Investigation number
199703691
Occurrence date
Location
11 km south-west of Adelaide Aerodrome
State
South Australia
Report release date
Report status
Final
Investigation type
Occurrence Investigation
Investigation status
Completed
Aviation occurrence category
Breakdown of co-ordination
Occurrence class
Incident

An Airbus A320 taxied at Adelaide and the crew requested an airways clearance to Brisbane. Air traffic control issued the crew with a clearance to Brisbane via UVUPU (064 AD VOR 181NM) and planned route to cruise at FL370 with a runway 23 RADAR 3 departure. This clearance was correctly read back by the crew. However, the departures flight progress strip (FPS) for this flight had been incorrectly annotated with an UVUPU 2 standard instrument departure (SID) instead of a standard radar departure (SRD) RADAR 3.

When the crew reported ready for take-off the approach east (APPE) radar controller issued an "unrestricted" instruction to the aerodrome controller (ADC). The ADC cleared the aircraft for take-off without assigning a radar heading. The flight crew did not query this instruction and the A320 became airborne, the crew electing to maintain runway heading. The crew contacted APPE and reported "tracking runway heading, climbing to FL370 left 2,800". They requested approval to track direct to UVUPU which was approved by the controller. Believing the aircraft to be tracking via the SID, a discussion between the pilot and APPE then revealed that the pilot understood that he had been cleared on a RADAR 3 Departure, while the controller understood that the aircraft was tracking via the UVUPU 2 SID.

There were no traffic conflictions. The investigation revealed that there were two contributing factors in this occurrence. The aircraft callsign had been changed on the FPS and the APPE controller was concerned that the SSR code on the strip may have been entered incorrectly. While confirming this detail he was distracted and annotated the FPS with an incorrect clearance. The technique of writing the clearance on the FPS prior to the issuance was considered a significant factor. The controller had already written UVUPU 2 on the FPS and when he was distracted during the issuing of the clearance, he had made an incorrect assumption, which had been influenced by the clearance already written on the FPS. The pilot in command had been issued with a standard radar departure clearance which required an assigned heading to be issued by the ADC with the take-off clearance. When the crew received the take-off clearance without the assigned heading, they should have immediately queried the instruction.

However, they elected to take-off and maintain runway heading. This action was consistent with the SID procedure. On first contact with APPE, the crew did not specifically mention that they did not have a heading to fly, and the controller incorrectly assumed that they were departing on a SID, in accordance with the annotation on the FPS. There were explicit instructions in the Aeronautical Information Publication, which detailed the requirements to be followed when departing on a SRD. The controller was required to assign a heading prior to issuing the take-off clearance and the pilot was required to read-back that heading. Considering that air traffic control had two clearances current for the departure, the last safety defence was the assigned heading in the standard radar departure. Had the crew queried that no heading had been assigned for their departure, APPE would have immediately queried the requirement

Aircraft Details
Manufacturer
Airbus
Model
A320-211
Registration
VH-HYX
Operation type
Air Transport High Capacity
Sector
Jet
Departure point
Adelaide SA
Destination
Brisbane Qld
Damage
Nil