why the rotation felt mushy. Upon arrival; a walk around revealed a scrape on the tailskid. No other damage found by mechanic. Believe the event was caused by Pilot Monitoring (PM) setting wrong Vr speed bug; Pilot Flying failed to catch that error and had already transitioned visual scan to outside the aircraft and failed to verify speed when PM made rotate call. Flaps 5 takeoff; reduced thrust made tail clearance minimal to begin with and margin for error was small. I feel proper adherence to standard rotation rate helped identify an irregular condition and subsequent action of slowing rotation rate prevented any damage from occurring.

Paint scape on tail skid noticed on through flight inspection. Slightly early rotation on takeoff may have been a factor. Rotation rate was not excessive and no unusual attitudes noted on takeoff or landing. No cockpit indications of tail strike occurred. Maintenance inspection revealed no damage to tail skid other than paint scrape. Aircraft returned to service. Being even more vigilant on flaps 5 reduced thrust takeoff rotation speeds and rate may prevent this in the future.

A B767 flight crew reported that the tail skid contacted the runway on takeoff because a Vr speed lower than the performance data specified was entered in the FMC.


Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor; Ground Event / Encounter Other / Unknown; No Specific Anomaly Occurred Unwanted Situation

Pre-flight; Routine Inspection; Aircraft In Service At Gate

Company Policy; Procedure; Human Factors

The crew waited on the jet-bridge during the plane cleaning and electrostatic spraying process. The crews aren't being allowed even 30 seconds after spraying completion to wait boarding the airplane. As we board the plane there is still the overwhelming smell of chemicals in the cabin. It would be helpful if policies were put into place that allows time for the smell of the chemical to dissipate before we have to board the plane.

Air Carrier Flight Attendant reported electrostatic cleaning fumes linger during boarding of the aircraft.


Flight Crew Last 90 Days 250; Flight Crew Total 21000; Flight Crew Type 8500

Flight Crew Last 90 Days 200; Flight Crew Total 24000; Flight Crew Type 12000

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy

On six to eight mile final in VFR conditions for Runway 34L at Tokyo Narita an EICAS FLAPS PRIMARY FLAPS appeared. This occurred when flaps 20 was selected for reducing to target speed in compliance with the 10 DME 160 KTS speed to 4.8 DME then reduce to target speed restriction. The aircraft at the time was at 160 KTS and landing gear was down. The flaps fully extended to flaps 20 and the airplane was fully stabilized. I was the pilot flying and was hand flying at the time. The Captain and other First Officer worked the problem and we jointly determined it was prudent; desirable; and safe to continue to land rather than go-around since we were fully stabilized and there were no other issues to address with Maintenance or Dispatch. Landing conditions were ideal and 34L is very long runway. Since we were at flaps 20 the VREF was changed to 20 REF and we added 5 KTS to the target speed and reduced to that speed (auto-throttles were on). The 500 FT call was made and we verified flaps 20. We did however forget to select the GPWS for Flap Override Switch and we did receive the aural warning. It was quickly selected and we landed without incident.After landing we contacted Dispatch on SATCOM to advise him of the incident. I agree with the Captain and our crew decision to continue the approach as we were ahead of the airplane and fully stabilized. If there was any doubt in our minds there would have been no hesitation to go-around especially when IMC; behind the airplane; on a shorter runway; or at an unfamiliar airport. In retrospect I could have briefly reengaged the autopilot and perhaps caught the flap override switch omission; but that too could have been only for a brief time before having to disengage it for the landing. Exercising Captain's emergency authority was addressed but it we felt that this not rise to that standard nor was it necessary.

[Narrative 2 has no additional information]

An air carrier First Officer and Relief Pilot reported that they experienced an EICAS FLAPS PRIMARY message on final approach to RJAA. They decided since they were stabilized and familiar with the airport and the long runway they were okay to continue with the landing.


Confusion; Troubleshooting; Training / Qualification

Aircraft Equipment Problem Critical; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor; Ground Event / Encounter Other / Unknown

Flight Crew Returned To Gate; General Flight Cancelled / Delayed; General Maintenance Action

Procedure; Manuals; Human Factors; Aircraft

On Taxi out; received 'Fire Det 2 Fault' Level 1 Alert. Referenced QRH and it stated that this required a 'NO Take-Off' status. After stopping the aircraft to further investigate the situation; I performed another Fire Detection System Test and then following this test we received an 'Eng #2 Fire' Level 3 Alert. We then ran the QRH procedures for Engine Fire/Severe Damage; shut down the engine; discharged the first Fire Bottle. After 30 Seconds we still had the Engine Fire alert and so we discharged the second Fire Bottle. At this time we notified ZZZ Fire Rescue of our possible engine fire. Prior to Fire Rescue's arrival; the 'Eng 2 Fire' Alert had extinguished. Fire Rescue inspected Engine #2 both visually and with Firefighter Thermal Imaging Camera (FLIR) and notified us that it appeared that there wasn't any fire present and that all was safe to taxi back to the Ramp area. Fire Rescue escorted us back to Ramp with no further action on their part. After parking; we debriefed our Maintenance [personnel] and released the aircraft to Company ZZZ Station Maintenance.After discussing the event with our Maintenance; it was determined that the initial fault ('Fire Det 2 Fault') was caused by a Fire Detection Controller System failure; (Intermittent failure). The outcome of this Alert is a total failure of Engine #2 Fire Detection System; so takeoff is not authorized. The Human Factor Error was on my part; when I ran another Fire Detection Test; this I believe caused the 'Engine 2 Fire' Alert due to system design. After the Alert was displayed and failed to extinguish; we had no options but to respond to the Fire Alert; i.e. shut down engine and discharge the Fire Bottles. At this point; without verification from an outside source; we felt our actions were appropriate along with notifying the Fire Rescue. There is no prevention to a system failure; but as far as the possible human error; maybe just sit on my hands and take in the situation for a few minutes before doing any system tests; as they can produce a possible wrong indication.

Reporter stated when they received the initial fault of 'Fire Det 2 Fault'; Level 1 alert; they checked their QRH which only had a reference asking if the Fire Detection System was not available. He just did not know if the Fire Detection System was 'not' available.  So he performed another Fire Detection System Test and that Test set off the 'Eng #2 Fire' Level 3 alert requiring him to shut down #2 Engine and discharge the Engine Fire Bottles. He would like to see the QRH revised to alert flight crews 'not' to perform another Fire Detection System Test if a similar 'Fire Det 2 Fault' Level 1 alert appears.

On taxi out; received a Level-1 ('Fire Det 2 Fail'). After stopping aircraft and checking the QRH for the Level-1 Alert; a Fire Test was accomplished and then we received a Level 3 'Eng 2 Fire' Alert. We suspected an indicator issue; but still had to run QRH procedures; for Engine Fire Severe Damage Checklist.  Fired first [Fire] Bottle and Alert remained 'ON' after 30-seconds. Fired second bottle. After about two minutes; alert went out.  Both 'Fire Det 2 Fail' and 'Eng 2 Fire' indications remained off and 'Agent Lo' Alert was on. Alerted Ground Control to send out fire trucks while we were still on the taxiway as a precaution. They inspected the Number-2 Engine area and found no evidence of a fire. We taxied back to the gate and had the Fire Department follow us. We suspect that the Fire Detection System failure caused false indications which led to this event.

A Captain and First Officer report that during taxi out in an MD-11 aircraft; a 'Fire Det 2 Fault' Level-1 Alert appeared. QRH stated 'No Take-Off' status. Another Fire Detection System Test was performed; followed by 'Eng #2 Fire' Level-3 Alert. Both Fire Bottles were discharged. Fire Rescue checked engine and said no fire present. Fire Detection Controller had failed.


Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument; Flight Crew Multiengine

Confusion; Distraction; Human-Machine Interface; Situational Awareness; Troubleshooting; Workload

Aircraft Equipment Problem Less Severe; Inflight Event / Encounter Other / Unknown

ATC Equipment / Nav Facility / Buildings; Aircraft; Airspace Structure

GPS jamming: GPS position unavailable and ADS-B OUT L. Cause: GPS jamming.

Air Carrier Captain reported GPS position unavailable and ADS-B OUT L. Possible GPS jamming.


Flight Crew Last 90 Days 45; Flight Crew Total 1570; Flight Crew Type 35

Airspace Violation All Types; Deviation / Discrepancy - Procedural FAR; Inflight Event / Encounter Weather / Turbulence

Flight Crew Became Reoriented; Flight Crew Exited Penetrated Airspace

After briefing and NOTAM report; personal flight to GKT. En route; weather was clear until reaching east of ATL; a line of convection moving east/northeast. NEXRAD showed storm dissipating to the west. Made the decision to fly west under ATL Class B west outer shelf. Upon heading north east along edge of weather under ATL Class B; started encountering terrain (mountains). Turned north in order to maintain VMC and climbed to 4;500 FT. Storm clouds still to the east and clouds to north; opening to the northwest; so we turned left to go to the clearing and upon doing so we entered the 3;500 to 12;500 FT shelf by 00GA and Yellow River without clearance. Aircraft radio reception marginal. New antenna going on this week; so communications will be greatly improved. Lessons learned: weather avoidance next to Class B is a bad combination; especially with marginal communication. Land and wait it out.

Experimental aircraft pilot reports inadvertently entering ATL Class B airspace while attempting to avoid both the airspace; weather; and rising terrain on the east side.


Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument

Aircraft Equipment Problem Critical; Deviation / Discrepancy - Procedural FAR; Deviation / Discrepancy - Procedural Maintenance; Deviation / Discrepancy - Procedural Published Material / Policy

Air Traffic Control Provided Assistance; Flight Crew Took Evasive Action; Flight Crew Requested ATC Assistance / Clarification; General Flight Cancelled / Delayed; General Maintenance Action

During climbout passing thru 10;000 ft. MSL on the way to 15;000 ft. MSL we received a CABIN ALTITUDE HI master warning EICAS message. I was the PM and immediately called ATC and requested a level off at 10;000 ft. MSL. This was followed by the immediate action of running the QRC and memory items followed by the QRH. The first item on the QRH after the QRC is to ensure that the pressurization MODE switch is set to AUTO and the DUMP button is pushed out. The pressurization MODE switch was set to MAN. As the PM running the QRH I returned the MODE switch to AUTO and then monitored Cabin Altitude in accordance with the QRH. During this time the First Officer (FO) who was Pilot Flying (PF) was accepting vectors from ATC and maintaining 10;000 ft. MSL. Once the Cabin Altitude returned to normal pressurization we were both comfortable with continuing on with the flight. We requested back on course from ATC and continued on to ZZZ without any further issues.There are two causes for this event to have occurred. One; according to the aircraft logbook a pressurization leak check maintenance procedure was done after the top cap DV window seal re-bonding was done. This is noted on log. The pressurization MODE switch was not returned to the AUTO position and left in the MAN position after this procedure was accomplished. During my preflight inspection of the aircraft logbook I did take notice of this maintenance item and pointed it out to my FO. This brings us to the second cause. Two; despite making a note of the maintenance item and procedure both my preflight flow and my FO's preflight flow failed to notice that the MODE switch was set to MAN and not AUTO. We also both failed to notice that the CABIN ALT indications on the EICAS was not displaying any values. To my knowledge there are no other EICAS messages associated with the MODE switch being in MAN. This oversight in my preflight flow directly contributed to the aircraft failing to pressurize after take off and subsequently getting a CABIN ALTITUDE HI master warning and EICAS message right as we hit 10;000 ft. MSL. I will endeavor in the future to pay much closer attention to my preflight flow of the aircraft to make sure every switch is in its proper position so that such an incident will not happen in the future.

EMB-170 Captain reported cabin pressure control switches were not placed in proper positions and resulted in a CABIN ALT HI annunciation in flight. The flight continued after the flight crew positioned the cabin pressure controls to the correct positions.


Situational Awareness; Confusion; Communication Breakdown

Party1 Flight Attendant; Party2 Other; Party2 Flight Attendant

Human Factors; Environment - Non Weather Related

We swapped airplanes; and during cabin prep for pre-departure I noticed that the R1 door was still armed. I never touched it prior except to pre-flight the slide gage. I immediately dis-armed the door. I turned off the music; and the L1 door had just been closed. We were waiting for them to move the jetway back. As soon as they did that I made the PA to arm doors; cross check and stand by for call. I armed L1 and re-armed R1. I called my FA partner and told her forward doors armed and cross checked. She said aft doors armed and cross checked. I told the Captain cabin secure. After the safety demo I told the FA that the R1 was armed when we got on the plane but didn't notice it until I turned off the music. She said she had seen that before. It made me nervous as to why the last crew did not disarm it. I told the Captain on taxi out that it was armed; I disarmed it and rearmed it when we were supposed to arm it. I asked if there could be a reason why it was never disarmed? The Captain said he would call me during cruise to discuss it. My FA partner lectured me because it was not important to tell the Captain and that it was not a live door. I told her I had been on leave for 7 months; and just wanted to verify that it was OK. The Captain called during cruise. We discussed the door. I told him I noticed it was armed still and had never previously touched it. So it must have never been disarmed from the last crew. I disarmed it; and then rearmed it. He said does it look normal to you? I said yes. He said the door should be fine. He didn't have any other indications of an abnormal condition. He even came out for a lavatory break and I showed him. He said it was fine and to not worry. We landed; and parked; I disarmed R1; and all was fine with the door. The Captain appreciated that I was concerned and informed him. He said it was good to verify.Make sure that crews follow dis-arming procedure. Stop distractions. Make it a pre-flight item to make sure it was disarmed.

Air Carrier Flight Attendant reported being uncertain of door arming/disarming procedures after being off for several months.


Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP); Flight Crew Flight Engineer; Flight Crew Flight Instructor; Flight Crew Instrument

Flight Crew Last 90 Days 210; Flight Crew Total 26000; Flight Crew Type 35

ATC Issue All Types; Airspace Violation All Types; Deviation / Discrepancy - Procedural Clearance; Deviation / Discrepancy - Procedural Published Material / Policy

Air Traffic Control Issued Advisory / Alert; Flight Crew Became Reoriented

Called and briefed by FSS just prior to departure. Flew for fun to BKL. Beautiful evening. Traffic advisories from CLE Approach. Advised Approach we planned a touch and go at BKL. Contacted BKL TWR and we were advised that we couldn't do a touch and go due to TFR. Additionally we were not allowed 'training flights' due to TFR. WE WEREN'T A TRAINING FLIGHT! Worked it out to full stop and depart. Tower said they were not getting their TFR into the system with FSS and we weren't the first. I specifically asked FSS about TFRs and NOTAMs for BKL. Somewhat confused!

RV-12 pilot reported considerable confusion regarding a TFR during a pleasure flight to BKL.


Maintenance Airframe; Maintenance Powerplant

Maintenance Inspector 3; Maintenance Lead Technician 5; Maintenance Technician 19

Aircraft Equipment Problem Critical; Deviation / Discrepancy - Procedural Published Material / Policy; Deviation / Discrepancy - Procedural FAR

Company Policy; Environment - Non Weather Related; Human Factors; Aircraft

Recently our [maintenance] program has been scrutinized for finding problems and defects in the aircraft while performing routine maintenance. Company Management has called and questioned our rationalization for finding aircraft defects; especially if it involved taking the aircraft out of service once the defect had been found. The aircraft are looked at daily to make certain that it is mission ready and safe to operate. We have been asked on numerous occasions why we looked at a particular area of the aircraft if it might end up grounding it for a defect. Just recently we were called 'uncooperative' for not modifying a critical flight control when a part that had been delivered to us did not fit. There is no approved procedure to modify this component. While we are required to perform an aircraft maintenance check regularly; it is almost certain that defects or safety related issues will be found and sometimes with other aircraft [already] out of service. It is the nature of mechanics to look into areas that are typically problem areas; paying particular attention to those that may be safety related. When Management scrutinizes or comments that we should not be looking for problems; it tends to create an attitude that 'if we are going to be told we are wrong then we just won't report the issue'. Unfortunately that lack of integrity just might be the cause of an accident. I see the problem as a lack of support to the field level and too much pressure to keep the aircraft flying and to 'close one eye' when performing maintenance. This constant 'waiting to be clubbed' [environment] has caused a high degree of degradation of morale; and I fear has; and may lead to; more apathy within the mechanics ranks.

Reporter stated he works for an air ambulance helicopter operator. They operate several helicopters including Bell 407's; Eurocopters; BK-117 and others. Company Management has not changed their attitude towards mechanics since he filed his report and Management continues to ignore their own maintenance safety policies. He believes the trend of intimidating mechanics who find defects; even when performing required checks; will continue to increase as the pressure to keep their helicopters flying increases. The critical flight control item he was referring to involved the push tube for the cyclic and collective controls on one of their Bell-407's.

An air ambulance helicopter Mechanic describes a deteriorating work environment where Maintenance Management increasingly scrutinizes defects found by mechanics. Comments have also been made that mechanics should not be looking for problems even during regular checks. Intimidation towards mechanics and apathy within the mechanics ranks continues to grow.


Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural FAR; Deviation / Discrepancy - Procedural Maintenance; Deviation / Discrepancy - Procedural Published Material / Policy

Aircraft X arrived to the gate with FAA-required marking outside of [the] FO (First Officer) window stenciled with white color - this is wrong. The word should be stenciled red on [a] white background. See Log XXXXXXX for details.

Technician reported incorrect external markings on numerous aircraft in violation of FAR's.


Flight Crew Commercial; Flight Crew Flight Instructor; Flight Crew Instrument

Flight Crew Last 90 Days 125; Flight Crew Total 2400; Flight Crew Type 700

Aircraft Equipment Problem Critical; Inflight Event / Encounter Weather / Turbulence

Air Traffic Control Provided Assistance; Flight Crew Diverted; Flight Crew Landed in Emergency Condition; Flight Crew Requested ATC Assistance / Clarification; General Declared Emergency

This was an IFR flight; takeoff and climb was normal and the original altitude request of 4;000 FT was amended to 6;000 FT by the pilot in order to get on top of the cloud layer at 4;000 FT. No visible ice was observed during the climb out.Upon reaching 6;000 FT MSL; oil started to flow freely onto the wind screen. Under the control of TRACON an emergency was declared and assistance requested. TRACON responded by providing a new transponder code and vectors to the nearest airport. As oil pressure was decreasing rapidly; power was reduced and an emergency descent started. Because oil covered the windscreen; visibility was greatly reduced and the descent was made on instruments. TRACON continued to provide vectors to the airport until radar and voice contact was lost at about 2;300 FT MSL. Airport was identified and landing was made. Upon inspection of the aircraft; it was determined that the crankcase breather tube was blocked by ice. This caused the crankcase to be pressurized and oil was forced out through the crankcase/prop seal. The aircraft lost 5 quarts of its 8 quart capacity. Contributing factors could have been that the aircraft was placed on heat 48 hours prior to take off; creating an excessive amount of moisture within engine crankcase and within engine compartment. Ambient air temperature was below 0 degrees F. Air intake winterization kit was not installed. Engine was not generating enough heat to dissipate moisture. Moisture picked up from climb through clouds.

PA-28 pilot experiences loss of engine oil and pressure; an emergency is declared followed by an uneventful landing.


Eurocopter AS 350/355/EC130 - Astar/Twinstar/Ecureuil

Any Unknown or Unlisted Aircraft Manufacturer

Flight Crew Commercial; Flight Crew Instrument

Flight Crew Last 90 Days 30; Flight Crew Total 4830; Flight Crew Type 4830

Conflict NMAC; Deviation / Discrepancy - Procedural Published Material / Policy

[I] called for a departure from present position departure to the east. Traffic responded on a 7 mile final for Runway XX. I started a takeoff on a 090 heading. At about 200 feet AGL the flight nurse started to say plane; and right then I saw the airplane taking off from Runway YY. I made a rapid right turn to avoid the airplane who had made no radio calls at all up to this point or after the incident. I confirmed this with the FBO and fellow pilots; and made sure that everyone heard my radio call.

AS350 pilot reported an NMAC departing an airport.


