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|
Attributes | |
ACN | 112800 |
Time | |
Date | 198905 |
Day | Wed |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | atc facility : mia |
State Reference | FL |
Altitude | msl bound lower : 16000 msl bound upper : 16000 |
Environment | |
Flight Conditions | VMC |
Light | Dusk |
Aircraft 1 | |
Controlling Facilities | artcc : zma |
Operator | common carrier : air carrier |
Make Model Name | Heavy Transport, Low Wing, 4 Turbojet Eng |
Flight Phase | climbout : intermediate altitude descent other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
Experience | flight time last 90 days : 200 flight time total : 18000 flight time type : 6000 |
ASRS Report | 112800 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : commercial |
Events | |
Anomaly | aircraft equipment problem : less severe other anomaly other |
Independent Detector | other flight crewa |
Resolutory Action | none taken : detected after the fact |
Consequence | Other |
Supplementary | |
Primary Problem | Flight Crew Human Performance |
Air Traffic Incident | other |
Narrative:
Followed book procedures for high oil temperature. Company suspended F/east for 2 weeks. Forced captain to resign after 6 years service. Believe F/east misread switch position due to this being the only aircraft with no guards on switches. Normal takeoff. All checklists completed. Approaching FL160 the F/east reported that the #2 and #3 engines were running hot and that the #4 was following but that he thought that the #4 was an electrical problem because he had written it up on the previous flight. I observed the F/east double checking the position of all the switches on the F/east's fuel panel, then he checked the oil pressure and temperature and quantity gauges. I then asked him to check if there were any circuit breakers popped. He replied that everything was normal and that there were no circuit breakers popped. I told him to check the book for any additional possible solutions and asked him if anything else was abnormal. He replied that he had checked the book and that everything else was normal and that he could not do anything about the problem. I then told him to contact fwa maintenance and get their inputs. Maintenance came back and had no suggestions about the high oil temperature. 4 minutes into our 15 min limit I decided to turn around. I felt that I had done everything possible by 1) checking the panel, 2) having the engineer check the book and the 3) checking with maintenance. I had 11 minutes until I would have to shut down the 2 inboard engines and I knew that when I reduced power things would not get better due to the lack of fuel flow across the coolers, and that the temperatures would go up. I did not want to be on 2 engines above 215,000 pounds, but decided that I would have enough time to make that decision around 10,000' so I told the F/east to dump only to 247,000 pounds and keep monitoring the temperatures. He told me that the temperatures were coming down as we approached biscayne and told me we would be on 4 engines so I told him to terminate the dump and that's when we discovered that the right hand dump chute would not retract (later we found that it was the left hand dump chute the lights apparently were wired backwards). We called maintenance again and asked for suggestions and a no flap landing was suggested. I discarded the idea as I felt that we would do no damage to the chute, and additionally the runway was wet. After landing maintenance told us that all the fuel heat switches had been left on. I questioned the F/east about this and he said that he was trying to see if he had a valve stuck open and that he could have missed it on his shut down check.
Original NASA ASRS Text
Title: HIGH OIL TEMPERATURE ON 3 ENGINES CAUSED CAPT TO DUMP FUEL, RETURN AND LAND. DUMPED FUEL. A FUEL DUMP CHUTE STAYED DOWN. POSTFLT INSPECTION REVEALED FUEL HEAT SWITCHES HAD BEEN LEFT ON FOR ENTIRE FLT.
Narrative: FOLLOWED BOOK PROCS FOR HIGH OIL TEMP. COMPANY SUSPENDED F/E FOR 2 WEEKS. FORCED CAPT TO RESIGN AFTER 6 YEARS SERVICE. BELIEVE F/E MISREAD SWITCH POSITION DUE TO THIS BEING THE ONLY ACFT WITH NO GUARDS ON SWITCHES. NORMAL TKOF. ALL CHECKLISTS COMPLETED. APCHING FL160 THE F/E REPORTED THAT THE #2 AND #3 ENGINES WERE RUNNING HOT AND THAT THE #4 WAS FOLLOWING BUT THAT HE THOUGHT THAT THE #4 WAS AN ELECTRICAL PROBLEM BECAUSE HE HAD WRITTEN IT UP ON THE PREVIOUS FLT. I OBSERVED THE F/E DOUBLE CHECKING THE POSITION OF ALL THE SWITCHES ON THE F/E'S FUEL PANEL, THEN HE CHECKED THE OIL PRESSURE AND TEMP AND QUANTITY GAUGES. I THEN ASKED HIM TO CHECK IF THERE WERE ANY CIRCUIT BREAKERS POPPED. HE REPLIED THAT EVERYTHING WAS NORMAL AND THAT THERE WERE NO CIRCUIT BREAKERS POPPED. I TOLD HIM TO CHECK THE BOOK FOR ANY ADDITIONAL POSSIBLE SOLUTIONS AND ASKED HIM IF ANYTHING ELSE WAS ABNORMAL. HE REPLIED THAT HE HAD CHECKED THE BOOK AND THAT EVERYTHING ELSE WAS NORMAL AND THAT HE COULD NOT DO ANYTHING ABOUT THE PROBLEM. I THEN TOLD HIM TO CONTACT FWA MAINT AND GET THEIR INPUTS. MAINT CAME BACK AND HAD NO SUGGESTIONS ABOUT THE HIGH OIL TEMP. 4 MINUTES INTO OUR 15 MIN LIMIT I DECIDED TO TURN AROUND. I FELT THAT I HAD DONE EVERYTHING POSSIBLE BY 1) CHECKING THE PANEL, 2) HAVING THE ENGINEER CHECK THE BOOK AND THE 3) CHECKING WITH MAINT. I HAD 11 MINUTES UNTIL I WOULD HAVE TO SHUT DOWN THE 2 INBOARD ENGINES AND I KNEW THAT WHEN I REDUCED POWER THINGS WOULD NOT GET BETTER DUE TO THE LACK OF FUEL FLOW ACROSS THE COOLERS, AND THAT THE TEMPS WOULD GO UP. I DID NOT WANT TO BE ON 2 ENGINES ABOVE 215,000 LBS, BUT DECIDED THAT I WOULD HAVE ENOUGH TIME TO MAKE THAT DECISION AROUND 10,000' SO I TOLD THE F/E TO DUMP ONLY TO 247,000 LBS AND KEEP MONITORING THE TEMPS. HE TOLD ME THAT THE TEMPS WERE COMING DOWN AS WE APCHED BISCAYNE AND TOLD ME WE WOULD BE ON 4 ENGINES SO I TOLD HIM TO TERMINATE THE DUMP AND THAT'S WHEN WE DISCOVERED THAT THE RIGHT HAND DUMP CHUTE WOULD NOT RETRACT (LATER WE FOUND THAT IT WAS THE LEFT HAND DUMP CHUTE THE LIGHTS APPARENTLY WERE WIRED BACKWARDS). WE CALLED MAINT AGAIN AND ASKED FOR SUGGESTIONS AND A NO FLAP LNDG WAS SUGGESTED. I DISCARDED THE IDEA AS I FELT THAT WE WOULD DO NO DAMAGE TO THE CHUTE, AND ADDITIONALLY THE RWY WAS WET. AFTER LNDG MAINT TOLD US THAT ALL THE FUEL HEAT SWITCHES HAD BEEN LEFT ON. I QUESTIONED THE F/E ABOUT THIS AND HE SAID THAT HE WAS TRYING TO SEE IF HE HAD A VALVE STUCK OPEN AND THAT HE COULD HAVE MISSED IT ON HIS SHUT DOWN CHECK.
Data retrieved from NASA's ASRS site as of August 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.