UKNOWN
Boeing B744
N395DN
Boeing B737-800
On August 28, 2008, at approximately 1837 Atlantic standard time, Russian Registered Transaero flight 554, a Boeing 744, and Delta Airlines flight 845, a Boeing 738, came within zero feet vertical and 1 minute lateral separation (15 minutes is required in non-radar environment) at FL330 179N San Juan, PR. Transaero 554 descended 200-300 feet due to a traffic alert and collision avoidance system (TCAS) resolution alert.
On August 28, 2008 at approximately 1837 Atlantic Standard Time, a controller error was reported when Russian registered Transaero (TSO), also known as Transoviet flight 554, a Boeing 744, and Delta Airlines (DAL) flight 485, a Boeing 738, came within zero feet vertical and 1 minute lateral separation at flight level (FL) 330, 179 nautical miles (nm) north of San Juan, Puerto Rico. TSO554 descended 200-300 feet in response to a traffic alert and collision avoidance system (TCAS) resolution advisory (RA) alert and DAL485 climbed from FL 330 to FL 340, also in response to a TCAS RA. Both pilots of DAL485 visually observed TSO554 as it appeared to be on a merging course prior to executing their climb in response to the TCAS RA. Per FAA Order 7110.65, Air Traffic Control, paragraph 8-8-3, Caribbean ICAO Region, Longitudinal Separation, 15 minutes lateral separation between aircraft was required in this environment. San Juan Center Radar Approach Control (CERAP) was providing ATC service to both aircraft. San Juan CERAP was a level 9 ATC facility responsible for approach control and radar and non-radar ATC services in and around Puerto Rico. These services include approach control services for Louis Munoz Marin International Airport in San Juan, Puerto Rico and numerous controlled and uncontrolled airports on the island of Puerto Rico and numerous islands in the vicinity of Puerto Rico. En-route radar and non-radar ATC services were provided for an area of approximately 216,000 square miles around Puerto Rico. The vertical limits of this airspace were from the surface to unlimited. San Juan's airspace was adjacent to Miami Air Route Traffic Control Center (ARTCC) airspace to the northwest, New York ARTCC airspace to the north and northeast, Picarro Netherland's Antilles airspace to the southeast, Venezuela's airspace to the south and Santo Domingo, Dominican Republic's airspace to the west. San Juan CERAP received radar information from an FPS-67 200 nm long range radar located at Pico Del Este, Puerto Rico, secondary radar information from an air route surveillance long range radar (ARSR/LRR) via a beacon only site (BOS) with an air traffic control beacon interrogator, model 6 (ATCRBI-6) located at Grand Turk, in the Grand Turk Islands, an airport surveillance radar (ASR-8) medium range 60 nm primary and 180 nm secondary radar located at Luis Munoz Marin International Airport San Juan, Puerto Rico (SJU), and an ASR-8 located at Cyril E King Airport/Charlotte Amalie, Saint Thomas Island, U.S. Virgin Islands (STT). San Juan CERAP operated 24 hours a day, seven days a week. Annual air activity for the facility averaged 620,000 operations. San Juan CERAP was comprised of two areas. Area 1 included the San Juan Air Route Traffic Control Center (ARTCC) and Area 2 included the San Juan Approach Control. Area 1 was divided into 5 sectors: Ocean 10 (O-10) which included the MARCOR, PRCHA, ONETA, and ZABOR non-radar sectors; Radar Controller 6 (R6)/Radar Associate/Manual Controller 6 (D6) which included the radar and non-radar CONCH sector; R4/D4 which included the radar and non-radar LENNT, THANK, and YIYYO sectors; R8/D8 which included the radar and non-radar BQN, ALASK, and ANNER sectors; and R2/D2 which included the radar and non-radar PJM and COY sectors. The 0-10 position covered approximately 48 percent of San Juan CERAP's airspace with the remainder divided between the R/D control positions. The 0-10 position was traditionally combined with other positions in the CERAP and seldom staffed as a stand alone position. Each of these sub area positions may include an assistant position identified as A6, A4, etc. depending on workload and staffing. The radar controller (R) was responsible for the movement of instrument flight rules (IFR) traffic in the assigned sector. The radar associate/manual controller (D) was responsible for the non-radar separation of IFR traffic in the assigned sector. The radar flight data controller was responsible for the distribution of flight progress strips, as appropriate, and making all computer entries as instructed by the sector controllers. The O10 sector 10 was composed of a manual (non-radar) oceanic controller and shared sector 4's Radar Flight Data Controller position (O10/A4). On the day of the incident, the D4, A4, D6, A6 and O10 positions were combined at one position. The R4 and R6 positions were combined at one position adjacent to the D4/A4/D6/A6/O10 combined position. TSO554 had departed Punta Cana International Airport, Punta Cana, Dominican Republic (ICAO - MPDC/IATA - PUJ) and was enroute to Domodedovo International Airport, Moscow, Russia (ICAO - UUDD/IATA - DME). TSO554's route of flight through San Juan's airspace was via jet route M597 after the BETIR intersection. The route of flight included intersections along M597. The intersections included FIVZE, TILDI, JANMA, THANK, NECKS, QNEPA, and TARMO. Each intersection along the route of flight had an associated flight progress strip used by ATC to track aircraft. TSO 554 was estimated to be at the THANK intersection at 1837. TSO554 was radar identified at the BETIR intersection and directed to climb to FL330 at approximately 1815. At approximately 1825, the R4/R6 controller terminated radar services for TSO554 at FL330 approximately 80 miles southwest of the THANK intersection while still in radar coverage and directed the pilot to contact New York ARINC for non-radar advisories. When the R4/R6 controller terminated radar services, he dropped the radar data block . DAL485 had departed John F. Kennedy International Airport, New York, New York (ICAO - KJFK) and was enroute to Picaro International Airport, Picaro, Trinidad (ICAO - TTPP/IATA- POS). DAL485's route of flight through San Juan's airspace was via jet route L456 to the DORADO intersection then to jet route G449 direct to TIPP/POS via the ANADA intersection. DAL485 entered San Juan's airspace at FL330 with a non-radar estimate to arrive at the THANK intersection at 1836. At 1836, San Juan ATC radar identified DAL485 over the THANK intersection at FL330. On initial contact with San Juan ATC, DAL485 advised that they had just maneuvered in response to a TCAS resolution advisory and climbed to a higher altitude to avoid a 747 passing by on the right side of the aircraft. Shortly thereafter, the Operations Manager in Charge (OMIC) received a call from New York Aeronautical Radio, Incorporated (ARINC) advising that TSO554 had reported a TCAS RA within San Juan airspace. The D controller, working the O10/D6/A6/D4/A4 position, was responsible for coordinating time and altitude of non-radar aircraft and ensuring the information was available to the R4/D4 controller. This was accomplished via verbal coordination and via information on the flight progress strips, which were posted between the two controllers. The flight progress strips were posted according to the sectors the aircraft were operating in and proposed to operate in. In this incident, the D controller failed to activate the flight plan when initially notified of the proposed inbound on TSO554. Accordingly, the flight progress strips were not printed in advance of TSO554 entering San Juan airspace. The D controller was further delayed by lengthy coordination efforts with New York ARTCC. These two events resulted in the flight progress strips for TSO554 not being posted in a timely manner. Accordingly, the R controller, working the R4/R6 combined position, was unaware that TSO554 and DAL485 were in conflict at the THANK intersection at FL330 within one minute of each other until advised by DAL485 and the OMIC regarding TSO554's radio call to ARINC.
The San Juan CERAP controllers failure to ensure the two aircraft were properly separated using non-radar separation standards.
Source: NTSB Aviation Accident Database
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