Flight Crew Air Transport Pilot (ATP); Flight Crew Flight Instructor; Flight Crew Flight Engineer

Flight Crew Last 90 Days 250; Flight Crew Total 26000; Flight Crew Type 9000

ATC Issue All Types; Deviation / Discrepancy - Procedural Published Material / Policy

Air Traffic Control Issued New Clearance

Airport; Procedure; Human Factors; Company Policy

[We were] given Runway 13 by MIA Approach. I asked for Runway 9L (Runway 13 is 6;930 FT; Runway 9L is 9;000 FT). Runway 9L has always been the primary runway for jet operations. A321 aircraft are not known for great deceleration performance. MIA Approach asked why I wanted Runway 9L. I answered; 'A321; I want longer runway.' Once on FLL Tower; I was asked to call MIA TRACON Supervisor. The Supervisor stated that a new program was starting at FLL to up the hourly count during construction on Runway 9R and for expected future growth. All aircraft would use Runway 9L for departure and Runway 13 for arrival. He said I was hurting their count and operation by using Runway 9L. The Supervisor had a commitment from the air carrier that all aircraft could land Runway 13. I was unable to set a return call from the air carrier safety department to discuss the commitment issue. Why would the air carrier commit to this program? Who at the air carrier would commit to a program of all aircraft using a 6;900 FT runway over a 9;000 FT runway whenever 'legal?' I was told by the Supervisor that one air carrier did refuse to participate. Under the FAA safety philosophy that change should be 'safer or as safe;' this does not fly. A jet aircraft landing on a 6;900 FT runway when a 9;000 FT runway is available is not 'safer or as safe.' It may be legal by charts and numbers; but it is not safe.

A321 Captain reports being assigned Runway 13 for landing at FLL due to construction; which he rejects in favor of Runway 9L. Reporter is informed by ATC that his company had made a commitment that all aircraft arriving FLL could land Runway 13.


Flight Crew Last 90 Days 15; Flight Crew Total 300; Flight Crew Type 300

Communication Breakdown; Other / Unknown

Aircraft Equipment Problem Less Severe; Airspace Violation All Types; Deviation / Discrepancy - Procedural Published Material / Policy

Automation Air Traffic Control; Person Flight Crew

Air Traffic Control Issued Advisory / Alert

I departed HAO and flew direct to RID on a VFR flight. I thought I was departing just prior to the presidential TFR which I believed to be starting in 15 minutes. My plan was to fly out of the TFR stop in Richmond for 30 minutes and then fly to Port Columbus to pick up a passenger. Unfortunately I was mistaken on the TFR start time either due to a change or an error on my part but the TFR went into effect 2 minutes before I departed. I was asked upon landing at RID to call the FAA which I did. I then took off and flew with VFR flight following to Port Columbus. Unfortunately the AWOS at HAO and LUK that I checked via phone prior to departure did not have any special NOTAMs for the TFR prior to my departure. In addition my Garmin 496 must have been delayed with the data feed because I only saw the TFR pop up on my display as I was leaving the TFR.

General Aviation pilot reports discovering airborne via his Garmin 496 that a TFR had gone into effect 15 minutes earlier than expected. NOTAMs were not checked directly just prior to departure; relying instead on local AWOS.


Flight Crew Instrument; Flight Crew Multiengine

Flight Crew Last 90 Days 120; Flight Crew Total 3800; Flight Crew Type 400

Airspace Violation All Types; Conflict Airborne Conflict

I was towing a banner along the Santa Monica shoreline. While Southbound I noticed the parasail headed directly for me; from offshore towards the beach. To avoid the parasail I turned left and started to climb. I had nowhere to go except over Santa Monica Pier. The parasail boat driver appeared to be driving straight for me. In conclusion; Parasail operators need proper training regarding aircraft avoidance. Especially if the parasail is operating in controlled airspace; and interfering with aircraft. Please regulate Parasailing before they kill more people.

A small aircraft pilot towing a banner had a near miss with a parasail. His evasive actions prevented a collision. He suggests that parasail operators need more training and that parasail operations should be regulated.


Workload; Situational Awareness; Troubleshooting

Automation Aircraft Other Automation; Person Flight Crew

Flight Crew Took Evasive Action; Flight Crew FLC complied w / Automation / Advisory; General Maintenance Action

When configuring for landing; the trailing edge flaps and leading edge devices did not move when the flap handle was moved. The approach was discontinued; the situation was discussed with ATC; and a long final approach to 25R was arranged. The flight attendants and passengers were briefed. Due to abnormal flap system operation rescue services were requested. The aircraft was light weight with no landing performance issues indicated.Flaps were positioned to 15 using alternate flaps. An uneventful landing was accomplished with a termination of the emergency shortly after clearing the runway. Maintenance was notified; a logbook write up was accomplished; and I received a call from Dispatch. Later that day I contacted Maintenance Control and was told that a faulty sensor had caused the problem. If there are any questions please contact me.Reviewing this event; I would suggest a change in title to the 'Trailing edge flap disagree' QRH checklist to include 'no flap movement with flap lever'.The new QRH has many changes. It is a complex document that needs to be aggressively trained. Self-study can only go so far in ensuring correct operational knowledge and use of the document.

A B737-700 flaps and slats did not move with flap selections. The QRH was completed; flaps 15 alternate flaps followed by an uneventful landing. A faulty sensor was discovered. The new QRH procedure is complex.


Human-Machine Interface; Situational Awareness

Flight Crew Executed Go Around / Missed Approach; General Maintenance Action

On approach in after putting gear and flaps down at about 1;500 feet AGL ECAM on status page normal brakes INOP and ALT Brakes INOP. We decided to go around and look at ECAM. After go around ECAM changed to brakes AUTO BRK FAULT. Went in for normal landing. Called Ops and Maintenance on ground; wrote up problem in logbook.

A320 Captain experiences an ECAM Status message during approach indicating both normal and alternate brakes are inoperative. A go around is initiated. After go around the ECAM message has changed to AUTO BRK FAULT and a normal landing ensues.


Small Aircraft; High Wing; 1 Eng; Fixed Gear

Small Aircraft; Low Wing; 1 Eng; Fixed Gear

Flight Crew Last 90 Days 21; Flight Crew Total 153; Flight Crew Type 153

Communication Breakdown; Situational Awareness

ATC Issue All Types; Conflict NMAC; Deviation / Discrepancy - Procedural Clearance

Procedure; Environment - Non Weather Related; Airspace Structure

I was flying Aircraft X. I was incoming to SQL from the north for [a] full stop landing; exiting the SFO Bravo; heading south towards the airport. SQL Tower initially asked me to enter a left downwind for Runway 30; keeping 101 freeway to my left; and they would call my left base for Runway 30. A couple of minutes later they asked me to turn left; overfly the runway and enter a right base for Runway 30. I crossed the runway at 1200 feet and began to descend to pattern altitude. SQL Tower told me to follow Aircraft Y that was on an extended right base for 30. As I was searching for Aircraft Y; I began to turn right downwind for 30 right as I noticed Aircraft Z cross in front of me....both of us executing an evasive maneuver. I told Tower that I had a near miss with Aircraft Z....and Tower responded that this aircraft was not on frequency. I was able to land safely.   Upon reviewing ADS-B data and ATC recording of the event; it appears that Aircraft Z took off from Runway 30 and was asked to follow Aircraft A; Aircraft A was told to proceed to KNBR [radio station] antenna and then proceed on course; which they did. Aircraft Z however did not follow Aircraft A and turned too early into downwind. The tower also gave Aircraft Z a very early frequency change so they were not on frequency at the time of [the] near miss. It seems to me that the failure of the Tower to verify that Aircraft Z had Aircraft A in sight was a factor in this near miss; as well as the Tower's early frequency change for Aircraft Z.

Pilot of a single engine aircraft reported an NMAC occurred during traffic pattern entry; resulting in evasive action.


Flight Crew Rejected Takeoff; Flight Crew Returned To Gate

On takeoff roll; set standard power and after power set at approximately 50 knots; we heard 3 loud bangs; aircraft yawed sharply to the left. Performed reject at 50 kts. Fire rescue inspected tires and found no tire damage. Taxi back to gate. Engine compressor stall suspected.

Flight Crew encountered engine malfunction during takeoff roll.


Flight Crew Last 90 Days 60; Flight Crew Total 13000; Flight Crew Type 1100

Situational Awareness; Workload; Training / Qualification

Aircraft Equipment Problem Critical; Inflight Event / Encounter Loss Of Aircraft Control

Aircraft Aircraft Damaged; Flight Crew Took Evasive Action; General Maintenance Action

Normal approach and landing. After the touchdown on normal landing roll; the airplane made a little yaw to the right; I did the correction smoothly to the left to keep the aircraft at the center of the runway; and the aircraft started to go left with no control. I did everything to keep control. Applying right rudder pedal and differential brakes; but the aircraft did not respond and started to skid until stopped on the runway close to Taxiway Delta. Four tires exploded; [it] looks like an antiskid malfunction.

A G200 anti-skid system apparently malfunctioned on landing causing all four tires to explode but the pilot was able to keep the aircraft on the runway.


Airbus Industrie Undifferentiated or Other Model

Flight Crew Instrument; Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP)

ATC Issue All Types; Conflict Ground Conflict; Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy

After exiting Runway 16R SLC; given clearance to taxi via taxiway Echo to Golf to the ramp entry point/ While taxing on Echo approaching Golf slowing to taxi speed of 15 knots or less; noticed an [air carrier] [regional jet] holding short of Hotel on Echo and blocking Golf. Immediately applied brakes and came to a Stop on Echo about 30 feet from regional jet. Night time operation and the aircraft silhouette was poorly lit and blended in with Runway 16 left and taxiway. Told SLC Ground Control you need to give us a heads-up that there was another aircraft blocking taxiway Golf. ATC acknowledged and given taxi instructions to ramp without incident. Night time taxi operations. Aircraft had poor silhouette lighting from rear view. ATC Ground Control gave no report of said aircraft holding on taxiway route cleared. Better situational awareness from ATC and absolute vigilance from flight crew during taxi operations.

A300 Captain reported heavy braking needed to avoid aircraft blocking taxiway.


