Serious incident Boeing 737-8HX (WL) D-ASXP,
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ASN Wikibase Occurrence # 343696
 
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Date:Sunday 12 August 2018
Time:08:45
Type:Silhouette image of generic B738 model; specific model in this crash may look slightly different    
Boeing 737-8HX (WL)
Owner/operator:SunExpress
Registration: D-ASXP
MSN: 29684/2539
Year of manufacture:2008
Fatalities:Fatalities: 0 / Occupants:
Aircraft damage: None
Category:Serious incident
Location:85 nm NW of Burgas Airport -   Bulgaria
Phase: En route
Nature:Passenger - Non-Scheduled/charter/Air Taxi
Departure airport:Bourgas Airport (BOJ/LBBG)
Destination airport:Frankfurt International Airport (FRA/EDDF)
Investigating agency: AAIU Bulgaria
Confidence Rating: Accident investigation report completed and information captured
Narrative:
Two Boeing 737-800 aircraft with callsigns TVQ6129 (D-ASXP) and SXD7BY (OM-GTF) were cruising in the Bulgarian airspace under the control of the Sofia Area Control Centre (ACC).

At 06:29:48 UTC, while at FL 240, the crew of TVQ6129, performing a charter flight from Antalya (LTAI) to Bratislava (LZIB) reported to the Sofia ACC East Sector air traffic controller (ATCO), FL 240 to point ETUBA and did not want to change the current flight level. At 06:38:18, the crew of SXD7BY, performing a charter flight from Burgas (LBBG) to Frankfurt (EDDF), also reported to the ATCO climbing to FL200 to point NAVOD and requested a climb to FL380. Initially, the ATCO allowed climbing to FL220. At 06: 41:48 UTC, ATCO issued an instruction to SXD7BY on FL220 to turn left to heading 270°. Instead of carrying out the instruction, the flight crew started to climb to FL270, which led to the approximation of 2.5 NM horizontal separation from TVQ6129, which was flying on FL 240 at the time.


Causes
Based on the analysis performed, the Commission points out that the serious incident resulted from the following causes:
- Misunderstanding by the flight crew of SXD7BY of the ATC clearance issued by EXE air traffic controller, that lead to climb to FL 270 instead to turn left onto heading 270°
- EXE and PLN air traffic controller did not detect the discrepancy between the received read-back and the issued instructions.
- EXE and PLN air traffic controller did not detect and interpret the deviation message in the track label of SXD7BY for the difference between the Selected Altitude downlinked Mode S parameter and the cleared flight level.

Accident investigation:
cover
  
Investigating agency: AAIU Bulgaria
Report number: 
Status: Investigation completed
Duration: 2 years
Download report: Final report

Sources:

BFU18-1263-6X

Revision history:

Date/timeContributorUpdates
18-Aug-2023 16:22 harro Updated
29-Mar-2024 15:08 ASN Updated [Aircraft type, Registration, Cn, Operator, Location, Phase, Departure airport, Destination airport, Source, Narrative, Accident report]

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