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|
Attributes | |
ACN | 1501859 |
Time | |
Date | 201711 |
Local Time Of Day | 0601-1200 |
Place | |
Locale Reference | ZZZ.Airport |
State Reference | US |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Make Model Name | B737 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Flight Phase | Climb |
Flight Plan | IFR |
Component | |
Aircraft Component | Engine Temperature Indication |
Person 1 | |
Function | First Officer Pilot Not Flying |
Qualification | Flight Crew Air Transport Pilot (ATP) |
Events | |
Anomaly | Aircraft Equipment Problem Less Severe Deviation - Procedural Published Material / Policy |
Narrative:
We had an engine over temp climbing out of ZZZ; an ior was completed by the captain and incident report was also completed - for details concerning the actual incident you can refer to those reports. [ATC was advised] and partial power air return to ZZZ was uneventful. For the purpose of this report; I am concerned about the inaccuracy of the QRH. I notified the cpo of my concerns. I will include a 'cut and paste' of that email below. So we had an engine overheat; that required an air return to ZZZ with partial power on the #1 engine - no shutdown required. Once the engine overheat caution was recognized; I opened the QRH to the front index; identified the page to turn to as 80.9 and turned to 80.9. The only checklist to start on 80.9 is the 'engine fire/overheat detector fault'. I knew this could not be right; so referred then to the 'fire protection' table of contents which again directed me to the 80.9 page of the QRH for 'engine overheat' ... Again not correct. The 'engine overheat' checklist is on page 8.10 - and is mislabeled in the QRH! My concern is this; we have a lot of different pilots with a wide range of systems knowledge; experience and wide ranges of complacency. Under the circumstances; with perhaps two pilots who are level 1 or 2 professional then we risk someone turning to page 80.9 in the QRH; see the words 'engine' and 'overheat' in the checklist header - proceeds to run a one line checklist which is quite simple and then decides all is well and presses on when the fact is they may have an engine that is about to catch on fire and become a major catastrophe. I am very concerned about this and am disappointed that no change has yet been made - no pilot bulletin or something to at least let pilots know about this error in the QRH. Yes... It may be another year or more until this incident occurs again; or it could happen within minutes of me submitting this report! And under the right circumstances we may end up with an engine overheat that is not properly managed with dire consequences. I do not feel I am being dramatic - I am concerned about the safety implications of this situation. I would appreciate a timely response from the erc; I am willing and able to speak to the concerns of this report further with a phone call but really expect to see this addressed and remedied in a timely manner. I trust that in this narrative you can sense my sincere concern for the possible consequences of not addressing or correcting this error. Please note - I would appreciate a personal response to this report please.following is the email that was sent after the incident:ZZZ pilots conducted an air return for #1 engine overheat---see report belowgrabbing the paper QRH and looking up 'engine overheat' it directed them to page 80.9 which is the wrong checklist. That page number is incorrect. Correct page number for engine overheat is 80.10. We discovered that the hyperlink on the ipad QRH also directs them to page 80.9 but correctly places them on page 80.10. Pilots utilizing the paper QRH will be placed on page 80.9 and will run the engine fire/overheat detector fault checklist. Which is wrong. The new QRH hyperlinks and directs the pilot to 80.9---again; wrong checklist. If I have confused you guys we are on the same team. It took ZZZ 10 hours to type this up. Best thing to do is go to the ipad and you'll see what we are talking about.
Original NASA ASRS Text
Title: B737 First Officer reported that the the QRH reference was incorrect for an engine over-temp.
Narrative: We had an engine over temp climbing out of ZZZ; an IOR was completed by the Captain and incident report was also completed - for details concerning the actual incident you can refer to those reports. [ATC was advised] and partial power air return to ZZZ was uneventful. For the purpose of this report; I am concerned about the inaccuracy of the QRH. I notified the CPO of my concerns. I will include a 'cut and paste' of that email below. So we had an engine overheat; that required an air return to ZZZ with partial power on the #1 engine - no shutdown required. Once the engine overheat caution was recognized; I opened the QRH to the front index; identified the page to turn to as 80.9 and turned to 80.9. The only checklist to start on 80.9 is the 'Engine Fire/Overheat Detector Fault'. I knew this could not be right; so referred then to the 'Fire Protection' Table of contents which again directed me to the 80.9 page of the QRH for 'Engine Overheat' ... again not correct. The 'Engine Overheat' checklist is on page 8.10 - and is mislabeled in the QRH! My concern is this; we have a lot of different pilots with a wide range of systems knowledge; experience and wide ranges of complacency. Under the circumstances; with perhaps two pilots who are level 1 or 2 professional then we risk someone turning to page 80.9 in the QRH; see the words 'engine' and 'overheat' in the Checklist header - proceeds to run a one line checklist which is quite simple and then decides all is well and presses on when the fact is they may have an engine that is about to catch on fire and become a major catastrophe. I am VERY CONCERNED about this and am disappointed that no change has yet been made - no pilot bulletin or something to at least let pilots know about this error in the QRH. Yes... it may be another year or more until this incident occurs again; or it could happen within minutes of me submitting this report! And under the right circumstances we may end up with an engine overheat that is not properly managed with dire consequences. I do not feel I am being dramatic - I am concerned about the safety implications of this situation. I would appreciate a timely response from the ERC; I am willing and able to speak to the concerns of this report further with a phone call but really expect to see this addressed and remedied in a timely manner. I trust that in this narrative you can sense my sincere concern for the possible consequences of not addressing or correcting this error. Please note - I would appreciate a personal response to this report please.Following is the email that was sent after the incident:ZZZ pilots conducted an air return for #1 Engine Overheat---see report belowGrabbing the paper QRH and looking up 'ENGINE OVERHEAT' it directed them to page 80.9 which is the wrong checklist. That page number is incorrect. Correct page number for Engine Overheat is 80.10. We discovered that the hyperlink on the iPad QRH also directs them to page 80.9 but correctly places them on page 80.10. Pilots utilizing the paper QRH will be placed on page 80.9 and will run the Engine Fire/Overheat Detector fault checklist. Which is wrong. The new QRH hyperlinks and directs the pilot to 80.9---again; wrong checklist. If I have confused you guys we are on the same team. It took ZZZ 10 hours to type this up. Best thing to do is go to the iPad and you'll see what we are talking about.
Data retrieved from NASA's ASRS site 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.