Large Transport; Low Wing; 2 Turbojet Eng

Party1 Flight Crew; Party2 Ground Personnel

Deviation / Discrepancy - Procedural Published Material / Policy

Every accident has a chain of events. Each chain can have several links. Fortunately; we broke the chain today in MUSC. My intent in writing this report is primarily to prevent a similar event from happening in the future where a Ramp Agent is injured or worse. While preparing to depart from MUSC; we noticed a large air carrier parked on the ramp between Taxiway A and B. There was little space to maneuver as a result (Link 1). I asked the Agent if we would be pushed back by a tug and he said 'yes.' I gave my normal brief to the Ramp Agent (thought I was talking to the Tug Driver). The brief I received from the Ramp Agent was not the full brief I normally get in the USA. (Link 2). So; I asked the Ramp Agent for more information; but I never asked how many people were in the push.(Link 3). The Tug Driver pushed the aircraft out onto Runway 26 (without Tower clearance from the Pilots) into the 'line up and wait' position while we were starting both engines.(Link 4). I set the parking brake while on the runway. I do not remember the Ramp Agent ever saying 'Towbar has been disconnected and bypass pin is removed' which is my 'TRIGGER' to say 'You are cleared off.'(Link 5). Without a Pilot to Ramp Agent communication; the tug disconnected. The tug had an enclosed cockpit (could not see how many people were inside the tug) and the Wing Walker departed the runway and returned to the ramp. After we acknowledged to each other that the Pushback Crew had departed; we did our after start flows; set flaps; did a control check; etc. While conducting our 'Before Taxi Checklist; we heard a woman's voice on the headsets (Link 6; the one that saved the Ramp Agent's life). I thought it was one of our Flight Attendants attempting to communicate with us. Who else could it be?We were seconds away from running the Before Takeoff Checklist and advancing the thrust levers for our takeoff roll on Runway 26. We immediately realized that there was a Ramp Agent standing on Runway 26; in front of our Number 2 engine; on a headset; connected to our Exterior Power Access Panel; communicating with us. Apparently she was waiting to hear 'You are cleared off.' I did not know she was there to say 'You are cleared off.' Normally when the tug leaves; the Tug Driver (who has been talking with us) leaves too. Well the tug left a few minutes ago (with the person we thought was talking to us); and the tug was already parked. I had NO idea that there was a Ramp Agent standing alongside my aircraft. If she had not said anything; OR we had not heard her say something; I am convinced that we would have commenced our takeoff roll with NO idea that she was still there. 1. We need to receive a more complete and accurate Tug Driver Briefing. The Pilots need to know; as a minimum; how many people are in the pushback (MOST important).2. The Pilots need to know if there is someone walking alongside the aircraft talking to the Captain (who is not the Tug Driver). Common? Another Captain briefed me that this may be common in Mexico; Costa Rica; etc. If so; pilots need to know.3. I recommend NOT pushing the aircraft onto an active runway.4. Use approved Pushback Crew terminology before disconnecting the tug and departing (i.e. 'Tug has been disconnected and bypass pin has been removed.') so that the Captain has the 'TRIGGER' to say 'You are cleared off' (EVERYONE; including the Ramp Agent connected to the External Power Access Panel with a headset.) 5. I normally make eye contact with the entire Pushback Crew; salute or wave; and hold up 2-3 fingers acknowledging the proper number of Crew Members; as they leave together (Teamwork; looking out for one another). A Pushback Crew member should never be left alone as the rest of the Crew leaves. In such a case where a person is left alone; no one 'has his/her back.'

Air carrier Captain reported a pushback incident onto the active runway that nearly resulted in the aircraft taking off with a Ramp Agent attached to the aircraft via headset.


Flight Crew Last 90 Days 178; Flight Crew Type 17000

Aircraft Equipment Problem Critical; Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor

Flight Crew Landed in Emergency Condition; Flight Crew Returned To Departure Airport; General Declared Emergency; General Maintenance Action

After departure; at approximately 5;000 FT; [I] selected full power. Seconds later; I heard 'B' Flight Attendant call 'A' and report smoke in cabin and lavatory fire alarm on. (I was monitoring service interphone.) I got online and told them to stay on and report any change and I would be listening. I then told First Officer the situation and asked him to tell ATC; we were returning and declaring an emergency. Then; I assumed the radio; and we did boxed QRH items and he began to run QRH; while I placed aircraft on autopilot and used radios. We performed most all items; and as we got to recirculation (recirc) fan off; 'B' Flight Attendant reported smoke dissipating. I then directed First Officer to help me prepare for landing. He pointed out it would be an overweight landing by about 700 LBS. That was noted and later entered into logbook. Approach and landing were uneventful and ARFF followed us to gate. I then asked passengers to remain seated and allow ARFF to use IR detector to check for hot spots. None were found; and they went to cargo and exterior to check there; and we deplaned passengers. Fortunately; a maintenance crew was there to work on another aircraft and was able to work [our] problem. They discovered one disconnected duct and another unwrapped duct. They also MEL'd recirc fan; and swapped out lavatory fire detection units; which leads to another report concerning the next flight.

As per prior report; aircraft had previous smoke in cabin occur at same location in flight. Once again; declared emergency; performed QRH boxed items; pilot flying took radios while pilot not flying did QRH Checklist. Returned to final and landed uneventfully. My big issue is how I failed as a Captain; and onsite Supervisor to assist the flight attendants and agents with the passengers; due to the constant queries from: Dispatch; Maintenance Control (even though there were Company Mechanics) including an Inspector present; Scheduling; Chief Pilot on Duty; Station Manager. I was busy repeating over and over what had happened while the different entities checked there boxes off on what to ask. My favorite; 'Did you do the QRH?' Is this the time to ask such a thing? I felt I needed to answer the queries because I assumed that was the right thing to do. But; we had at least 20 mentally-challenged adults on board; was I really doing the right thing by being on the phone instead of helping; answering questions and allaying fears?Flight Operations needs to rethink information gathering procedures and allow time for on-site personnel; flight attendants; [ground] operations; and pilots to complete their responsibilities.

B737-300 Captain is informed of smoke in the cabin by a Flight Attendant during initial climb after takeoff. The QRH is complied with; and emergency is declared and the flight returns to the departure airport. After maintenance action is performed the flight departs a second time and the scenario repeats in its entirety.


Flight Crew Last 90 Days 24; Flight Crew Total 826; Flight Crew Type 826

Time Pressure; Confusion; Distraction; Situational Awareness; Workload

Ground Event / Encounter Loss Of Aircraft Control; Inflight Event / Encounter Weather / Turbulence

Flight Crew Regained Aircraft Control; Flight Crew Became Reoriented

Aircraft X VFR Flight Operations Sight Seeing Hot Air Balloon.Approximately 15 minutes into the flight; I descended near the [the] River upstream of the Falls at [the] State Park. A low-level inversion over the river caused the balloon to rise slightly. Shortly after a wind rotor pushed the balloon down over the edge of the falls and back into the cascading water. The mechanical turbulence of this wind was stronger than I have ever experienced. I operated the burners to arrest the descent; gain altitude and ascend out of the gorge. The balloon landed safely 2 miles from the waterfalls. There were no injuries to passengers or pilot and no damage to the aircraft.Since this incident I have spent days reflecting on what occurred; the seriousness of this event; and what I can do differently in the future so that this never happens again. I've reached out to my colleagues for peer pilot review to process this self-critique. I've reviewed the FAA Balloon Flying Handbook. My research and reflection have led me to develop a corrective procedure and make immediate changes to my flight operations. Mechanical wind turbulence- resulting from wind flowing over irregular terrain or obstructions. When the air near the surface of the Earth flows over obstructions; such as irregular terrain; (bluffs; hills; mountains) and buildings; the normal horizontal wind flow is disturbed. As a result; it is transformed into eddies or other irregular air movements. The strength and magnitude of mechanical turbulence depends on: the speed of the wind; the nature of the obstruction; the stability of the air; and the angle at which the wind moves over the obstacle. As the air flows down the leeward side of the mountain; the air follows the contour of the terrain and is increasingly turbulent. This tends to push an aircraft into the side of a mountain. The stronger the wind; the greater the downward pressure and turbulence become. Due to the effect terrain has on the wind in valleys or canyons; downdrafts may be severe.	I flew the balloon too close to an irregular terrain feature; canyon; river and waterfalls where Mechanical Wind Turbulence can be present and at varying levels of severity. I will no longer conduct low level waterfall passages as part of my flight operations. Instead I will approach them at no lower than half the height of the irregular terrain similar to flying over a mountain in a balloon. For example: The Falls in [the] State Park is 100 ft. tall. My flight procedure will be to fly no lower than 50 ft. above the river and falls below. This will insure safe altitude from the effects of mechanical wind turbulence on a hot air balloon.

A Hot Air Balloon pilot reported unexpected wind currents forced the balloon to descend into a waterfall and river but they were able to regain control and climb away to a safe landing area.


Flight Crew Rejected Takeoff; Flight Crew Returned To Gate; General Maintenance Action

I was the Pilot Flying. During the takeoff roll on runway 17R; as the aircraft accelerated through 80 knots; I didn't hear the 80 knot call from the Pilot Monitoring. I called 90 knots to which I didn't hear a response. I looked at the First Officer's airspeed indicator and observed it indicating significantly less than mine; approximately 70 knots. I announced 'Reject' and rejected the takeoff. Approximately 95 knots was the highest indicated airspeed I observed in my indicator as we executed the Rejected Takeoff maneuver. The First Officer notified the Tower of our reject. We received initial taxi instructions after informing them that we didn't require any additional assistance. During our taxi to the ramp; an airspeed flag briefly appeared in the First Officer's airspeed indicator and then remained out of view. I informed Ramp Control that our brakes were heating and asked to be expedited. After approximately 10 minutes the marshaller began to direct us to our parking spot. Approximately 15 minutes after the RTO; we were chocked and able to release the brakes. The Brake Temp indicator illuminated with one brake temp of 5 as the highest reading. Maintenance informed us that we required one hour of brake cooling to which we agreed referencing the Recommended Brake Cooling Schedule based on our EICAS indication.

