The Japan Transport Safety Board (JTSB) concluded in their investigation into a serious runway incursion incident that a preoccupied air traffic controller at Tokushima Airport cleared a Boeing 767 to land while an airport vehicle was still on the runway.

A Boeing 767-346 (registration JA8299) operated as Japan Air Lines flight JL455 from Tokyo-Haneda to Tokushima attempted to land at the runway 29 when the flight crew noticed a vehicle on the runway. The aircraft briefly touched down but the pilots selected go around power and the aircraft climbed away safely. The aircraft passed over the vehicle at a height of 40 feet (12 m).

The second approach was also aborted due to turbulence, and the plane landed in the third attempt at 11:24 JST, half an hour after the incident.

At the time of the incident, the vehicle was on the duty to exchange a runway distance marker lights. However, the controller of Tokushima Tower forgot the presence of the vehicle on the runway, and gave a landing clearance to JL455. The ATC of the Tokushima Airfield is operated by Japan Maritime Self-Defence Force.

Probable Causes:

It is highly probable that the serious incident occurred as JA8299 attempted to land because local control at Tokushima Aerodrome control tower had issued a landing clearance to JA8299 on the runway occupied by the Work Vehicle.

It is probable that the Tower had issued a landing clearance to JA8299 to land because the Supervisor, who had the combined duties of the Tower and the Ground, had forgotten about the presence of the Work Vehicle. It is probable that contributing factors were that, in a situation in which only one Air Traffic Controller was on duty in the aerodrome control tower and no support could be received from other controllers, he was preoccupied with selecting a runway for the Departure Aircraft, and that he did not use a reminder indicating that the runway was unusable for take-offs and landings.

Official accident investigation report

investigating agency: Japan Transport Safety Board (JTSB) – Japan report status: Final report number: AI2016-4 report released: 25 August 2016 duration of investigation: 1 year and 5 months download report: AI2016-4

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Filed under: Investigation Reports by Harro Ranter

