 |
37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
A B737-500 diverted shortly after takeoff due to unable to pressurize the aircraft caused by the exhaust air control valve installed incorrectly.
| Attributes | |
| ACN | 372035 |
| Time | |
| Date | 199706 |
| Day | Mon |
| Local Time Of Day | 1201 To 1800 |
| 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 | B737-500 |
| Operating Under FAR Part | Part 121 |
| Navigation In Use | Other Other |
| Flight Phase | other |
| Flight Plan | None |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | other personnel other |
| Qualification | other other : other |
| ASRS Report | 372035 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | other personnel other |
| Qualification | other other : other |
| ASRS Report | 371583 |
| Events | |
| Anomaly | aircraft equipment problem : critical non adherence : published procedure other anomaly other |
| Independent Detector | other flight crewa other other : unspecified cockpit |
| Resolutory Action | other |
| Consequence | Other |
| Supplementary | |
| Problem Areas | Aircraft Maintenance Human Performance |
| Primary Problem | Maintenance Human Performance |
| Air Traffic Incident | other |
Narrative:
On jun/xx/97, at approximately XA00 hours, at the ZZZ international airport, I assisted the lead mechanic, on the air carrier aircraft xx, to replace a flow control valve. After I replaced the valve I did not recognize the arrow on the valve for flow direction, which may have been pointing the wrong direction. The valve checked okay for exhausting air overboard, as that was the problem before I put the new valve in. Being rushed by air carrier, which does not possess any maintenance manuals at the ZZZ international airport and did not furnish any paperwork for contract maintenance, I failed to complete the step that required the aircraft to be pressurized to fully check the valve operation. The aircraft departed from ZZZ international airport and diverted to xyz international airport for the inability to be pressurized, because the valve may have been installed incorrectly. Even though I represent abc maintenance, we at abc do not have any B737-500 maintenance manuals or ipc effectivity tapes which could have avoided this dilemma.
Original NASA ASRS Text
Title: A B737-500 DIVERTED SHORTLY AFTER TKOF DUE TO UNABLE TO PRESSURIZE THE ACFT CAUSED BY THE EXHAUST AIR CTL VALVE INSTALLED INCORRECTLY.
Narrative: ON JUN/XX/97, AT APPROX XA00 HRS, AT THE ZZZ INTL ARPT, I ASSISTED THE LEAD MECH, ON THE ACR ACFT XX, TO REPLACE A FLOW CTL VALVE. AFTER I REPLACED THE VALVE I DID NOT RECOGNIZE THE ARROW ON THE VALVE FOR FLOW DIRECTION, WHICH MAY HAVE BEEN POINTING THE WRONG DIRECTION. THE VALVE CHKED OKAY FOR EXHAUSTING AIR OVERBOARD, AS THAT WAS THE PROB BEFORE I PUT THE NEW VALVE IN. BEING RUSHED BY ACR, WHICH DOES NOT POSSESS ANY MAINT MANUALS AT THE ZZZ INTL ARPT AND DID NOT FURNISH ANY PAPERWORK FOR CONTRACT MAINT, I FAILED TO COMPLETE THE STEP THAT REQUIRED THE ACFT TO BE PRESSURIZED TO FULLY CHK THE VALVE OP. THE ACFT DEPARTED FROM ZZZ INTL ARPT AND DIVERTED TO XYZ INTL ARPT FOR THE INABILITY TO BE PRESSURIZED, BECAUSE THE VALVE MAY HAVE BEEN INSTALLED INCORRECTLY. EVEN THOUGH I REPRESENT ABC MAINT, WE AT ABC DO NOT HAVE ANY B737-500 MAINT MANUALS OR IPC EFFECTIVITY TAPES WHICH COULD HAVE AVOIDED THIS DILEMMA.
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.