[Report narrative contained no additional information.]

B767-300 flight crew rejected the takeoff at approximately 90 knots in response to conflicting airspeed indications.


Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy

Flight Crew Landed in Emergency Condition; General Declared Emergency

Approach to visual; received GLD UNSAFE caution message.  The message was intermittent when thrust levers were advanced or retracted to flight idle.  Ran QRH; which calls to disarm GLD and message extinguished.  As we put the gear down; received message again; executed a go around; ran QRH with message persisting as it calls to land with flaps 20.  Message extinguished once again when gear was retracted during the go around.  We landed safely with flaps 20; taxied to gate; called dispatch; sector manager; and maintenance.  As First Officer (FO) and I were discussing what had happened; FO stated he thought it was a GLD DISARMED caution message after we put gear down.  This very well could have been as I was in the frame of mind that we had the GLD UNSAFE message several times (intermittent) to this point and so  it was this time also.  We were unable to verify which exact message it was after the gear was selected down as the message extinguished once gear was retracted.  So if it was a GLD DISARMED message after the gear was selected; then that would have let us to land flaps 45 instead of the flaps 20 landing.  Threats were that the message was intermittent; and our communication.  Also the QRH not stating that you will receive a GLD disarm caution message once gear is selected down; and that I was working a QRH procedure for a GLD UNSAFE caution message; and the FO was thinking as if it was a GLD DISARM caution message. Slow down; take our time; verify that we are on the same page.  The QRH procedure for the GLD UNSAFE message needs to have a note stating you will receive a GLD DISARM message only when gear is selected down.

On approach we received a GLD UNSAFE caution message. The message repeatedly cleared and reposted with throttle movement [the aircraft had an existing Engine Speed switch deferral; I do not know if this was related]. The captain; pilot monitoring (PM); ran the QRH; while I PF (pilot flying) slowed the aircraft and followed vectors from ATC for the visual approach. With the ORH completed; ATC cleared us for the approach and sent us to tower frequency. We then lowered the gear and we received a GLD NOT ARMED caution message. Our miscommunication occurred at this point. Given the earlier repeated postings of GLD UNSAFE and seeing 'GLD' the captain was under the impression that we had received the same message as previous [GLD UNSAFE]. Although I asked if the message was associated with the QRH procedure (which had us disarm the GLD); the captain responded with no; we need to run this procedure. Both my question and the captains reponse seemed to fit with our individual thoughts - he was thinking the same message had reposted and he needed to continue with the next section of the GLD UNSAFE procedure; I thought he was referring to running the GLD NOT ARMED procedure.This occurred during a high workload/distraction environment - we were responding to the message; breaking off the approach; and cleaning up the aircraft; and explaining the situation to ATC. Once we retracted the landing gear the message cleared - so we lost the opportunity to verify the QRH procedure with the posted message.While I flew the aircraft & worked the radios; the captain ran the GLD UNSAFE QRH and prepared us for a flaps 20 landing.We [advised ATC] & had asked to have the trucks standing by as a precaution. The captain then handed me the QRH and took the aircraft. It is at this point that I missed another opportunity to expose our miscommunication - the captain handed me the QRH opened to the GLD UNSAFE procedure. Had I questioned him; rather than assuming the page had simply flipped (GLD NOT ARMED was on the following page) we would have realized our error.We performed the flaps 20 landing without incident and taxied to the gate. It was only when we were reviewing the events afterward that we discovered our error. I had seen both messages; but due to the repeat postings of the first message; and the short duration of the second - the captain had only seen GLD UNSAFE.Since the two procedures contradict each other (one has you disarm the GLD; the other has you arm the GLD) I believe that the GLD NOT ARMED message was associated with following the GLD UNSAFE QRH procedure (although the QRH does not note you will receive this message).False situational awareness of both pilots - the captain thought only one message had posted; I thought the captain was running the QRH for the second message.  Aircraft state - since the GLD UNSAFE message had not actually reposted after running the GLD UNSAFE QRH; in hindsight; I believe the flaps 20 landing was unnecessary. While we preformed this procedure with the utmost attention to safety; the procedure itself increased the risks involved in landing the aircraft.  Threats - high workload - not taking the time to verbally announce the posted message. The message was only posted a short time leaving us working off of memory of what we thought had been posted.bv  Errors - I didn't question which procedure the captain ran when he handed me to QRH opened to a page I didn't expect. Instead I assumed the page had flipped.Was the GLD NOT ARMED message associated with the GLD UNSAFE QRH procedure - if so; perhaps a note can be added to expect that message.Verbally verify what message we both saw posted and the correct QRH procedure - rather than assuming we were both on the same page. Since the message was only posted for a short time - that would have been the best way to highlight the problem.

CRJ200 Flight Crew reports confusing a GLD UNSAFE caution message and a GLD NOT ARMED message and ended up preforming the wrong procedure for landing.


Flight Crew Commercial; Flight Crew Flight Instructor; Flight Crew Multiengine; Flight Crew Instrument

Flight Crew Last 90 Days 208; Flight Crew Total 1190; Flight Crew Type 524

Situational Awareness; Confusion; Training / Qualification; Troubleshooting

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural FAR; Deviation / Discrepancy - Procedural Published Material / Policy

I flew with two of my students to a distant airport. I began the flight as usual with a preflight and a ground check before taking off. I flew with my first student direct and did three practice approaches before landing. The flight down went without any abnormalities. During the flight all engine instruments were in the green arc.On the ground after landing we ran through the Shutdown checklist. When we moved the mixture to idle cutoff; the engine did not completely shut down. The engine ran very rough and was obviously still getting enough fuel to keep it from shutting down but not enough to create any power. I then shut the engine off by turning off the magnetos. My thoughts were that the mixture cable needed to be readjusted because idle cutoff was not completely cutting off fuel to the cylinders. As we started up the engine for the remainder of the flight with the second student; the engine started normally and the ground check was normal. We took off and did three practice approaches at that airport before returning to our home base. During the return flight all engine instruments were in the green arc and the engine ran normally.We landed without incident; but when we ran the Shutdown checklist; idle cutoff gave us no noticeable difference in power change and the engine still ran like I had not changed the mixture setting at all. I did not want any fuel to be left in the cylinders after I shut the engine down; so I turned off the fuel selector to shut down the engine. I then notified maintenance through dispatch of our squawk. Later; I learned that the mixture cable did not just need to be readjusted but it had broken. I am very aware of how serious the issue could have become.I believe that several human factors could have played a role to why I chose not to stop at the out station and report the issue. The night before; I had only slept for about three hours because my schedule began at a much earlier time than it normally does. I was working a sixth day and with the combination may have been suffering fatigue. I believe I also had a hazardous attitude of invulnerability in which I thought I knew what the problem was and didn't think anything bad could happen because of it. The combination of these factors led to poor decision making.To prevent something like this from happening again; I plan to pay very close attention to the amount of sleep I get each night before flying so that I can be sure to have an alert mind. I also plan to always contact our dispatch so that I can speak with maintenance about any abnormality or issue before continuing any flight no matter how minor I may think it is at the time.

After the engine did not shut down with the Mixture OFF on two occasions; Maintenance determined the Mixture cable failed and did not control the engine.


Troubleshooting; Communication Breakdown; Time Pressure; Workload

Communication Breakdown; Time Pressure; Situational Awareness; Workload

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Maintenance; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Other / Unknown

Flight Crew FLC complied w / Automation / Advisory; Flight Crew Took Evasive Action; General Maintenance Action

Aircraft; Procedure; Manuals; Company Policy; Human Factors

During preflight I performed the Crew Oxygen Test in accordance with the AOM. During the test; I observed a noticeable drop in oxygen pressure. The AOM Crew Oxygen Test description states; 'If there is a drop in oxygen pressure during the test; corrective Maintenance action must be performed prior to flight.' I made a logbook entry and contacted MX Control through my Dispatcher. The first MX Controller instructed me to order Contract MX; and we hung up to wait. Not long afterwards; I received a message to Contact MX Control. When I reestablished contact; a different MX Controller insisted that the test was normal; and the system was functioning normally.He stated that his manual described the test to be successful only if there was a pressure drop. He went on to explain if the valve was closed; the pressure would drop to zero. When I asked about a partially closed valve; he said the system was operating normally. When I told him I had never in my experience seen an O2 pressure drop like the one on the aircraft today; he told me I should pay closer attention. We got the Chief Pilot on Call on the line; but the MX Controller would not let us have a conversion without constant interruptions. He continued to the point of berating me; mentioned about how long it would take to check the valve; all the time getting more agitated and emotional. He then stated when the Contract Mechanic arrived; nothing would change; and he would write in the logbook that the system was normal. When the Contract Mechanic arrived; I watched him inspect the valve on the O2 tank installed forward of the forward bulkhead in the forward cargo compartment. He removed the Safety wire; and turned the valve handle counter clockwise; and reinstalled the Safety wire.I returned to the cockpit; and again performed the Crew Oxygen Test. The pressure indicator did not move; indicating normal system operation. When the Contract Mechanic returned with the logbook; I checked it to make sure the discrepancy was signed off. The entry was to the effect that the valve was in the full open position; and the system was normal. I asked the Mechanic why he had not written that he fully opened the valve. He said the MX Controller told him to clear the discrepancy as if the system had operated normally the whole time.Upon arrival; the flight delay report [included] the explanation: 'UPON BOARDING COMPLETION CAPT CALLED MX CONTROL AFTER CLEARED BY MX CONTROL CAPT STILL WANTED TO CALL CONTRACT MX.' The Agents comment demonstrates a fundamental lack of understanding of the pre-flight procedures; the details of the event itself; and more worrisome a focus on blame for the late departure without any concern for the Safety aspect of the flight. 1. Check to see if the AOM and MX manuals agree about the details of what constitutes a successful or failed Crew Oxygen Test. 2. Remove the pressure on Ground Operations and Technical Operations (MX) to push on time at all costs. 3. Change the metrics so the sole focus by which Stations and Departments are evaluated is not on time performance. 4. Re-emphasize to all Operational Departments that SAFETY is our number one priority. 5. Treat all Employees with respect; and recognize that Pilots are professional observers with valuable inputs that can help resolve problems.

