I Didn’t Get Killed or Crash the Jet, but Blindly Following the Checklist…

Consulting Tools and Frameworks

I didn’t get killed or crash the jet, but blindly following the checklist without considering the context created my most embarrassing moment.

T-38 twin engine trainer

T-38 twin engine trainer

It was a typical summer afternoon at the US Air Force base in Arizona where as a lieutenant I was learning to fly a twin-engine jet. A “typical summer day” for Arizona means 4% humidity and about 112 degrees Fahrenheit (44 C) in the shade. And cactus don’t give much shade. The acrylic canopy was known to turn the cockpit into a solar oven – one of my classmates had gone to the hospital with a serious burn on his neck from a parachute buckle. It was hot!

The incident happened on a landing. I was about half-way through the pilot training, not so confident that I was cocky, but feeling like I knew what to do. An instructor sat in the backseat to cross-check me, but I still had to seriously focus on the landing.

Pilots always use checklists during major transitions, like startup, before landing, or engine shutdown. They had become commonplace and too routine. And that is what bit me! The routine checklist – a killer waiting to happen!

Unlike the straight-in approach of a commercial jet, military fighter jets fly parallel to the runway in the opposite direction to landing. As they pass the end of the runway they bank steeply, descending quickly to the threshold at the end of the runway. Touchdown is about 135 knots plus a few extra knots for fuel weight. The whole intense maneuver is designed to land quickly avoiding potential enemy ground fire.

The landing wasn’t too bad. I rolled out to the end of the runway, turned off the active runway, and pressed the breaks to stop.

That’s when I made the checklist mistake.

I blindly started using the checklist without thinking about what I was really doing. I’m sure hundreds of pilots lives have been saved since checklists were first used with aircraft in 1935. http://www.atchistory.org/History/checklst.htm

But in this case, my ill use of the checklist was my biggest embarrassment.

I started running through the “After Landing” checklist. Robot-like I completed the first three items.

“Yeah! Done this before. Done that before.” As I completed the fourth item on the checklist I heard the engines shutting down.

The inner-voice in my head was screaming, “What’s going on. This can’t be happening.” We were sitting in a small turnout at the end of the runway.

Over the intercom I heard the instructor pilot say, “Good one, Ron. I’ll leave you here with the plane. I’ll walk in and get you a tug (tractor) to pull you in. Wave “Hi” to your classmates as they land and taxi passed you.”

What had happened? I realized then that I had flipped the checklist strapped to my leg to the “Engine Shut-down Checklist.” I should have been reading the “After Landing Checklist.” The first three items were the same on both checklists. I had not paid attention to the big picture, the context.

A jet can’t restart its engines without a starter tug (tractor). Without engine power we had no radios. So the instructor popped the canopy, jumped down the seven or so feet to the ground, and walked about a half mile of hot asphalt to call me a tug.

Me? What did I do? I sat there and watched as my classmates taxied passed me smiling on their way in.

Don’t follow checklists by rote! Pay attention to their purpose and context.