37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 429454 |
Time | |
Date | 199902 |
Day | Tue |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : zzz |
State Reference | US |
Altitude | msl bound lower : 1500 msl bound upper : 1500 |
Environment | |
Flight Conditions | VMC |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Navigation In Use | Other |
Flight Phase | other other |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : flight engineer |
Experience | flight time last 90 days : 80 flight time total : 11000 flight time type : 2000 |
ASRS Report | 429454 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain |
Qualification | pilot : flight engineer pilot : instrument pilot : commercial |
Experience | flight time last 90 days : 100 flight time total : 16000 flight time type : 45 |
ASRS Report | 429660 |
Events | |
Anomaly | aircraft equipment problem : critical non adherence : far non adherence : published procedure |
Independent Detector | other other : unspecified |
Resolutory Action | none taken : detected after the fact other |
Consequence | Other |
Narrative:
Door 5L would not arm escape slide, it kept moving back to disarmed position, sent non flying captain back to open and close door as reseating door in frame usually lines up the girt bar to engage in floor mount. Girt bar and part of escape chute apron fell outside aircraft. When door opened and closed pilot didn't see it due to bustle (cover over escape slide) and no one outside saw it. People outside were not required to check door (no procedure in place). We had green armed indication in cockpit and arming lever freely moved to the arm position. Why? Because B747-400 only has 1 proximity switch for door closed and one that says arming lever is in armed position. Both were satisfied. This information was unknown to crew due to new (last 10 yrs) philosophy by company to make manuals operational. B757 has 2 sensors on ends of the girt bar B747-400 doesn't. Lack of information drew crew (and most mechanics on line maintenance) to conclude the B747-400 and B757 sensed the same as both have a door synoptic page that has an orange 'M' for manual and a green 'a' when door is in automatic. Callback conversation with reporter revealed the following information: the reporter states the aft cabin flight attendant had trouble arming 5L door and the relief captain went aft to assist in arming the door. The reporter said the door was disarmed then opened and closed and then armed in a normal manner with the correct cockpit indications of the 'slide armed and the door closed and locked.' the reporter said the takeoff was normal till advised at 1500 ft of a banging noise and the girt bar hanging outside. The reporter said fuel was dumped and a diversion made uneventfully. The reporter stated the aircraft sustained damage from the girt bar banging against the fuselage skin below the door and 1 small hole about .250 inches in diameter. The reporter stated the door slide arming handle has a sensor to sense if armed or disarmed and the door has a sensor to sense position. The reporter said there are no flight attendant procedures requiring checking the girt bar to make certain that when the door is armed the bar is locked to the threshold. The reporter said without the girt bar locked to the threshold the slide is worthless. The reporter stated the crews flying this type airplane are unaware of this situation.
Original NASA ASRS Text
Title: A B747-400 ON INITIAL CLB AT 1500 FT DECLARED AN EMER AND DIVERTED DUE TO DOOR 5L GIRT BAR AND SEGMENT OF ESCAPE SLIDE HANGING OUT.
Narrative: DOOR 5L WOULD NOT ARM ESCAPE SLIDE, IT KEPT MOVING BACK TO DISARMED POS, SENT NON FLYING CAPT BACK TO OPEN AND CLOSE DOOR AS RESEATING DOOR IN FRAME USUALLY LINES UP THE GIRT BAR TO ENGAGE IN FLOOR MOUNT. GIRT BAR AND PART OF ESCAPE CHUTE APRON FELL OUTSIDE ACFT. WHEN DOOR OPENED AND CLOSED PLT DIDN'T SEE IT DUE TO BUSTLE (COVER OVER ESCAPE SLIDE) AND NO ONE OUTSIDE SAW IT. PEOPLE OUTSIDE WERE NOT REQUIRED TO CHK DOOR (NO PROC IN PLACE). WE HAD GREEN ARMED INDICATION IN COCKPIT AND ARMING LEVER FREELY MOVED TO THE ARM POS. WHY? BECAUSE B747-400 ONLY HAS 1 PROX SWITCH FOR DOOR CLOSED AND ONE THAT SAYS ARMING LEVER IS IN ARMED POS. BOTH WERE SATISFIED. THIS INFO WAS UNKNOWN TO CREW DUE TO NEW (LAST 10 YRS) PHILOSOPHY BY COMPANY TO MAKE MANUALS OPERATIONAL. B757 HAS 2 SENSORS ON ENDS OF THE GIRT BAR B747-400 DOESN'T. LACK OF INFO DREW CREW (AND MOST MECHS ON LINE MAINT) TO CONCLUDE THE B747-400 AND B757 SENSED THE SAME AS BOTH HAVE A DOOR SYNOPTIC PAGE THAT HAS AN ORANGE 'M' FOR MANUAL AND A GREEN 'A' WHEN DOOR IS IN AUTOMATIC. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THE RPTR STATES THE AFT CABIN FLT ATTENDANT HAD TROUBLE ARMING 5L DOOR AND THE RELIEF CAPT WENT AFT TO ASSIST IN ARMING THE DOOR. THE RPTR SAID THE DOOR WAS DISARMED THEN OPENED AND CLOSED AND THEN ARMED IN A NORMAL MANNER WITH THE CORRECT COCKPIT INDICATIONS OF THE 'SLIDE ARMED AND THE DOOR CLOSED AND LOCKED.' THE RPTR SAID THE TKOF WAS NORMAL TILL ADVISED AT 1500 FT OF A BANGING NOISE AND THE GIRT BAR HANGING OUTSIDE. THE RPTR SAID FUEL WAS DUMPED AND A DIVERSION MADE UNEVENTFULLY. THE RPTR STATED THE ACFT SUSTAINED DAMAGE FROM THE GIRT BAR BANGING AGAINST THE FUSELAGE SKIN BELOW THE DOOR AND 1 SMALL HOLE ABOUT .250 INCHES IN DIAMETER. THE RPTR STATED THE DOOR SLIDE ARMING HANDLE HAS A SENSOR TO SENSE IF ARMED OR DISARMED AND THE DOOR HAS A SENSOR TO SENSE POS. THE RPTR SAID THERE ARE NO FLT ATTENDANT PROCS REQUIRING CHKING THE GIRT BAR TO MAKE CERTAIN THAT WHEN THE DOOR IS ARMED THE BAR IS LOCKED TO THE THRESHOLD. THE RPTR SAID WITHOUT THE GIRT BAR LOCKED TO THE THRESHOLD THE SLIDE IS WORTHLESS. THE RPTR STATED THE CREWS FLYING THIS TYPE AIRPLANE ARE UNAWARE OF THIS SIT.
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.