37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 484016 |
Time | |
Date | 200005 |
Day | Fri |
Local Time Of Day | 0601 To 1200 |
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 : parked ground : maintenance |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 38 |
ASRS Report | 484016 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : powerplant technician : airframe |
Experience | maintenance technician : 35 |
ASRS Report | 484015 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance non adherence : published procedure |
Independent Detector | other other : person 3 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : work cards contributing factor : manuals contributing factor : engineering procedure performance deficiency : installation performance deficiency : repair performance deficiency : non compliance with legal requirements |
Supplementary | |
Problem Areas | Aircraft Chart Or Publication Company Maintenance Human Performance |
Primary Problem | Chart Or Publication |
Situations | |
Publication | MAINT MANUAL PROCEDURE |
Narrative:
On may/xa/00 at XA00, I was assigned to aircraft xyz left elevator tab change. A hinge bracket was worn and needed replacing. A new bracket was ordered, drilled and installed. Inspection gave an ok to install the tab. The tab had worn bearings and needed replacing. The tab was replaced as an assembly per maintenance manual 27-31-31 which states either a castellated or non castellated nut. The tab installation kit ordered at the same time as the tab did not contain the proper hardware as mandated by airworthiness directive xx-WWW which had previously been complied with on this aircraft. New hardware was used from bench stock. Maintenance manual 27-31-31 states new nuts be used on control rod aft attach bolts. The maintenance manual shows no reference to this airworthiness directive which installs a self-locking castellated nut. The aircraft and the nuts installed were thought to be airworthy. An xb card (shift turnover) was then written by me to rig tab and close up area which was accomplished by second shift. Inspection verified safeties and rig.
Original NASA ASRS Text
Title: A B737-300 WAS DISPATCHED IN NON COMPLIANCE WITH A L ELEVATOR TAB INSTALLED PER THE MAINT MANUAL USING HARDWARE THAT INVALIDATED A PREVIOUS AIRWORTHINESS DIRECTIVE.
Narrative: ON MAY/XA/00 AT XA00, I WAS ASSIGNED TO ACFT XYZ L ELEVATOR TAB CHANGE. A HINGE BRACKET WAS WORN AND NEEDED REPLACING. A NEW BRACKET WAS ORDERED, DRILLED AND INSTALLED. INSPECTION GAVE AN OK TO INSTALL THE TAB. THE TAB HAD WORN BEARINGS AND NEEDED REPLACING. THE TAB WAS REPLACED AS AN ASSEMBLY PER MAINT MANUAL 27-31-31 WHICH STATES EITHER A CASTELLATED OR NON CASTELLATED NUT. THE TAB INSTALLATION KIT ORDERED AT THE SAME TIME AS THE TAB DID NOT CONTAIN THE PROPER HARDWARE AS MANDATED BY AIRWORTHINESS DIRECTIVE XX-WWW WHICH HAD PREVIOUSLY BEEN COMPLIED WITH ON THIS ACFT. NEW HARDWARE WAS USED FROM BENCH STOCK. MAINT MANUAL 27-31-31 STATES NEW NUTS BE USED ON CTL ROD AFT ATTACH BOLTS. THE MAINT MANUAL SHOWS NO REF TO THIS AIRWORTHINESS DIRECTIVE WHICH INSTALLS A SELF-LOCKING CASTELLATED NUT. THE ACFT AND THE NUTS INSTALLED WERE THOUGHT TO BE AIRWORTHY. AN XB CARD (SHIFT TURNOVER) WAS THEN WRITTEN BY ME TO RIG TAB AND CLOSE UP AREA WHICH WAS ACCOMPLISHED BY SECOND SHIFT. INSPECTION VERIFIED SAFETIES AND RIG.
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.