Lessons Learned: Wrong Runway
Pilot possibly distracted, chose wrong approach and runway.
After attending to an uneasy passenger while orbiting over the sea, the pilot inadvertently approached and landed on Runway 03 instead of the active Runway 08.
The ATCO, who was attending to ground activities, did not observe the aircraft during its final approach.
The [AAIB, Air Accidents Investigation Bureau] report considers the importance of recovering situation awareness and adopting sterile cockpit procedures before commencing with an approach. It discusses vigilance in ATC and the importance of teamwork in detecting possible misperceptions.
The air traffic services unit is taking safety action relating to the monitoring of aircraft, and team resource management training.
The aircraft was cleared on Ronaldsway’s radar frequency to enter the control zone under VFR, and advised to expect joining right hand downwind for landing on Runway 08, which was in use. When around 3.5 nm south-east of the airport at 2,800 ft amsl, the aircraft was transferred to the tower frequency. The ATCO reported a surface wind from 080° at 9 kt, offering the pilot a choice of Runways 08 or 03.
The pilot requested Runway 08 before being instructed to ‘report ready for right base runway zero eight.’ The aircraft appeared to turn downwind for Runway 08 although its position was also consistent with right base for Runway 03.
From there, the pilot reported ready for right base (Figure 2). He was instructed to orbit left to accommodate an ATR 76 on a commercial air transport flight that was joining final for Runway 08 at 8 nm.
The pilot was unable to see the ATR during its approach so the ATCO advised him when it landed, and the pilot reported ready to leave the orbit.
Content/source credit: Read the full AAIB report, “AAIB investigation to Vans RV-7, G-RVDB,” published December 14, 2023.
Sign up for a TapRooT® Root Cause Analysis Training Course
Circumstances can crop up anywhere at any time if proper and safe sequence and procedures are not planned and followed. We encourage you to learn and use the TapRooT® System to find and fix problems.
TapRooT® has a team of investigators and instructors with years of extensive training ready to offer assistance worldwide. We also offer ongoing support to our clients through free newsletters and Root cause tip videoS, the root cause analysis blog, and our annual Global TapRooT® Summit.
Register for one of our courses. We offer a basic 2-Day course and an advanced 5-Day course.
Contact us or call 865.539.2139 about having a course at your site or for further root cause analysis opportunities. We’re here to find solutions for you.
TapRooT® courses are taught all over the world; if you need specific times or locations, please see our full selection of courses.