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Associated links (A22O0146)

TSB releases investigation report into 2022 runway incursion and risk of collision at Toronto/Lester B. Pearson International Airport

Toronto, Ontario, 20 December 2023 — Today, the Transportation Safety Board of Canada (TSB) released its investigation report (A22O0146) into a runway incursion and risk of collision at the Toronto/Lester B. Pearson International Airport.

Shortly after midnight on 15 October 2022, the driver of a maintenance vehicle, operated by the Greater Toronto Airports Authority (GTAA), crossed the displaced threshold of an active runway even though the driver had received and read back an instruction to hold short of the runway. At the time of the runway incursion, an Air Canada Boeing 737 was on final approach for the runway. The air traffic controller, who was watching the approaching aircraft through the window of the control tower, observed the incursion as it was happening and instructed the crew of the aircraft to go around for another approach. The flight crew complied and the aircraft landed uneventfully following a second approach.

The investigation found that the driver’s attention was split between his driving duties and the planning of the upcoming tasks that he would be supervising. As a result, he was paying less attention to monitoring the route for hazards. As well, because the driver had crossed the runway at the displaced threshold many times without stopping, the mental model he developed did not include stopping at the holding position, even though he read back the instruction to hold short.

Although contrary to the GTAA’s Airport Traffic Directives, drivers normally used the airport manoeuvring areas as opposed to the North Service Road because these areas are perceived to be quicker given typical runway operations on the east/west runways. Given the driver’s split attention, the visual cues that were available to designate the holding position were not salient enough to alter his mental model and stop him from entering the runway.

The risk of collisions from runway incursions has been on the TSB’s Watchlist since 2010. This occurrence illustrates how a lapse in attention by even an experienced airport maintenance vehicle driver can result in a runway incursion.

See the investigation page for more information.

The TSB is an independent agency that investigates air, marine, pipeline, and rail transportation occurrences. Its sole aim is the advancement of transportation safety. It is not the function of the Board to assign fault or determine civil or criminal liability.

For more information, contact:
Transportation Safety Board of Canada
Media Relations
Telephone: 819-360-4376