37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 302627 |
Time | |
Date | 199504 |
Day | Sat |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | atc facility : air |
State Reference | OH |
Altitude | msl bound lower : 37000 msl bound upper : 37000 |
Environment | |
Light | Daylight |
Aircraft 1 | |
Controlling Facilities | artcc : zob |
Operator | common carrier : air carrier |
Make Model Name | Commercial Fixed Wing |
Operating Under FAR Part | Part 121 |
Flight Phase | cruise other ground : preflight |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : flight engineer pilot : commercial pilot : cfi pilot : atp |
Experience | flight time last 90 days : 150 flight time total : 9500 flight time type : 180 |
ASRS Report | 302627 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : instrument pilot : commercial |
Events | |
Anomaly | non adherence : far non adherence : published procedure other anomaly other |
Independent Detector | other other : unspecified cockpit |
Resolutory Action | none taken : detected after the fact |
Consequence | Other |
Supplementary | |
Primary Problem | Chart Or Publication |
Air Traffic Incident | other |
Situations | |
Publication | Unspecified |
Narrative:
An MEL item was added to the flight release. The logbook was signed off by maintenance and a placard installed. Our company procedure for inoperative component was followed at the gate. Our MEL crew procedure section refers us to the supplemental section of our cockpit operating manual. This section has us verify some of the maintenance actions, but not all of them. The dispatch deviation guide contains the remainder of the items that is to be performed by mechanics. Once airborne, it was discovered that all the maintenance procedures were not followed. Maintenance department was notified and instructed crew to complete the procedures. From a human factors standpoint, the checks and balances did not occur perhaps due to too many references need to be checked to ensure MEL compliance. All references do not refer to each other once a different manual is referred to as the crews prepare for departure. One factor which contributes to human performance is short turnaround times for flcs and maintenance personnel.
Original NASA ASRS Text
Title: MEL PROCS NOT COMPLIED WITH.
Narrative: AN MEL ITEM WAS ADDED TO THE FLT RELEASE. THE LOGBOOK WAS SIGNED OFF BY MAINT AND A PLACARD INSTALLED. OUR COMPANY PROC FOR INOP COMPONENT WAS FOLLOWED AT THE GATE. OUR MEL CREW PROC SECTION REFERS US TO THE SUPPLEMENTAL SECTION OF OUR COCKPIT OPERATING MANUAL. THIS SECTION HAS US VERIFY SOME OF THE MAINT ACTIONS, BUT NOT ALL OF THEM. THE DISPATCH DEV GUIDE CONTAINS THE REMAINDER OF THE ITEMS THAT IS TO BE PERFORMED BY MECHS. ONCE AIRBORNE, IT WAS DISCOVERED THAT ALL THE MAINT PROCS WERE NOT FOLLOWED. MAINT DEPT WAS NOTIFIED AND INSTRUCTED CREW TO COMPLETE THE PROCS. FROM A HUMAN FACTORS STANDPOINT, THE CHKS AND BALS DID NOT OCCUR PERHAPS DUE TO TOO MANY REFS NEED TO BE CHKED TO ENSURE MEL COMPLIANCE. ALL REFS DO NOT REFER TO EACH OTHER ONCE A DIFFERENT MANUAL IS REFERRED TO AS THE CREWS PREPARE FOR DEP. ONE FACTOR WHICH CONTRIBUTES TO HUMAN PERFORMANCE IS SHORT TURNAROUND TIMES FOR FLCS AND MAINT PERSONNEL.
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.