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|
Attributes | |
ACN | 423760 |
Time | |
Date | 199812 |
Day | Wed |
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 | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Flight Phase | other |
Flight Plan | None |
Person 1 | |
Affiliation | company : air carrier |
Function | other personnel other |
Qualification | other other : other |
ASRS Report | 423760 |
Person 2 | |
Affiliation | company : air carrier |
Function | other personnel other |
Qualification | other other : other |
Events | |
Anomaly | aircraft equipment problem : less severe non adherence : published procedure non adherence : far |
Independent Detector | aircraft equipment other aircraft equipment : unspecified other flight crewa |
Resolutory Action | none taken : detected after the fact |
Consequence | Other |
Supplementary | |
Air Traffic Incident | other |
Narrative:
Air carrier engine change job card uvwxyz item 24 requires mechanic to install lvdt transducer on certain aircraft. The 'check by' block is X'ed out indicating inspection 'buy-back' not required. Item B requires adjustment, and provides for mechanic and inspection signoffs. If mechanic determines that lvdt is not required, he will north/a the block and the subsequent blocks relating to rigging inspection will then north/a and stamp 'check by' block due to the fact that since the component has not been installed there is no rigging to check. In order to prevent this maintenance error from recurring, I propose to have air carrier revise job card uvwxyz item 24 to include inspection buy-back regarding requirement for lvdt transmitters on aircraft xyzz-zyzy. Also, revise 'note' in item 24 to clarify requirement for lvdt transmitter. Contributing factors: fatigue. The technician and I had worked 16 hours each.
Original NASA ASRS Text
Title: A B737-200 WAS DISPATCHED AFTER ENG CHANGE WITH THE ENG AUTOTHROTTLE TRANSDUCER NOT INSTALLED IN NON COMPLIANCE WITH THE ENG CHANGE JOB CARD.
Narrative: ACR ENG CHANGE JOB CARD UVWXYZ ITEM 24 REQUIRES MECH TO INSTALL LVDT TRANSDUCER ON CERTAIN ACFT. THE 'CHK BY' BLOCK IS X'ED OUT INDICATING INSPECTION 'BUY-BACK' NOT REQUIRED. ITEM B REQUIRES ADJUSTMENT, AND PROVIDES FOR MECH AND INSPECTION SIGNOFFS. IF MECH DETERMINES THAT LVDT IS NOT REQUIRED, HE WILL N/A THE BLOCK AND THE SUBSEQUENT BLOCKS RELATING TO RIGGING INSPECTION WILL THEN N/A AND STAMP 'CHK BY' BLOCK DUE TO THE FACT THAT SINCE THE COMPONENT HAS NOT BEEN INSTALLED THERE IS NO RIGGING TO CHK. IN ORDER TO PREVENT THIS MAINT ERROR FROM RECURRING, I PROPOSE TO HAVE ACR REVISE JOB CARD UVWXYZ ITEM 24 TO INCLUDE INSPECTION BUY-BACK REGARDING REQUIREMENT FOR LVDT TRANSMITTERS ON ACFT XYZZ-ZYZY. ALSO, REVISE 'NOTE' IN ITEM 24 TO CLARIFY REQUIREMENT FOR LVDT TRANSMITTER. CONTRIBUTING FACTORS: FATIGUE. THE TECHNICIAN AND I HAD WORKED 16 HRS EACH.
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.