Occurrence Briefs are concise reports that detail the facts surrounding a transport safety occurrence, as received in the initial notification and any follow-up enquiries. They provide an opportunity to share safety messages in the absence of an investigation. |
What happened
On 9 April 2018, while on taxi for departure at Brisbane Airport, Qld, Air Traffic Control (ATC) instructed the crew of a Bombardier DHC-8 to hold short of runway 01. After a Boeing 737 landed, the DHC-8 entered and lined up on the runway in preparation for departure, without a clearance, whilst another Boeing 737 was on short final.
ATC provided the 737 on final approach a clearance to land at around 500 ft. ATC then issued a conditional clearance for the DHC-8 to line up behind the 737 on short final. The DHC-8 crew informed the tower by radio that they were already occupying runway 01 and were ready for departure.
ATC subsequently instructed the Boeing 737 on short final to conduct a go-around[1] from about 300 ft. Departure instructions were provided and the Boeing 737 was transferred to the approach frequency for another approach to land. A short time later, ATC provided the DHC-8 with a clearance for take-off.
Figure 1: Sequence of events relating to aircraft movements at Brisbane Airport
Source: Background image Google Earth; annotated/modified by ATSB
Airservices Australia investigation
An occurrence review conducted by Operational Risk and Assurance, indicated that the runway incursion had not been detected by ATC and that the second Boeing 737 was cleared to land whilst the runway was occupied.
The occurrence review indicated that although the conflict had not been identified by ATC, that when recognised, the actions taken to recover the situation were appropriately managed.
Safety message
Maintaining situational awareness is imperative for both pilots and ATC in busy operational environments. Effective situational awareness is the timely and accurate perception of information pertaining to a situation, comprehension of that current situation and projection of what may occur in the future based on this information.
The risk of runway incursions and other separation events can be minimised through good communication. This incident highlights the importance of:
- ATC and flight crews using correct phraseology
- ATC and pilots challenging instructions which they have not heard or understood fully
- pilots looking carefully for aircraft or other hazards before entering an active runway.
About this report
Decisions regarding whether to conduct an investigation, and the scope of an investigation, are based on many factors, including the level of safety benefit likely to be obtained from an investigation. For this occurrence, no investigation has been conducted and the ATSB did not verify the accuracy of the information. A brief description has been written using information supplied in the notification and any follow-up information in order to produce a short summary report, and allow for greater industry awareness of potential safety issues and possible safety actions.
__________