Pilot Error

CAAP  Releases Final Report of Davao Incident 

24 October 2015

By David Kaminski-Morrow
Pilots of a Cebu Pacific Airbus A320 should have executed a go-around rather than pursue an unstable approach into Davao, which resulted in a runway excursion that damaged the jet.

The aircraft passed through a burst of intense rain as it neared touchdown and the captain “misconstrued” runway edge lights as centreline lights, states the Civil Aviation Authority of the Philippines.

It says the weather conditions “severely affected the judgement and decision-making” of the captain, who was flying, and that the rain “obscured” visibility of the runway.

The aircraft “failed to maintain” a stabilised profile during the VOR/DME approach and was still left of the runway 23 centreline moments before touchdown.

Investigators point out that the first officer was calling for the aircraft’s course to be shifted more to the right. But the subsequent correction took the aircraft too far to the right of the centreline, aligning it with the right-hand edge lights.

It landed about 30m before the touchdown point, some 190m from the threshold, close to the right-hand runway edge and crabbing about 3° to the right.

All three landing-gear assemblies had left the runway by the time the aircraft had rolled some 500m, and the jet travelled another 330m on soft ground. There were no injuries among the 165 passengers and six crew.

The jet had been landing at Davao in darkness on 2 June 2013.

Investigators found evidence of “lapses, omissions and contradictory words” by the crew, adding that the captain was probably apprehensive about landing in poor weather, at night, using a non-precision approach.

While a go-around was “necessary”, it was not carried out, possibly because the pilot’s attention was “narrowed” by his focus on the difficult conditions, says the inquiry.

Missed-approach procedures in such conditions were “seldom practised” during recurrent training, the inquiry adds, and the “over-use” of airports with centreline lights “deprived” crews of the chance to improve flight skills at airports without such systems.

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