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Southwest Airlines Boeing 737-7H4 incident

3 Jun 2009 · Cleveland, OH, United States

Boeing 737-7H4 and ExpressJet Airlines Embraer EMB-145LR · Incident: runway incursion (vehicle, aircraft or person) while taxiing

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Event

NTSB case
OPS09IA007
Event typeAccident: someone killed or seriously injured, or the aircraft substantially damaged (NTSB definition). Incident: an occurrence that affected or could have affected safety, short of that. Glossary
Incident
InvestigationHow far the investigation had got when the record was published: preliminary, ongoing, final or completed. Unknown where the source does not say. Glossary
Completed
API-reported fatalities
0 · all aircraft and ground
Ground fatalities
Unknown
OperationWhat kind of flying it was, grouped by the rules it flew under: airline (US Part 121), air taxi and commuter (Part 135), general aviation (Part 91 and similar), military or government. Glossary
Airline
WeatherVisual meteorological conditions (VMC): good enough to fly by looking outside. Instrument conditions (IMC): cloud or low visibility, flying by instruments. Glossary
Visual Meteorological Cond

Aircraft 1 · Boeing 737-7H4

Aircraft type
Boeing 737
Category
Airplane
RegistrationThe aircraft's tail number, such as N12345 or G-ABCD. Registrations are reissued, so the same one years apart can be a different aircraft. Glossary
N299WN
Onboard fatalities
Unknown
Route
From Cleveland Hopkins International Airport (CLE), Cleveland, OHTo Chicago Midway International Airport (MDW), Chicago, IL
Aircraft age
Not recorded
Flight rulesThe regulations the flight operated under: in the US, Part 91 (general aviation), Part 121 (airlines), Part 135 (air taxi and commuter) and others; for flights abroad, the NTSB's coarser commercial or non-commercial code. Glossary
Part 121: Air Carrier
Phase of flightThe stage of the flight when things started to go wrong: standing, taxi, takeoff, initial climb, en route, maneuvering, approach or landing. Glossary
Taxi · to runway
Defining eventThe single coded event the NTSB judges best describes what happened (records from 2008 on). Older records name the first occurrence in the sequence instead. Glossary
Runway incursion (vehicle, aircraft or person)
DamageDestroyed: beyond practical repair. Substantial: damage that affects the structure, performance or handling and normally needs major repair. Minor: less than that. Glossary
None

Aircraft 2 · Embraer EMB-145LR

Aircraft type
Embraer EMB-145
Category
Airplane
RegistrationThe aircraft's tail number, such as N12345 or G-ABCD. Registrations are reissued, so the same one years apart can be a different aircraft. Glossary
N16963
Onboard fatalities
Unknown
Route
From Cleveland Hopkins International Airport (CLE), Cleveland, OHTo Chicago O'Hare International Airport (ORD), Chicago, IL
Aircraft age
Not recorded
Flight rulesThe regulations the flight operated under: in the US, Part 91 (general aviation), Part 121 (airlines), Part 135 (air taxi and commuter) and others; for flights abroad, the NTSB's coarser commercial or non-commercial code. Glossary
Part 135: Air Taxi & Commuter
Phase of flightThe stage of the flight when things started to go wrong: standing, taxi, takeoff, initial climb, en route, maneuvering, approach or landing. Glossary
Not recorded
Defining eventThe single coded event the NTSB judges best describes what happened (records from 2008 on). Older records name the first occurrence in the sequence instead. Glossary
Not recorded
DamageDestroyed: beyond practical repair. Substantial: damage that affects the structure, performance or handling and normally needs major repair. Minor: less than that. Glossary
None

Cause areas

  • Personnel issues › Action/decision

Approximate · Coordinates as recorded by the NTSB; no uncertainty radius is established.

NTSB narrative

On Wednesday, June 3, 2009 at 3:15 p.m., a runway incursion occurred at CLE when SWA1080 was directed to taxi into position and hold on runway 6L prior to the departure of BTA2491 that had been previously cleared for takeoff from the same runway. BTA2491 queried the ATCT with “Hey tower, I thought we were cleared to go”. The ATCS immediately directed SWA1080 to hold short of runway 6R and corrected the location to runway 6L followed by directions to BTA2491 to hold present position. According to the airport movement and surveillance system (AMASS) playback, both aircraft had entered runway 6L, BTA2491 at the approach end and SWA1080 at the intersection of taxiway T and runway 6L. Taxiway T intersected runway 6L 1,475 feet from the approach end of runway 6L.

CLE was in a north flow configuration, departing runway 6L, arriving runway 6R.

Reported weather at CLE at 2:51 p.m. EDT/1851 UTC was: wind 350 degrees at 6 knots, visibility 6 statute miles in light rain showers. Few clouds at 1,200 feet, scattered clouds at 1,800 feet, overcast at 8500 feet. The temperature was 14 degrees Celsius, dew point 12 degrees Celsius. The altimeter was 30.11 inches of mercury.

Air traffic control tower (ATCT) staffing included 1 front line manager (FLM) on position with a developmental, local control (LC) 1 and 2 combined with a developmental, Ground Control (GC) 1 and 2 combined, and flight data (FD)/clearance delivery (CD) combined on position.

Probable cause

The ground controller did not issue taxi instructions in accordance with FAA Order 7110.65, paragraph 3-7-2. The local controller did not scan the runways prior to issuing a taxi into position and hold instruction to SWA1080 as required by FAA Order 7110.65 paragraph 3-1-12. The local controller did not cancel takeoff clearance for BTA2941 as required by FAA Order 7110.65, paragraph 3-9-10.

Verbatim NTSB analysis and probable cause from the NTSB dataset

Sources

NTSB record OPS09IA007
Event ID
20090612X13814
Case number
OPS09IA007
Dataset
full-current
Source SHA-256
5cf380f0061817c0331a6b2d8cc7e0ee3a79bea469a1001dc5c10e56f35f5ab3
Source notes (6)
  • Unreviewed is an editorial label, not an investigation status. API-sourced is not report-checked or human-reviewed. Explicit event totals are used without summing aircraft injury tables; onboard allocation is withheld. Unknown values remain unknown. The operation category is mapped from the NTSB-reported FAR part and has not been reviewed.
  • Filled from the NTSB case API where the bulk record had no value: investigation status, damage. Values present in the bulk record are kept.
  • The date is the local date, which is the same as the UTC date the NTSB stores.
  • API snapshot SHA-256: 4d11d5a3845ef6960fafdadc8638644451b36999601a8cab0fe252787513ecb8; retrieved 2026-09-13T18:15:27.860Z.
  • The NTSB's operator name is blank for N299WN; the operator shown is the name the NTSB's other records give its FAA operator code, SWAA.
  • The NTSB's operator name is blank for N16963; the operator shown is the name the NTSB's other records give its FAA operator code, C2XA.