I felt that Maintenance Control was attempting to pressure the Captain to continue the flight without a Maintenance check of the oxygen system. This; despite the fact that he had already made a logbook entry; and contacted the Operations Center regarding the issue. I'm not really sure why Maintenance was trying to get us to press on; when at the very least; the logbook entry would need to be cleared by Maintenance; even if nothing was found. According to our manuals; a possible reason for a drop in oxygen pressure is that the valve of the oxygen bottle could be closed; or only partially open.I don't think I have to state here what would happen if there were smoke and fumes in the aircraft at cruise; and the Crew oxygen valve was closed. When Contract Maintenance finally arrived; we described the problem; and he checked the valve in the cargo compartment. According to the Captain that watched him; the valve did move a significant amount of turn when he checked it.The Captain also relayed that they checked the oxygen mask again; and it appeared to pass the test after the adjustment. (I was not present then). Finally; the logbook entry came back saying there was nothing wrong with the system; and our delay reason blamed the Crew. My assumption is that Maintenance Control directly influenced both writeups. After the logbook was signed; we finished pre-departure prep and departed expeditiously.

B737-700 flight crew reported the crew oxygen pressure dropped significantly during the preflight procedure. The valve was found to not be fully open; however the signoff did not indicate so; and the delay was charged to the crew.


While climbing through FL250 we received a 'DUCT FAIL' warning message. Complied with QRH; which included leaving icing conditions. While in cruise determined to continue to destination because of the weather conditions in our area; the fuel we had available; and the weather conditions at the possible diversion airports.) We felt that with the fuel we had available we were unable to fly to an airport where we would not encounter any icing at all. We decided the best course of action was to declare an emergency as a precautionary measure and continue to our destination. We flew the approach and landed without further incident.

In speaking with our Dispatcher; we decided that staying high and avoiding icing conditions until descent was best. We landed without incident in the Flaps 20 configuration in accordance with the QRH in case we did accrete ice and needed the speed to keep flying.

When all feasible diversion airports were reporting icing conditions more problematic than their destination; a CRJ-200 flight crew opted to remain out of icing conditions and continue to their destination after complying with the checklist for an ANTI ICE DUCT CAS warning.


Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Published Material / Policy; Inflight Event / Encounter CFTT / CFIT; Inflight Event / Encounter Unstabilized Approach

Automation Aircraft Terrain Warning; Person Flight Crew

Flight Crew Executed Go Around / Missed Approach; Flight Crew Became Reoriented

We were level at 3;000 flying base vectors for the ILS RWY 5R at IND. We were given at turn to intercept and cleared for approach at or above 2;500 MSL. We started the turn; but I did not arm the approach. Just as it was apparent we were going to not intercept; the Pilot Monitoring mentioned I needed to arm the approach. I adjusted the heading to avoid overshoot; but we still ended up overshooting. The Approach Controller gave just a heading to again intercept. I had the LOC armed; but neglected to arm approach. This time; we did intercept; but since I had only pushed LOC; we were not descending and were high on the approach. When we realized this; I disengaged the autopilot and tried to increase descent with speed brake. Our configuration was gear down; flaps 20; with speed brake out. Our sink rate caused the GPWS to call out 'sink rate.' We decided to initiate a go-around; as we were not going to be stable. Tower asked us our reason and we told them we were not stable. The Controller said no problem and had us continue to 3;000 and handed us back to Approach. We were vectored back around and fly the same 5R approach and landed. As Pilot Flying; I did not arm the Approach when cleared. This started a chain of errors which included me then only arming LOC when again; I should have armed Approach. One factor that did distract us was the ATC radios as we arrived in the 25 NM area of IND. It was extremely busy and many were given vectors off the GIBBS arrival; only to be directed back to Knight.  There were a couple aircraft who received runway changes and another aircraft who answered instructions that were not meant for them. I really got engulfed trying to figure out how our aircraft was going to work in the sequence. I let this distract me too much from also focusing on flying the aircraft correctly (i.e.; get cleared and arm the Approach mode).Don't forget basic procedures like arming the approach when cleared and in a position to intercept localizer course.

As we recaptured the localizer and approaching the glideslope we were told to contact tower. During the frequency change I noticed we had not captured the glideslope and realized Pilot Flying had not armed it; only the localizer and stated such; and he armed it but we were already above the glideslope and I told him we have to descend to it. I think he then disconnected the autopilot to fly down to the glideslope and we heard the GPWS 'sink rate; sink rate'. As he arrested the sink rate we then heard 'terrain; terrain'. As I commanded a go-around we then broke out of the clouds and could see we were level flight and still had one white light on the PAPI so I told him 'OK; continue'. It proved too difficult to do as he had already depressed the Takeoff Go Around (TOGA) switch and the flight guidance was not appropriate; so I again commanded 'go around'. I then contacted tower for the first time and told them we were going around. I don't believe we ever got below 1;000 feet AGL. We were then vectored around for an uneventful second approach and landing.

Air carrier flight crew reported executing a go-around after the approach became unstabilized following failure to arm the approach mode.


Flight Crew Multiengine; Flight Crew Instrument; Flight Crew Air Transport Pilot (ATP)

Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy; Ground Event / Encounter Other / Unknown

We unknowingly flew an un-airworthy from ZZZ to ZZZ1. We had an inoperative APU on our aircraft. We performed the external air pneumatic start checklist. During the start (maybe 45 seconds in) we heard a loud bang. I monitored the engine indications for any sign of damage or an irregular start attempt. The ground crew then stated to let them know when they could disconnect ground air and power; the start was not finished yet so I told them to wait. I had the First Officer look out his window to see if he could see the engine and make sure everything looked okay; it did. We then asked the ground crew what had happened; they said 'The air hose popped out early by itself; it broke'. By this time we had a normal start and I told them they could disconnect ground power and the air. They did so and told us they were ready for push; at no point did they tell us that the air hose had damaged the aircraft when it broke/popped out. We continued the flight to ZZZ1 without further incident and noticed the damage on our post flight walk around. We immediately notified maintenance control and the company of the damage.

E175 Flight Crew reported the air hose from the air starter unit unexpectedly disconnected from aircraft; causing damage to the aircraft.


Flight Crew Last 90 Days 50; Flight Crew Type 10000

Situational Awareness; Communication Breakdown

Deviation / Discrepancy - Procedural Published Material / Policy; Ground Event / Encounter Loss Of Aircraft Control; Ground Event / Encounter Weather / Turbulence

Upon pushback from ZZZ Gate 1; it was soon apparent the Pushback Crew was experiencing a problem. They said nothing but it was increasingly clear the Tug was sliding as well as the aircraft not proceeding in a direction I would expect. I tried asking the Driver if there was a problem but did not receive an answer via wireless headset. When his Tug was starting to jackknife; I decided to use my brakes to stop the aircraft. By this time; the Tug came very close to impacting the aircraft on my side. I later learned that his headset was working; but he was trying to talk to the other Ramp Agents instead and not me. I also believe he was cognitively overwhelmed with the unexpected situation as that same phenomena (not responding to me) continued later when we attempted to another push after re-attaching the tow bar/Tug. The First Officer was also adding his input; which was not helping the situation with communication. It was a communications mess. We called the station to inform them of the situation and eventually a Ramp Supervisor came out and took over. We then discussed the option of attempting to move the aircraft to another part of the ramp where it was known to be less than nil braking. Going back to the same gate would only have been to an area of known poor/nil control. We eventually got to an area where the Ramp Agents could safely walk and feel that the ramp was in better condition and where other aircraft were not experiencing any problems.When I landed approximately an hour prior in a different aircraft; my taxi to Gate 2 took me to an area where I lost all steering and braking control for about five seconds. We immediately notified this on Ops frequency; and at least one other Crew stated they experienced the same. Luckily; we slid to an area where I regained control and then carefully proceeded to the gate when the aircraft performed adequately. I then called Dispatch via my cell phone immediately after block in. He said he would pass it on to the supervisor; but I did not hear any apparent immediate concern. Instead; he said I needed to alert the Station; as it is their job to manage that info (I was really puzzled that our Dispatch gave me that answer). I eventually found the Ops Agent and wanted to make sure the Station had this information; as I was very concerned that others could experience worse.Q1: What does it take for a Pilot to state before any real concern is expressed by those managing our operation? Was poor or nil braking not a big enough concern?Q2: Why had nothing been done to correct the situation or at least alert other Crews that some areas were okay but others were NIL? Or stop the operation?Q3: Why would a Push Crew try to fix this problem without getting any other assistance or guidance? I could see they were guessing and even willing to just leave us there as they told us to try to taxi out of it. They even tried to tow us forward on the re-attempt with our engines running. They were completely overwhelmed; which gave me even greater concern.Q4: As Crews; we have no accurate resources (ZZZ is a joke as it is often old and/or inaccurate) to tell us real time conditions on other parts of the airport other than asking Ground Control (which I did). I was concerned that everything was starting to freeze over; and I did not want to the PIREP stating I was in NIL or off the taxiway later on. Without having routine freezing rain experience; how can I know how quickly conditions can go from good to bad?Q5: What does it take for a pause or stop in our operation? Damage? Injury? Taxiway departure? It seems like we just continue pushing with no apparent oversight. That is not a comforting feeling nor does it give me much confidence our system has mechanisms to protect me before getting in a terrible spot.I would appreciate answers to these questions and would like to know if anyone in Headquarters feels this situation was acceptable or not?

Air carrier Captain reported that during pushback the tug began sliding and the Captain applied brakes to stop the aircraft; avoiding a collision. Captain expressed concern that ramp conditions were poor and that company operations were not properly addressing the safety issues.


