Sydney Airport announces safety review after Qantas 737 near-miss

An aerial view of Kingsford Smith Airport in Sydney.

The Australian Transport Safety Bureau (ATSB) has announced that several safety actions have been made or are planned after a near-miss between two aircraft at Sydney Airport last year.

On April 29 2023, one Qantas Boeing 737 was ready to take off from Sydney’s runway 16L while another Qantas 737 was on approach to land on the same runway. After the first plane started its take-off roll, the control room operator warned that the incoming plane was too close.

After being delayed by about 12 seconds due to an inadvertent interjection by the tower shift manager, the controller instructed the second aircraft to go-around, while the first continued its take-off.

Shortly after the go-around, the controller then instructed the second aircraft to turn left off the runway heading after reaching 2,100 ft altitude.

Qantas Boeing 737 (iStock/BeyondImages)

“The flight crew of the second aircraft, at this time of high workload, misinterpreted this instruction as overriding the published missed approach procedure, which calls for a left turn at 600 ft,” ATSB director transport safety Dr. Stuart Godley said.

Due to misinterpreting the controller’s instruction, the crew of the second aircraft maintained the runway heading as they climbed through 600 feet and, as the two aircraft climbed away from the runway, separation reduced to a minimum of 1.5 km laterally and 330 feet vertically.

The controller had both aircraft in sight throughout the occurrence, and the ATSB assessed that adequate visual separation had been maintained.

In response to the incident, the air traffic services provider, Airservices Australia, advised the ATSB that it had undertaken, and would undertake, a range of safety actions.

“These include a detailed analysis of landing runway occupancy times at Sydney, and possibly other major airports, to determine expected runway occupancy times for different types of aircraft and conditions,” Dr. Godley noted.

Further actions, detailed in the final report, include adding defensive controlling techniques and minimum assignable altitudes for go-around scenarios, conducting an assurance review of go-arounds at Sydney involving a second aircraft requiring controller intervention, and adding night-time go-around scenarios to compromised separation training.

“In complex airspace settings, it is inevitable errors will sometimes be made by controllers and pilots alike,” Dr Godley said.

“Consequently, the system within which these activities take place should be designed to be resilient to error and to reduce the impact that individual actions can have on the overall safety of operations.”

(Featured Image: Aerial view of Kingsford Smith Airport in Sydney)

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