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|
Attributes | |
ACN | 443363 |
Time | |
Date | 199907 |
Day | Sat |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : dtw.airport |
State Reference | MI |
Environment | |
Light | Daylight |
Aircraft 1 | |
Make Model Name | Medium Large Transport, Low Wing, 2 Turbojet Eng |
Operating Under FAR Part | Part 121 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
ASRS Report | 443363 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : multi engine pilot : instrument pilot : commercial |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : non compliance with mel non adherence : far non adherence : published procedure non adherence : company policies |
Independent Detector | other flight crewa other flight crewb |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Factors | |
Maintenance | contributing factor : schedule pressure performance deficiency : inspection performance deficiency : logbook entry performance deficiency : non compliance with legal requirements |
Supplementary | |
Problem Areas | Flight Crew Human Performance Company Aircraft Maintenance Human Performance |
Primary Problem | Maintenance Human Performance |
Narrative:
Late arrival at aircraft due to late inbound. Found PA system on MEL and reflected on flight release. PA circuit breaker had been pulled and collared. Aircraft flown from dtw to phl. Then flown from phl to mem. During flight to mem, I was advised that the cockpit to cabin chimes were not working (a requirement for placing PA on MEL). Upon troubleshooting in mem discovered that the chimes were tied to the PA circuit breaker. The circuit breaker had been pulled because a previous write-up complained that the circuit breaker popped. While the circuit breaker should have been pulled for the above reason, the resulting failure of the chimes made the MEL non applicable and the aircraft should not have been flown. I had no time to test the system on the first leg and the need to determine that the MEL had been complied with was forgotten for the second leg (there is no requirement for each leg, I simply had not checked). In addition to the 2 legs I flew the aircraft it had also flown others previously in the same condition. The biggest concern is that I had no way to communicate with my flight attendants in an emergency. Another case of maintenance setting up a crew.
Original NASA ASRS Text
Title: MLG CREW WAS DISPATCHED WITH ILLEGAL MEL ITEM.
Narrative: LATE ARR AT ACFT DUE TO LATE INBOUND. FOUND PA SYS ON MEL AND REFLECTED ON FLT RELEASE. PA CIRCUIT BREAKER HAD BEEN PULLED AND COLLARED. ACFT FLOWN FROM DTW TO PHL. THEN FLOWN FROM PHL TO MEM. DURING FLT TO MEM, I WAS ADVISED THAT THE COCKPIT TO CABIN CHIMES WERE NOT WORKING (A REQUIREMENT FOR PLACING PA ON MEL). UPON TROUBLESHOOTING IN MEM DISCOVERED THAT THE CHIMES WERE TIED TO THE PA CIRCUIT BREAKER. THE CIRCUIT BREAKER HAD BEEN PULLED BECAUSE A PREVIOUS WRITE-UP COMPLAINED THAT THE CIRCUIT BREAKER POPPED. WHILE THE CIRCUIT BREAKER SHOULD HAVE BEEN PULLED FOR THE ABOVE REASON, THE RESULTING FAILURE OF THE CHIMES MADE THE MEL NON APPLICABLE AND THE ACFT SHOULD NOT HAVE BEEN FLOWN. I HAD NO TIME TO TEST THE SYS ON THE FIRST LEG AND THE NEED TO DETERMINE THAT THE MEL HAD BEEN COMPLIED WITH WAS FORGOTTEN FOR THE SECOND LEG (THERE IS NO REQUIREMENT FOR EACH LEG, I SIMPLY HAD NOT CHKED). IN ADDITION TO THE 2 LEGS I FLEW THE ACFT IT HAD ALSO FLOWN OTHERS PREVIOUSLY IN THE SAME CONDITION. THE BIGGEST CONCERN IS THAT I HAD NO WAY TO COMMUNICATE WITH MY FLT ATTENDANTS IN AN EMER. ANOTHER CASE OF MAINT SETTING UP A CREW.
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.