Flight Crew Air Transport Pilot (ATP); Flight Crew Multiengine; Flight Crew Instrument

Flight Crew Last 90 Days 161.63; Flight Crew Type 1043.68

Inflight Event / Encounter Wake Vortex Encounter

General Physical Injury / Incapacitation

Procedure; Environment - Non Weather Related

While at FL340 in level flight; during smooth; night; VMC conditions; we encountered wake from a crossing jet at FL350. We received one solid jolt and returned to smooth flight. We immediately turned on the seatbelt sign. The First Officer called back to the cabin to check on crew. Nobody answered on the first call; and on the second call about 30 seconds later the Purser answered. She stated she may have fell or bumped into something; she wasn't sure just what happened; and her left shoulder hurt. I asked if I should call Medlink or not and she said she wanted to wait a while and see how she felt. There were no other reports of turbulence in the immediate area. About a minute after the event; we got an automated report on the printer advising us we were near a light turbulence event of .15. I believe that our own jet was the originator of that report.  I checked in on the Purser about 30 minutes later and asked her about how she felt. She stated she felt ok and would be able to make the return flight; but she was sore. I told her I was advising Dispatch and going to fill out a [report]. Dispatch asked if she wanted to be checked out by EMS before [the return flight] and she said yes. EMS met us at the gate where they evaluated her. They said the only thing they could do for her was give her some muscle relaxers; but she would have to go with them for that treatment.  [The Purser] was worried about canceling the outbound flight and refused that treatment until I told her that Scheduling was deadheading in a replacement just in case. She then agreed to go with EMS for treatment.

We were just given a new route clearance to avoid weather near the front range; in the turn ATC notified us of heavy traffic 1;000 feet above and passing at our 12 o'clock position. I observed the traffic passing slightly from our left to right and opposite direction. Approximately 30 sec to 1 minute after passing the traffic we encountered a single jolt; of moderate intensity. We did not encounter any rolling tendency and we believe that it was the result of the oncoming traffic's wake turbulence.

A319 flight crew reported encountering wake turbulence in cruise flight at FL340 from opposite direction heavy jet that resulted in minor injury to a Flight Attendant.


Flight Crew Last 90 Days 100; Flight Crew Total 7200; Flight Crew Type 2000

Deviation - Altitude Overshoot; Deviation - Altitude Crossing Restriction Not Met; Deviation / Discrepancy - Procedural Published Material / Policy; Deviation / Discrepancy - Procedural Clearance

Air Traffic Control Provided Assistance; Air Traffic Control Issued Advisory / Alert; Flight Crew Became Reoriented

As we leveled off at 11;000 FT [ATC asked us to verify] that we were leveling at 11;000. This made us check why he would ask and we realized that I had misread the descent profile. The Center Controller had cleared us to 'descend via' the Chins Arrival landing south and I saw the note at RADDY Intersection showing that aircraft landing at Boeing Field cross at 250 KTS and 11;000 FT.What I had missed was that it showed that this was for Runway 31. All I concentrated on was the ''Landing Boeing Field' note. Since we were landing south; we should have crossed RADDY at 16;000; but this restriction is in the same note as another Landing North note and in a separate box from the Boeing Field box. I would like to see an addition to the Boeing Field box that clarifies that Boeing Field aircraft also need to cross RADDY at 16;000 FT. I should have also briefed the descent better with the Co-pilot; but I thought it was simply the RADDY at 11;000 FT crossing.There was not a conflict with any other traffic.

Confused by the graphic and textual format of the CHINS STAR to SEA (although planning to land at BFI; an 'airport also served' by the arrival) the Captain of a G200 crossed RADDY at 11;000 as charted for arrivals landing BFI on Runway 31. Unfortunately; Runway 13 was his runway of intended landing which requires crossing RADDY at 16;000 FT and at an IAS 20 KTS faster than designated for a Runway 31 landing.


Deviation / Discrepancy - Procedural Maintenance; Deviation / Discrepancy - Procedural Published Material / Policy

Company Policy; Procedure; Environment - Non Weather Related

With the COVID-19 pandemic; technicians are concerned about proper safety with the removal and disposal of HEPA filters. The procedures are consistent with all of company fleet types; including both Manufacturer X and Manufacturer Y aircraft types. All of the AMM procedures include a list of the necessary PPE as well as Disposal requirements.DescriptionSTD-XXXX Coveralls - Hooded STD-XXXY Goggles - Safety; Non Vented STD-XXXZ Respirator - Particulate; meets NIOSH 42 CFR 84 Class N95; N99; N100 The question here is; what qualifications (if any) are needed and where can we find the company policy. The main item is the use of the respirator Class N95 as is called out for in the AMM procedures [for several aircraft types].The second question concerns proper disposal of used HEPA filters and used PPE. Obey the airline policy; local health department and law enforcement regulations when you discard this material. Obey these instructions to prevent injuries to personnel.

Technician reported requesting to know the company policy that governs the safe removal and disposal of HEPA filters and used PPE.  Technician is also unsure of what qualifications are needed to perform those tasks.


Flight Crew Last 90 Days 40; Flight Crew Total 48; Flight Crew Type 48

Confusion; Communication Breakdown; Training / Qualification; Situational Awareness

Flight Crew Commercial; Flight Crew Flight Instructor; Flight Crew Multiengine; Flight Crew Instrument

Flight Crew Last 90 Days 150; Flight Crew Total 15000; Flight Crew Type 3000

Communication Breakdown; Situational Awareness

ATC Issue All Types; Conflict Ground Conflict; Less Severe; Deviation / Discrepancy - Procedural Clearance; Deviation / Discrepancy - Procedural Landing Without Clearance; Ground Incursion Runway

Person Air Traffic Control; Person Flight Crew

I was flying in the pattern performing touch and goes (4 prior) when I was heading downwind turning onto base. ATC instructed me to stay at or above 600 feet; so that an inspection truck could enter onto the runway. I initially was confused and asked them to repeat a second time. They did and I read back the instructions. I still was a little confused; but thought they were instructing me to land at a steeper descent rate. I was used to hearing the term 'go around' and by hearing 'at or above 600 feet' didn't match with what I normally heard in the past. So maintaining 600 feet or above would have resulted in me 'going around' and I just didn't understand. When ATC realized that I wasn't complying; they asked the inspection truck to 'hold short' of the runway and no incident resulted. I reviewed the Pilot Controller Glossary and we weren't able to find the phrase 'restricted low approach at or above 600 feet'. Although; it was found in the Air Traffic Controller's Handbook (7110.65). But as my instructor suggested; it seems like it's asking a lot for a student pilot to review the ATC handbook. I found this to be a very confusing instruction when I was in a phase of flight; which required my complete attention on landing the airplane. For me; as a student pilot; is still a very new experience.I'm really sorry! I definitely understand the instructions now and won't make that mistake in the future. I will also make sure that I inform all ATC that I'm a 'student' pilot.

One of my primary students was gaining solo experience in the local area. He was practicing landings in the traffic pattern. While on downwind; ATC cleared him to 'Make a restricted low approach at or above 600 feet' in order to avoid a city vehicle that was performing the morning runway check.This was phraseology he was not familiar with. He did not comply with the clearance and elected to continue his approach for a touch and go. ATC saw that he was not complying with the clearance and instructed the city vehicle to hold short of his runway.As the instructor; I clearly failed in my duty to ensure that he was familiar with this clearance. However; I must also add that it is a rather confusing instruction and one that is not used very often. I have since polled several pilots and many of them find it a confusing instruction. I have talked extensively with this student. We have discussed the Pilot Controller Glossary and I have tested him on several of the phrases. I have also made it very clear; and I believe he understands; that a pilot cannot under any circumstances occupy a runway until he hears phrases that involve the word 'cleared' and the runway name. I have also re-insisted that he inform every controller he interacts with that he is a student pilot on the initial call. I believe this incident would probably not have happened if the controller had known that the aircraft was being operated by a student pilot.

C150 student pilot and the non-participating flight instructor reported a communication breakdown resulted in a runway incursion.


MD-80 Series (DC-9-80) Undifferentiated or Other Model

Flight Crew Instrument; Flight Crew Multiengine; Flight Crew Air Transport Pilot (ATP); Flight Crew Commercial

Conflict Ground Conflict; Less Severe; Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Clearance

Air Traffic Control Issued Advisory / Alert; Flight Crew Requested ATC Assistance / Clarification; Flight Crew Took Evasive Action

[We were] holding short on Runway XX. [Aircraft Y was] cleared to land on short final on [Runway] XY. Other aircraft; [Aircraft Z]; [was] further out on final and ATC cleared to land on [Runway] XY. Tower cleared us to line up and wait [Runway] XX. Both Captain and First Officer questioned each other as to the position of the incoming [Aircraft Z] still far out on final. [We] taxied forward to comply with Tower instructions [of] line up and wait. As we advanced forward; it became more apparent that [Aircraft Z] was lined up on the wrong runway; [Runway] XX. Our aircraft nose had crossed over the hold short line and stopped. First Officer notified Tower of our position and the incoming [Aircraft Z]. Tower directed [Aircraft Z] to go-around [because they were] lined up on wrong runway. Outcome [was] uneventful.

A319 Captain reported cleared on to runway by ATC; while traffic on final was mistakenly aligned to same runway.


Flight Crew Instrument; Flight Crew Air Transport Pilot (ATP); Flight Crew Multiengine

ATC Issue All Types; Deviation / Discrepancy - Procedural Published Material / Policy; Inflight Event / Encounter CFTT / CFIT

Air Traffic Control Issued New Clearance; Flight Crew Became Reoriented; Flight Crew Executed Go Around / Missed Approach; Flight Crew Took Evasive Action

Procedure; Human Factors; Environment - Non Weather Related

We were on a visual approach to Runway 6 at BHM from the southeast in VMC conditions but looking directly into the sun. ATC leveled us 3;000 ft. and asked us if we had the field. At this point we were pointed directly at the FAF from the south on a right base. We advised that we had the field and were cleared for the visual approach and sent to Tower; who subsequently cleared us to land. We configured to flaps 5 and started a slow descent to the FAF altitude of 2;200 ft. still pointing directly at the FAF. Once we started our descent at about 2;700 ft. we got a 'Caution-Obstacle' GPWS Alert. At the time of the alert I was looking at the field for landing and looked at the flight display which showed an obstacle; at this point I looked straight ahead and saw that we were descending toward a tower. I adjusted my flightpath both vertically and laterally (first started a right turn and leveled off). We then noticed a second tower and decided to go-around. We coordinated with Tower to overfly final and come around for a left base to after climbing back to 3;100 ft. We configured normally and landed uneventfully.After the flight I called and spoke with both Tower and Approach to voice my concern that we were heading directly at 2;000 ft. AGL towers with less than 1;000 ft. clearance and cleared the visual without any caution about the towers; even though we were vectored right at them. Had the sun not been blinding us we may have seen the towers sooner. Additionally; while I did brief the visual approach based on the FOM briefing requirements; I did not brief the 'highest obstacle;' which is required on an IMC; but not visual approach. While I did brief the SIP; I missed the note in the SIP which refers to this tower; which is actually a series of several large towers on a hill. Additionally; the fact that we were vectored right into the towers without being advised of them is; I believe; a shared responsibility while under IFR control. Perhaps a note in the SIP for the specific runway may highlight that this is a problem. Had we been in marginal VFR; not had GPWS or been at night with a tower light out; we may have gotten closer to the obstacle.

