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|
Attributes | |
ACN | 200710 |
Time | |
Date | 199201 |
Day | Thu |
Local Time Of Day | 0001 To 0600 |
Place | |
Locale Reference | airport : hln |
State Reference | MT |
Altitude | agl bound lower : 0 agl bound upper : 0 |
Environment | |
Flight Conditions | Mixed |
Light | Night |
Aircraft 1 | |
Controlling Facilities | tower : cll |
Operator | common carrier : air carrier |
Make Model Name | Large Transport, Low Wing, 2 Turbojet Eng |
Navigation In Use | Other Other |
Flight Phase | climbout : takeoff ground : preflight landing other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : cfi pilot : atp pilot : flight engineer |
Experience | flight time last 90 days : 140 flight time total : 11500 flight time type : 140 |
ASRS Report | 200710 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
Events | |
Anomaly | aircraft equipment problem : less severe non adherence : published procedure non adherence : far |
Independent Detector | other flight crewa |
Resolutory Action | none taken : detected after the fact |
Consequence | Other |
Supplementary | |
Primary Problem | Aircraft |
Air Traffic Incident | Pilot Deviation other |
Narrative:
When we accepted the aircraft in den, there was a deferred maintenance item for 1 channel of the eec on the left engine. The MEL authorized departure with one of the 4 channels inoperative provided both thrust reversers were verified to operate normally. Immediately after takeoff from den, a right rev isln valve caution message appeared on the upper EICAS, followed by the status message on the lower EICAS. The caution message disappeared after a few seconds and we were able to clear the status message on the ground in hnl. The right reverser also operated normally on landing in hln. I wanted to record the message in the log for tracking purposes and had the impression after talking to our maintenance operations at the hub that the local contract mechanic would simply have to cycle the reverser and then sign it off. As it turned out, the mechanic was instructed to lock out the reverser, since he did not have the equipment necessary to perform a required test procedure. I knew that normal reverser operation was a requirement of our previous deferred item, but incorrectly remembered it as pertaining to the left engine only. The result was that the aircraft was released to the line by maintenance, and we operated the aircraft to slc and den with 2 conflicting deferred items in the log. I believe that 2 factors contributed to my oversight in not reconfirming the applicable MEL restrictions. The slc WX was forecast well below landing mins, with fog dispersal operations in progress. This necessitated several calls to dispatch for a 'flight movement forecast' based on RVR, and several other release amendments, including updated release times. Also, just before leaving the hotel that night, I had spoken to my husband by phone and was told that my father-in-law would be going into the hospital the next day to have his foot amputated and that there was a great probability that he would not survive the operation. Needless to say, this weighed heavily on my mind throughout the evening.
Original NASA ASRS Text
Title: ACR LGT FLC ACCEPTS DISPATCH OF LGT AFTER ACFT EQUIP PROBLEM WAS RESOLVED THROUGH MEL REQUIREMENTS DISREGARDING PREVIOUS APPLICABLE MEL ITEM WHICH WAS CTLING AND LIMITING.
Narrative: WHEN WE ACCEPTED THE ACFT IN DEN, THERE WAS A DEFERRED MAINT ITEM FOR 1 CHANNEL OF THE EEC ON THE L ENG. THE MEL AUTHORIZED DEP WITH ONE OF THE 4 CHANNELS INOP PROVIDED BOTH THRUST REVERSERS WERE VERIFIED TO OPERATE NORMALLY. IMMEDIATELY AFTER TKOF FROM DEN, A R REV ISLN VALVE CAUTION MESSAGE APPEARED ON THE UPPER EICAS, FOLLOWED BY THE STATUS MESSAGE ON THE LOWER EICAS. THE CAUTION MESSAGE DISAPPEARED AFTER A FEW SECONDS AND WE WERE ABLE TO CLR THE STATUS MESSAGE ON THE GND IN HNL. THE R REVERSER ALSO OPERATED NORMALLY ON LNDG IN HLN. I WANTED TO RECORD THE MESSAGE IN THE LOG FOR TRACKING PURPOSES AND HAD THE IMPRESSION AFTER TALKING TO OUR MAINT OPS AT THE HUB THAT THE LCL CONTRACT MECH WOULD SIMPLY HAVE TO CYCLE THE REVERSER AND THEN SIGN IT OFF. AS IT TURNED OUT, THE MECH WAS INSTRUCTED TO LOCK OUT THE REVERSER, SINCE HE DID NOT HAVE THE EQUIP NECESSARY TO PERFORM A REQUIRED TEST PROC. I KNEW THAT NORMAL REVERSER OP WAS A REQUIREMENT OF OUR PREVIOUS DEFERRED ITEM, BUT INCORRECTLY REMEMBERED IT AS PERTAINING TO THE L ENG ONLY. THE RESULT WAS THAT THE ACFT WAS RELEASED TO THE LINE BY MAINT, AND WE OPERATED THE ACFT TO SLC AND DEN WITH 2 CONFLICTING DEFERRED ITEMS IN THE LOG. I BELIEVE THAT 2 FACTORS CONTRIBUTED TO MY OVERSIGHT IN NOT RECONFIRMING THE APPLICABLE MEL RESTRICTIONS. THE SLC WX WAS FORECAST WELL BELOW LNDG MINS, WITH FOG DISPERSAL OPS IN PROGRESS. THIS NECESSITATED SEVERAL CALLS TO DISPATCH FOR A 'FLT MOVEMENT FORECAST' BASED ON RVR, AND SEVERAL OTHER RELEASE AMENDMENTS, INCLUDING UPDATED RELEASE TIMES. ALSO, JUST BEFORE LEAVING THE HOTEL THAT NIGHT, I HAD SPOKEN TO MY HUSBAND BY PHONE AND WAS TOLD THAT MY FATHER-IN-LAW WOULD BE GOING INTO THE HOSPITAL THE NEXT DAY TO HAVE HIS FOOT AMPUTATED AND THAT THERE WAS A GREAT PROBABILITY THAT HE WOULD NOT SURVIVE THE OP. NEEDLESS TO SAY, THIS WEIGHED HEAVILY ON MY MIND THROUGHOUT THE EVENING.
Data retrieved from NASA's ASRS site as of July 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.