DCA07IA008

NTSB incident investigation · Boeing 737-200 · Seattle, WA · October 30, 2006

Incident · No injuriesIncident investigationFinal report
Date
October 30, 2006, 08:40 local (16:40 UTC)
Place
Seattle, WA
Injuries
76 uninjured
Damage
No damage
Phase of flight
Takeoff
Aircraft
N740ASBoeing 737-200
Weather
Visual (VMC) · Day
Status
Completed · report May 28, 2008
Report
Approved by Office Director
NTSB office
Major Investigations Division
Parties
FAA
Case key
64802

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the incident.

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Probable cause

the flight crew's failure to cross-check and verify that the airplane was on the correct runway before takeoff. Contributing to the incident was the flight crew's self-induced pressure to heed the takeoff clearance during a period of increased workload.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Miscellaneous/otherTakeoff
Excessive workload (task overload)FlightcrewFactor
Wrong runway - selectedFlightcrewCause

Analysis

The captain of the Boeing 737 stated that there was a short delay at the gate because of a "cargo issue." The automatic terminal information service broadcast indicated that departures were using runway 34R, either with the full length or from the intersection at taxiway Q. The ground controller cleared the flight to taxi to runway 34R at taxiway Q. During the taxi, the first officer was busy talking with dispatch and completing the flight paperwork while the captain taxied the airplane and handled the ATC communications. The flight crew received the amended flight release as the airplane approached taxiway Q. The captain then switched to the local control frequency and heard the local controller (LC) issue the flight clearance to taxi into position and hold on runway 34C. The captain read back the clearance, including "runway 34 center." As the FO was completing the preflight activities, the LC cleared the flight for takeoff from runway 34C and indicated that there was traffic on short final. The captain again repeated the clearance for takeoff on runway "34 center." However, the captain lined up the airplane on the 34R centerline and transferred control to the FO. The airplane departed uneventfully. The LC noticed the airplane departing on runway 34C and did not order an abort because there were no potential traffic conflicts.

Factual narrative

History of flight

On October 30, 2006, Alaska Airlines flight 61, a Boeing 737, N740AS, took off from runway 34R instead of runway 34C (center), which was the assigned runway, at Seattle-Tacoma International Airport, Seattle, Washington. None of the 5 crewmembers and the 71 passengers was injured, and the airplane was not damaged. The airplane, which was operating under the provisions of 14 Code of Federal Regulations Part 121, continued uneventfully to its destination of Juneau International Airport, Juneau, Alaska.

According to the captain of the flight, there was a short delay at the gate because of "a cargo issue." As a result, the flight crew had to correct the flight paperwork and obtain an amended release from dispatch. While at the gate, the first officer (FO) of the flight obtained the automatic terminal information service (ATIS) information "Golf" and received the flight's air traffic control clearance via the aircraft communications addressing and reporting system. ATIS "Golf" indicated that both full-length and taxiway Q intersection takeoff operations were being conducted from runway 34R.

According to the flight crewmembers, during the delay at the gate, they performed a taxi briefing, which included a departure briefing from runway 34R. After pushback from the gate, the ground controller instructed the flight to follow another airplane to runway 34R at taxiway Q.

The captain stated that he was taxiing slowly to allow time for dispatch to send the amended release. During the "short taxi," the captain handled the radios, and the FO worked with dispatch to complete the flight paperwork. As the flight approached taxiway Q, the FO received the amended release. The captain then switched over to the tower frequency and heard the local controller (LC) instruct the flight to taxi the airplane into position and hold on runway 34C. The captain stated that, even though he read back "34 center" to the controller, he was still thinking that the airplane would be taking off from runway 34R. During this time, the FO was completing the preflight activities.

The LC then issued the flight takeoff clearance from runway 34C and indicated that there was traffic on short final. The captain stated that he "was sure the tower controller said runway 34C" and "read back what he heard" but that he "was thinking runway 34R." As the airplane taxied onto the centerline, the captain conducted a compass check and then transferred control of the airplane to the FO. The airplane departed uneventfully from runway 34R. The flight crew stated that the first indication that the airplane had departed from the wrong runway was when the controller informed them after takeoff.

According to the local controller, he was scanning the runways and noticed that the airplane was rolling on runway 34R abeam the tower instead of runway 34C. Because there were no potential air traffic conflicts at the time, the controller thought that it would be safer to let the airplane depart from runway 34R than to have the pilots abort the takeoff.

Airport information

Seattle-Tacoma International Airport (SEA) has two operational runways, 16L/34R and 16C/34C. Runway 16R/34L is currently under construction. Runway 16L/34R is 11,901 feet long and 150 ft. wide. Runway 16L/34R is 9,426 feet long and 150 feet wide. Runway 34R has 9,426 feet remaining from intersection Q.

Aircraft

Registration
N740AS
Reported as
Boeing 737-200
Category
Airplane
Serial number
22578
Engines
Pratt & Whitney JT8D-17, 16,000 lbs thrust, turbo jetPratt & Whitney JT8D-17, 16,000 lbs thrust, turbo jet
Damage
No damage
Flight
Part 121
Registered owner
Alaska Airlines Inc
Airworthiness certificate
Standard, Transport
Departed
SEA · Seattle, WA
Destination
JNU · Juneau, AK
Flight plan
IFR
Airport
SEA · Seattle-Tacoma Intl, runway 34C, 11,901 × 150 ft, concrete

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
49
Injuries
None
Certificate
Airline transport
Airplane ratings
Single-engine sea, Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, Without waivers/limitations
Last flight review
October 1, 2006
Seat
Left
Flight hours
10,401 total · 6,392 in this make and model · 100 in the last 90 days
Role
Co-pilot
Age
40
Injuries
None
Certificates
Commercial, Airline transport
Airplane ratings
Multi-engine land, Single-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 1, Without waivers/limitations
Last flight review
May 1, 2006
Seat
Right
Flight hours
4,045 total · 254 in this make and model · 176 in the last 90 days

Weather

Conditions
Visual (VMC) · Day
Wind
30° at 8 knots
Lowest ceiling
None
Temperature
37 °F, dew point 30 °F
Altimeter
30.32 inHg
Observed at
SEA