37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 362602 |
Time | |
Date | 199703 |
Day | Sat |
Local Time Of Day | 0001 To 0600 |
Place | |
Locale Reference | airport : zzz |
State Reference | US |
Altitude | agl bound lower : 0 agl bound upper : 0 |
Environment | |
Light | Night |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | Fokker 100 |
Operating Under FAR Part | Part 121 |
Flight Phase | other |
Flight Plan | None |
Person 1 | |
Affiliation | company : air carrier |
Function | other personnel other |
Qualification | other other : other |
ASRS Report | 362602 |
Person 2 | |
Affiliation | company : air carrier |
Function | other personnel other |
Qualification | other other : other |
Events | |
Anomaly | aircraft equipment problem : critical non adherence : far non adherence : published procedure other anomaly other |
Independent Detector | other other : unspecified |
Resolutory Action | none taken : detected after the fact |
Consequence | Other |
Supplementary | |
Air Traffic Incident | other |
Narrative:
On mar/uu/97 when job card for #2 engine thrust reverser was accomplished, step #5Q did not comply. Maintenance control tech forman was notified and because of the time it would take to accomplish the task (reference the maintenance manual), tech foreman said it would be ok to program the adjustment in logbook. Job card did not mention anything about the thrust reversers requiring to be placed on MEL if any steps did not comply. There is an airworthiness directive reporting feedback sheet at the end of the job card asking if any steps failed and what maintenance manual procedure was used to correct the discrepancy and if an item was MEL'ed. Sheet was faxed to airworthiness specialist and director of engineering on mar/vv/97. On mar/ww/97 #2 engine thrust reverser was placed on MEL on a through flight per maintenance control. I was notified mar/xx/97 at approximately XA00 am, that the company notified the FAA with a self disclosure about the problem. There was no pilot reported problem before or after this incident. Also on mar/xx/97 the job card was updated adding step #6 that states if failure occurs to any thrust reverser per this check, it must be MEL'ed prior to further flight. On mar/yy/97 I called the same tech foreman and asked if he remembered the incident on mar/uu/97. He said yes, and he was asked if he knew the card was updated to reflect about the MEL procedure and he said no. Also he knew nothing about the thrust reverser being placed on MEL because of the problem with the thrust reverser job card. A lack of coordination will affect another person someday. Aircraft was fixed mar/zz/97 by adjusting the thrust reverser feedback cable. I was involved with the fix. MEL removed. Job card step #5Q complied with, with no failure.
Original NASA ASRS Text
Title: A FOKKER 100 UNDERGOING A THRUST REVERSER CHK PER JOB CARD DID NOT REQUIRE ANY DEFECTS FOUND TO BE DEFERRED. JOB CARD LATER REVISED TO REQUIRE DEFERRAL OF FAULTS FOUND. RPTR IMPLIES THAT THERE IS AN INTERNAL COMPANY COM PROB.
Narrative: ON MAR/UU/97 WHEN JOB CARD FOR #2 ENG THRUST REVERSER WAS ACCOMPLISHED, STEP #5Q DID NOT COMPLY. MAINT CTL TECH FORMAN WAS NOTIFIED AND BECAUSE OF THE TIME IT WOULD TAKE TO ACCOMPLISH THE TASK (REF THE MAINT MANUAL), TECH FOREMAN SAID IT WOULD BE OK TO PROGRAM THE ADJUSTMENT IN LOGBOOK. JOB CARD DID NOT MENTION ANYTHING ABOUT THE THRUST REVERSERS REQUIRING TO BE PLACED ON MEL IF ANY STEPS DID NOT COMPLY. THERE IS AN AIRWORTHINESS DIRECTIVE RPTING FEEDBACK SHEET AT THE END OF THE JOB CARD ASKING IF ANY STEPS FAILED AND WHAT MAINT MANUAL PROC WAS USED TO CORRECT THE DISCREPANCY AND IF AN ITEM WAS MEL'ED. SHEET WAS FAXED TO AIRWORTHINESS SPECIALIST AND DIRECTOR OF ENGINEERING ON MAR/VV/97. ON MAR/WW/97 #2 ENG THRUST REVERSER WAS PLACED ON MEL ON A THROUGH FLT PER MAINT CTL. I WAS NOTIFIED MAR/XX/97 AT APPROX XA00 AM, THAT THE COMPANY NOTIFIED THE FAA WITH A SELF DISCLOSURE ABOUT THE PROB. THERE WAS NO PLT RPTED PROB BEFORE OR AFTER THIS INCIDENT. ALSO ON MAR/XX/97 THE JOB CARD WAS UPDATED ADDING STEP #6 THAT STATES IF FAILURE OCCURS TO ANY THRUST REVERSER PER THIS CHK, IT MUST BE MEL'ED PRIOR TO FURTHER FLT. ON MAR/YY/97 I CALLED THE SAME TECH FOREMAN AND ASKED IF HE REMEMBERED THE INCIDENT ON MAR/UU/97. HE SAID YES, AND HE WAS ASKED IF HE KNEW THE CARD WAS UPDATED TO REFLECT ABOUT THE MEL PROC AND HE SAID NO. ALSO HE KNEW NOTHING ABOUT THE THRUST REVERSER BEING PLACED ON MEL BECAUSE OF THE PROB WITH THE THRUST REVERSER JOB CARD. A LACK OF COORD WILL AFFECT ANOTHER PERSON SOMEDAY. ACFT WAS FIXED MAR/ZZ/97 BY ADJUSTING THE THRUST REVERSER FEEDBACK CABLE. I WAS INVOLVED WITH THE FIX. MEL REMOVED. JOB CARD STEP #5Q COMPLIED WITH, WITH NO FAILURE.
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.