Pilot Debrief

CESSNA 550 near Reading, PA — 2008-08-03

Final reportNYC08FA265
Sign in to save
Date
2008-08-03
Location
Reading, PA, USA
Airport
RDG
Aircraft
CESSNA 550
Registration
N827DP
Category
Airplane
Highest injury
None
Fatalities
0
Phase of flight
Landing

Probable cause

The air traffic controller’s failure to properly monitor the runway environment. Contributing to the accident was the tractor operator’s failure to scan the active runway prior to crossing, and the Federal Aviation Administration’s inadequate emphasis on vehicle operator visual vigilance when crossing active runways with air traffic control clearance.

Contributing factors

Contributing to the accident was the tractor operator’s failure to scan the active runway prior to crossing, and the Federal Aviation Administration’s inadequate emphasis on vehicle operator visual vigilance when crossing active runways with air traffic control clearance.

NTSB narrative

The air traffic controller, with both ground and local (tower) responsibilities, cleared the accident airplane to land when it was about 8 miles from the runway. Another airplane landed in front of the accident flight, and the controller cleared that pilot to taxi to the hangar. The controller subsequently cleared a tractor with retractable (bat wing) mowers, one on each side, and both in the “up” position, to proceed from the terminal ramp and across the 6,350-foot active runway at an intersection about 2,600 feet from the threshold. The controller then shifted his attention back to the airplane taxiing to its hangar, and did not see the accident airplane land. During the landing rollout, the airplane’s left wing collided with the right side of the tractor when the tractor was “slightly” left of runway centerline. Calculations estimated that the airplane was about 1,000 feet from the collision point when the tractor emerged from the taxiway, and skid marks confirmed that the airplane had been steered to the right to avoid impact. Prior to the crossing attempt, the tractor operator did not scan the runway, and was concentrating on the left side bat wing. Federal Aviation Administration publications do not adequately address the need for ground vehicle operators to visually confirm that active runways/approaches are clear, prior to crossing with air traffic control authorization, thus overlooking an additional means to avoid a collision.

Analysis

Primary failure mode
Human factors
First missed decision gate
Tractor operator should have confirmed runway was clear before crossing.

NTSB coding

Evidence available

  • ATC audio
  • ADS-B / radar
  • Photos
  • 15 docket documents
View NTSB final reportView NTSB docket

Docket documents15

Related mishaps