Aviation safety investigations & reports

Flight below lowest safe altitude involving Boeing 747, N416MC, 15 km NNW Sydney Airport, NSW, on 12 February 2017

Investigation number:
AO-2017-023
Status: Completed
Investigation completed

Final Report

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On 12 February 2017, a Boeing 747-47UF (freighter) aircraft, registered N416MC, operating from Honolulu, Hawaii, conducted an approach to Sydney Airport, New South Wales. On board the aircraft were two flight crew. The captain was the pilot monitoring and the first officer was the pilot flying.  

Shortly after the turn onto the final approach for the runway 16R instrument landing system approach, the first officer called ‘glideslope captured’ and the aircraft started to descend with the autopilot engaged. However, the captain’s primary flight display indicated the aircraft was below the glideslope. As the aircraft descended through 2,100 ft, the approach controller requested confirmation that they were established on the glideslope. The captain responded that they had an interruption on glideslope and would maintain altitude until they could re-intercept. During the response, a minimum safe altitude warning alert appeared on the approach controller’s radar for N416MC. The controller immediately issued a go-around instruction and the captain immediately acknowledged the instruction and conducted a missed approach. A second approach was flown with the autopilot engaged and no anomalies were detected.

This incident highlights the importance of crosschecks on the flight deck and between air traffic control and the flight crew. After detecting unexpected indications on the flight deck, the flight crew intervened to stop the descent, which was then followed by an instruction from air traffic control to initiate a go-around.

The aircraft manufacturer and regulators have recommended that flight crew remain vigilant for instrument landing system disturbances with resulting unexpected flight control movements and be prepared to immediately disconnect the autopilot, particularly during autoland operations.

Aviation Short Investigations Bulletin Issue 61

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[Download  PDF: 228KB]
 
 
Alternate: [Download  DOCX: 1.5MB]
 

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General details
Date: 12 February 2017   Investigation status: Completed  
Time: 21:52 ESuT    
Location   (show map): Sydney Airport 15 km NNW   Investigation type: Occurrence Investigation  
State: New South Wales   Occurrence type: Flight below minimum altitude  
Release date: 27 July 2017   Occurrence class: Operational  
Report status: Final   Occurrence category: Incident  
  Highest injury level: None  

Aircraft details

Aircraft details
Aircraft manufacturer The Boeing Company  
Aircraft model 747-47UF  
Aircraft registration N416MC  
Serial number 32838  
Type of operation Air Transport High Capacity  
Sector Jet  
Damage to aircraft Nil  
Departure point Honolulu, US  
Destination Sydney, NSW  
Last update 14 November 2018