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Atlas / ASRS / ACN 2078449

NASA · Aviation Safety Reporting System

Air carrier flight crew reported a terrain obstacle alert while descending on the initial approach at night on a visual approach. The crew leveled out, then stabilized late on the approach, and continued the visual approach to landing.

ACN 2078449 2023-09 Commercial Fixed Wing Checklist Incidents
Initial ApproachPart 121

What is ASRS?

The Aviation Safety Reporting System is NASA's voluntary, confidential, non- punitive incident-reporting system, established 1976. Pilots, controllers, dispatchers, and maintenance technicians file reports describing safety- relevant events. NASA de-identifies every report before adding it to the public database. Reports are not investigated by NASA, the FAA, or the NTSB — they represent the reporter's perspective.

Pilot narratives

Verbatim from the de-identified NASA record. First-person account by the reporter. NASA strips identifying details (names, company, specific time); anonymization placeholders are ZZZ, X, Y.

Reporter 1

After a long day of delays into and out of ZZZ, we were on approach at approximately XA00am for runway 6L into CLE. PIC was PF and I was PM. PF loaded and briefed the ILS 6L. I recall when PF briefed company page taking note of the second caution about unusually low fix altitudes as he read it as I had never seen that before. This was my first flight into CLE with about 160 hours in the plane mostly in the northeast. About 20 nm east of the field approach cleared us for the visual approach to 6L. PF turned us onto a downwind and continued a descent to 3000 that had been previously set from a clearance. He activated vectors to final and began calling for flaps 1, then flaps 2. PF turned right base and in the turn bugged 2000 for the FAF BOEEE and began a descent in FLCH while calling for flaps 3. While manipulating the flaps approach handed me off to tower and I made the appropriate radio calls. While talking to ATC, I believe the combination of the moment resulting from the flaps 3 change while FLCH descent was beginning led to more of a descent rate than expected. PF noticed this, and I believe selected FPA (Flight Path Angle) to adjust descent but the combination of descent rate and proximity to a tower led to an obstacle alert. There are numerous towers around that area. Looking at the track, we were actually on track to intercept around FUZED which has a segment leading up to it with an MSA of 3800 ft. and after a segment with MSA of 2900 ft. due to a tower around FUZED at 1649 ft. which is likely the tower eliciting the caution. I don’t think either of us realized we were that far out due to the FMS having vectors to final loaded and degradation in our situational awareness. Once I audibly called “tower straight ahead” and pointed PF disconnected autopilot, reduced the descent rate, leveled off around 2300- 2400, and turned further right away from the tower and to intercept final approach course while calling for gear down, flaps 5, speed Vapp, and landing checklist. Tower also at that time offered 6R instead of 6L and PF requested we accept. I queried if PF wanted me to load anything in and he said he was okay to fly visual. As we approached final approach course I confirmed he was landing on 6R as I was concerned workload and lack of an approach could lead to further problems. He confirmed, and then asked me to load it in for him which I quickly did for lateral and vertical guidance. We were initially around I think a 1 1/4 dots low on GS once loaded in and upon looking outside had I believe 3 red on the VGSI. I called out “low” and PF responded “correcting,” and quickly did so requiring no further action. We were configured at 1000 ft. and stable at 500 ft. without any excessive inputs but due to task saturation of loading the approach late I was distracted and missed the 1000 ft. call out and I think due to fatigue made the 500 ft. stable call out late (~400) but was monitoring the approach closely at that point as I recognized our slips in situational awareness on the approach and was ready to call go around if PF had not corrected and maintained lateral and vertical guidance. Suggestions: I need to constantly be vigilant assessing my fitness for duty and not allow external factors to impact my decision. Again, I did think I was FFD (fit for duty) at outset, but in hindsight maybe I wasn’t. I am still learning at what point I need to call it. I need to grow in my confidence in speaking up, and challenge any decisions being made or actions requested of me that I think increase risk. I need to be more vigilant reviewing approach charts at unfamiliar airports, and take more time to understand why for example a caution note may be in the company pages. While the caution didn’t directly speak to this situation, it could have clued me into looking more closely. Operations might consider adding to the caution note something regarding multiple intermediate segments in unusually close proximity to FAF with significantly higher MSAs due to towers in the area. Scheduling might consider the long-term ramifications of excessive hold times and issues with hotels, and implementing alternate strategies to ensure lower wait times and better assistance to crews during IROPS (Irregular Operations). Again, my responsibility to assess FFD and not let this influence me, but can still subconsciously impact decision making I think.

Reporter 2

It was XA00 am and we were on approach into Cleveland cleared visual 6L. We were pretty tired due to the delays and both the FO (First Officer) and I agreed we were tired but focused on the approach. We were on a base to final turn just outside the final approach fix. When we received our visual clearance, we were at 3000 ft. The chart page states that we needed to configure early due to the low terrain. We were at flaps 2 at started descending 2000 ft. As stated we were outside the final approach fix which is at 2000 ft. I selected flaps 3 gear down. At this time the plane started to descend pretty steeply. I TCS’d it and increased power while trying to select altitude to level off. That is when we got a prox terrain caution. I immediately kicked off the autopilot and leveled off and increased power. There didn’t seem to be a tower or anything out there that triggered it but we leveled off. ATC didn’t say anything either. We think it had to do with the excessive descent rate that triggered the caution as the plane started a pretty steep descent. We continued the approach and received a side step to 6R. The flight concluded without any issues. Looking back the fix before the final showed 2300 ft. We were an out 2500 ft when the caution went off. Looking back, we could have stayed higher on the approach, however I was focused on configuring and making sure we were stable as it was a tight intercept. Fatigue was definitely a large factor to this. As stated we fixed the issue and maintained a safe and stable approach. Next time I will configure once we’re established on the approach.

NASA classification — Anomalies

  • Deviation / Discrepancy - Procedural
  • Inflight Event / Encounter

NASA classification — Assessments

Contributing Factors / Situations
Chart Or Publication · Environment - Non Weather Related · Software and Automation · Procedure · Human Factors
Primary Problem
Procedure

ASRS reports are voluntarily submitted, de-identified by NASA, and represent the reporter's perspective. The presence of reports on a topic cannot be used to infer prevalence in the National Airspace System. The authoritative source is the NASA ASRS Database Online at asrs.arc.nasa.gov ↗.