B737 flight crew reported executing a go-around from a visual approach to BHM after receiving an obstacle alert from the GPWS.


Flight Crew FLC complied w / Automation / Advisory; Flight Crew Landed in Emergency Condition; General Declared Emergency

On approach we had the flaps fail at 0. We stopped the approach to complied with the QRH; declared an emergency and landed with no further incident. Aircraft maintenance history of flap fail incidence.

A CRJ200 CAS alerted FLAPS FAIL at 0 while on approach; so a go-around was executed and the QRH complied with before landing. The aircraft had a maintenance history of flap faults.


Air Traffic Control Time Certified In Pos 1 (mon) 10

ATC Issue All Types; Conflict NMAC; Deviation - Track / Heading All Types; Deviation / Discrepancy - Procedural Clearance

Air Traffic Control Issued New Clearance

I was working Pearson Advisory.  Aircraft X called inbound somewhere from the north.  He said he wanted a touch and go at Pearson (VUO); then to go to Hillsboro (HIO).  Aircraft X had a poor radio and thick accent.  I had to make a couple transmissions to make sure he had the Pearson one minute weather due to my difficulty understanding him.  After I obtained the necessary information; I told him to fly direct Hillsboro after completion of his touch and go; as there were no aircraft on the scope at the time.  Aircraft X advised that he was full stop and taxiing back on the runway.  Realizing I had created a potentially unsafe situation should traffic appear; I told Aircraft X to depart over the north bank eastbound and expect to cross over the tower to get to HIO.  When Aircraft X called ready to depart; I instructed him to the same due to Aircraft Y and Aircraft Z inbound to 10R.  Aircraft X readback that he would head eastbound.  When Aircraft X was airborne I called traffic on Aircraft Y who was about six or seven mile final.  Aircraft X called Aircraft Y in sight.  I told him; 'Turning eastbound; contact tower 118.7.'  Aircraft X never turned eastbound.  He tracked about a half mile north of the 10L final westbound.  Aircraft Z was on base about six mile final.  To create space between him and Aircraft Y; final took Aircraft Z through final.  Aircraft Z was descending to 025 while Aircraft X was climbing through 020.  Aircraft Z flew over Aircraft X with about 004 verticle separation when he responded to a TCAS RA.First and foremost; I should never have given Aircraft X direct HIO after his touch and go.  At VUO; I have no control of how long he will take on the runway; and won't have eyes on him to know immediately when he does something other than what he said; what I told him; or the myriad of other things that could go wrong and result in a loss of separation with traffic on final.  Secondly; I should have told him; directly and bluntly; to turn to the east (either: 'turn eastbound now... [readback]... contact tower' or 'start your right turn to the east now') prior to switching him to tower.  Barring the first two things; I could have also told him to depart over the north bank *westbound* and to maintain VFR at or below 015 and instructed him to contact final (after coordinating).  The MVAs to the west make this a safe instruction and letting him go westbound is more of what he is expecting since HIO is southwest of both VUO and PDX.  This will keep him below the traffic on final (040 is the recommended crossing altitude over the Confluence for the Columbia Visual Approach; while 020 is the crossing altitude at POWLZ for the ILS 10R and BLAZR for the ILS 10R) and allows final to tunnel him underneath the arriving traffic safely and easily.  This was a perfect example of a problem finding its way through the block of swiss cheese.  Final vectored Aircraft Z too close for a visual than the weather allowed and; too close to Aircraft Y; which required the S-turn through final.  The tower controller had difficulty RADAR identifying Aircraft X in order to issue a meaningful instruction to keep him away from final traffic.  I am not exonerating myself from responsibility; I furthered the problem by not ensuring Aircraft X turned east prior to frequency change; or allowed him to continue west with an altitude restriction and switched him to final.

PDX Controller reports of a NMAC due to an aircraft not doing what he requested the pilot to do.  Aircraft departs an airport just NW of PDX and is enroute to an airport just on the east side of PDX.  Aircraft gets close to traffic on final for PDX.


Flight Crew Became Reoriented; Flight Crew Rejected Takeoff

On takeoff roll at about 100 knots got aural 'Flaps' warning. Rejected takeoff. Complied with QRH. Had green box for takeoff. Discovered dial a flap at 13 degrees with FMS Takeoff page set to 10 degrees. Original takeoff computation called for 13 degrees. Just prior to taking [the] runway tower called windshear advisories. Recalculated numbers for windshear profile; Max power and 10 degrees flaps. Forgot to adjust dial a flap but still had green box prior to taking runway. Don't know why we did not have white box or why Caution and Warning System (CAWS) did not annunciate at power push up or why it waited until about 100 kts to sound off. Should have done the before takeoff checklist again from the top. Easy to miss the dial a flap if it is close to desired setting. Thought we had everything squared away pulling onto runway subsequent takeoff uneventful.

On Taxi to [the] Runway we configured the aircraft and did the before Takeoff checklist. The dial flap was set at 13 and the FMS flaps to 13 and the PFD showed 11. At the approach end of [the Runway] we had to rerun the performance software for Windshear advisory in affect. The new computed flap setting was 10. We set the FMS to 10 Flaps and the PFD showed 11. The dial flap was at 13. We did the before takeoff checklist and I cross checked the FMS flap 10 with the PFD flap indicator of 11. However the dial a flap was at 13 but we had a green takeoff box. Got cleared for takeoff and pushed up power to max power setting and started our roll. No flap warning at power up and still had green takeoff box. Eighty knot check was fine but at 95 knots we got the flap audio warning and we rejected the Takeoff. We did the RTO procedures and cleared runway and finished the RTO QRH checklist. We did an after landing checklist and checked the brake temp charts. We wrote the RTO in the [maintenance log] and contacted maintenance. There was no maintenance required so we reconfigured the aircraft for Takeoff again and double check all settings. FMS at 10; PFD was 10 this time and the dial a flap set to 10. We had a green takeoff box and got cleared for takeoff. Did another Takeoff without any problems.We cross checked the new calculated flap setting of 10 in the FMS and the PFD indicator but did not reset the dial a flap to 10. The takeoff warning system should have said something at power up and not 95kts. Also there should have not been a green box. Need to cross check the dial a flap with FMS and PFD indications after recalculating the Takeoff flaps.

MD11 flight crew reported changing the FMS flap setting to 10 during taxi out due to a windshear advisory; but forgot to change the dial a flap setting from 13 to 10. A flap audio warning is annunciated during the takeoff and the takeoff is rejected.


Small Aircraft; Low Wing; 1 Eng; Fixed Gear

Air Traffic Control Time Certified In Pos 1 (yrs) 5

ATC Issue All Types; Deviation / Discrepancy - Procedural Published Material / Policy

Air Traffic Control Issued New Clearance; Air Traffic Control Separated Traffic

Procedure; Human Factors; Airspace Structure; Airport

The Ground Controller approved opposite direction operation for a GPS Approach when we were landing and departing RWY 22 L/R. I circled Aircraft X 7 miles off of the departure end of Runway 22L; as soon as the pilot reported having the runway in sight; for left traffic Runway 22L. There was no incident with the procedure other than the cumbersome ODO (Opposite Direction Operation) rules designed for large IFR airports with large fast moving aircraft; not busy VFR airports with slow moving traffic. I am sure the rules were fractured as I explained to the Ground Controller to never accept or approve any ODO operation as it simply cannot be done with the rules as they exist. Traffic at the time were six or more aircraft in the touch and go pattern on the north runway; and I had three Touch and Go aircraft on my runway with other departures and arrivals.TRACON should never ever call and request an ODO with the current rules in place. Period. They should find some other alternative plan of action; especially when they can see the high traffic volume at FFZ at the time of their request. We would have to basically shut the airport down or execute a runway change in order to be in compliance. A runway change with 9 or more planes in the pattern would introduce a lot of unnecessary risk into the system to accommodate one IFR training flight. Also more training is apparently necessary so everyone at FFZ understands that ODO equals UNABLE. Simple; I get it; why can't everyone else.

FFZ Tower Controller had to delay an aircraft to accommodate an opposite direction operation. The Controller does not feel opposite direction operations should ever be approved if there is traffic in the pattern.


Inflight Event / Encounter Bird / Animal

Aircraft Aircraft Damaged; Flight Crew Returned To Departure Airport; General Declared Emergency

After takeoff; for weather ATC turned us to 160 heading; passing approximately 5;000 FT we hit a bird. It struck the First Officer's window with great force and made a noise loud enough to be heard in the coach cabin. The wiper appeared damaged with a large amount of bird carcass on the window; blood and guts. Because of the force of the strike and location and vector of the bird I elected to return to [departure airport] for inspection. We declared an emergency; asked for a return; briefed the flight attendants and passengers and were vectored for an approach. I elected to land overweight. We landed at approximately 133;000 LBS; smooth touchdown and long roll to slow down. [We] stopped after clearing the runway for inspection by Fire Department and temperature check with a Forward Looking Infrared Radiometer (FLIR) of the gear. All okay and then proceeded to the gate. Recorded all the above in the logbook. We did not see the bird until just a split second prior to impact; no time for an evasive maneuver.

MD-82 Captain reported loud; strong bird strike shortly after takeoff. Wiper appeared damaged; so an emergency was declared and the flight returned to departure airport for an overweight landing.