37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 473056 |
Time | |
Date | 200005 |
Day | Tue |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Environment | |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B737-300 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance ground : parked |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 15 |
ASRS Report | 473056 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : powerplant technician : airframe |
Events | |
Anomaly | aircraft equipment problem : less severe maintenance problem : improper documentation non adherence : far non adherence : published procedure |
Independent Detector | other other : person 1 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : work cards contributing factor : schedule pressure performance deficiency : scheduled maintenance performance deficiency : non compliance with legal requirements performance deficiency : training performance deficiency : unqualified personnel performance deficiency : repair |
Supplementary | |
Problem Areas | Chart Or Publication Aircraft Company Maintenance Human Performance |
Primary Problem | Maintenance Human Performance |
Narrative:
My manager xabc put pressure on me to install a fuel panel access plate even if I didn't complete a damage assessment on the damaged bonding wire hold that connects the bonding strap to the panel. Xyz and me discovered that the bonding wire hold was found damaged when we were in the process of cleaning the panel to install new hardware. We made both our leads xzy and yxz aware of the late find damage. I was called to the office of the manager to explain myself why it was taking too long to install a fuel tank plate. The manager's words were 'don't worry about the bonding strap at this time...it won't bring the plane down. It doesn't take a surgeon's knowledge to slap on fuel plates on a plane. Just connect the bonding straps, put the screws in, fuel the tank. We are wasting too much time on fuel tanks -- 16 days is too long.' feeling the pressure and being under stress on the manager's demands, I went ahead and connected the bonding strap knowing full well that no damage assessment was done on the damaged fuel panel. I suspect that whoever connected the bonding strap previously did not tighten the bolt. Hence, after so many flight hours vibration worn through half the stiffener material. I went ahead and sealed the bonding strap. Loosely put the bolts to secure the plate. I came to work the next day and the center tank was fueled and sealed. Upon the date of filing, there was no documentation of the panel damage. The paperwork all stamped off by a probationary mechanic xjx. Training is very important. The probationary mechanic is not fully trained on all the maintenance policies of the company. I was too stressed to tell him the consequences of stamping the paperwork knowing that there's damage. The damage was witnessed by a manager xabc, 2 supervisors xwx and xxw, 2 leads xzy, yxz, and 2 mechanics xxa and xxb. Training: where do you find the damage limits to a fuel plate? I lack training on boeing manuals researching limits. Tooling availability: bonding meter was not readily available. Tool had to be shipped from XXX. I am not trained on fuel tanks. All knowledge is purely technical knowledge gained from following boeing's maintenance manual.
Original NASA ASRS Text
Title: A B737-300 WAS RELEASED FROM HVY MAINT IN NON COMPLIANCE WITH A FUEL TANK ACCESS PLATE BONDING WIRE STRAP REPAIR NOT DOCUMENTED.
Narrative: MY MGR XABC PUT PRESSURE ON ME TO INSTALL A FUEL PANEL ACCESS PLATE EVEN IF I DIDN'T COMPLETE A DAMAGE ASSESSMENT ON THE DAMAGED BONDING WIRE HOLD THAT CONNECTS THE BONDING STRAP TO THE PANEL. XYZ AND ME DISCOVERED THAT THE BONDING WIRE HOLD WAS FOUND DAMAGED WHEN WE WERE IN THE PROCESS OF CLEANING THE PANEL TO INSTALL NEW HARDWARE. WE MADE BOTH OUR LEADS XZY AND YXZ AWARE OF THE LATE FIND DAMAGE. I WAS CALLED TO THE OFFICE OF THE MGR TO EXPLAIN MYSELF WHY IT WAS TAKING TOO LONG TO INSTALL A FUEL TANK PLATE. THE MGR'S WORDS WERE 'DON'T WORRY ABOUT THE BONDING STRAP AT THIS TIME...IT WON'T BRING THE PLANE DOWN. IT DOESN'T TAKE A SURGEON'S KNOWLEDGE TO SLAP ON FUEL PLATES ON A PLANE. JUST CONNECT THE BONDING STRAPS, PUT THE SCREWS IN, FUEL THE TANK. WE ARE WASTING TOO MUCH TIME ON FUEL TANKS -- 16 DAYS IS TOO LONG.' FEELING THE PRESSURE AND BEING UNDER STRESS ON THE MGR'S DEMANDS, I WENT AHEAD AND CONNECTED THE BONDING STRAP KNOWING FULL WELL THAT NO DAMAGE ASSESSMENT WAS DONE ON THE DAMAGED FUEL PANEL. I SUSPECT THAT WHOEVER CONNECTED THE BONDING STRAP PREVIOUSLY DID NOT TIGHTEN THE BOLT. HENCE, AFTER SO MANY FLT HRS VIBRATION WORN THROUGH HALF THE STIFFENER MATERIAL. I WENT AHEAD AND SEALED THE BONDING STRAP. LOOSELY PUT THE BOLTS TO SECURE THE PLATE. I CAME TO WORK THE NEXT DAY AND THE CTR TANK WAS FUELED AND SEALED. UPON THE DATE OF FILING, THERE WAS NO DOCUMENTATION OF THE PANEL DAMAGE. THE PAPERWORK ALL STAMPED OFF BY A PROBATIONARY MECH XJX. TRAINING IS VERY IMPORTANT. THE PROBATIONARY MECH IS NOT FULLY TRAINED ON ALL THE MAINT POLICIES OF THE COMPANY. I WAS TOO STRESSED TO TELL HIM THE CONSEQUENCES OF STAMPING THE PAPERWORK KNOWING THAT THERE'S DAMAGE. THE DAMAGE WAS WITNESSED BY A MGR XABC, 2 SUPVRS XWX AND XXW, 2 LEADS XZY, YXZ, AND 2 MECHS XXA AND XXB. TRAINING: WHERE DO YOU FIND THE DAMAGE LIMITS TO A FUEL PLATE? I LACK TRAINING ON BOEING MANUALS RESEARCHING LIMITS. TOOLING AVAILABILITY: BONDING METER WAS NOT READILY AVAILABLE. TOOL HAD TO BE SHIPPED FROM XXX. I AM NOT TRAINED ON FUEL TANKS. ALL KNOWLEDGE IS PURELY TECHNICAL KNOWLEDGE GAINED FROM FOLLOWING BOEING'S MAINT MANUAL.
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.