A BAE146 was dispatched in non compliance with the right outboard axle sleeve not installed after a brake and wheel assembly replacement.

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Attributes
ACN	509775
Time
Date	200104
Day	Mon
Place
Locale Reference	airport : zzz.airport
State Reference	US
Altitude	agl single value : 0
Aircraft 1
Controlling Facilities	tower : btv.tower
Operator	common carrier : air carrier
Make Model Name	ATP Advanced Turboprop
Operating Under FAR Part	Part 121
Flight Phase	ground : maintenance
Person 1
Affiliation	company : air carrier
Function	maintenance : technician
Qualification	technician : powerplant technician : airframe
Experience	maintenance technician : 1.16
ASRS Report	509775
Person 2
Affiliation	company : air carrier
Function	maintenance : technician
Qualification	technician : airframe technician : powerplant
Experience	maintenance technician : 0.583
ASRS Report	510029
Events
Anomaly	aircraft equipment problem : critical maintenance problem : improper maintenance non adherence : published procedure
Resolutory Action	none taken : detected after the fact
Consequence	other other other
Factors
Maintenance	contributing factor : work cards performance deficiency : installation performance deficiency : unqualified personnel performance deficiency : training performance deficiency : inspection
Supplementary
Problem Areas	Aircraft Maintenance Human Performance
Primary Problem	Maintenance Human Performance

Narrative:

During routine maintenance check, it was discovered that r-hand outboard tire and brake needed to be changed. The r-hand outboard tire was worn to limits and brake indicator pin indicated that r-hand outboard brake needed changing. Due to low manpwr shortage, time was a factor. Working for air carrier X for 6 weeks, this was my first brake and tire change. I was being instructed by mr X and did a step-by-step procedure. Corrective action was to remove and replace tire and brake. Tire and brake installation completed, was signed off, operations checked good, and everything was normal. I was notified that our plane had landed in minneapolis, mn, from our hangar manager mr Y that a r-hand outboard tire on aircraft X was listing 30 degrees and was a possible bearing failure. Upon returning to work for next shift, I was told that a brake sleeve for said aircraft had not been installed, and missing sleeve was found on brake that was removed. What I have been told is that the damage was caused by missing sleeve during installation.

Original NASA ASRS Text

Title: A BAE146 WAS DISPATCHED IN NON COMPLIANCE WITH THE R OUTBOARD AXLE SLEEVE NOT INSTALLED AFTER A BRAKE AND WHEEL ASSEMBLY REPLACEMENT.

Narrative: DURING ROUTINE MAINT CHK, IT WAS DISCOVERED THAT R-HAND OUTBOARD TIRE AND BRAKE NEEDED TO BE CHANGED. THE R-HAND OUTBOARD TIRE WAS WORN TO LIMITS AND BRAKE INDICATOR PIN INDICATED THAT R-HAND OUTBOARD BRAKE NEEDED CHANGING. DUE TO LOW MANPWR SHORTAGE, TIME WAS A FACTOR. WORKING FOR ACR X FOR 6 WKS, THIS WAS MY FIRST BRAKE AND TIRE CHANGE. I WAS BEING INSTRUCTED BY MR X AND DID A STEP-BY-STEP PROC. CORRECTIVE ACTION WAS TO REMOVE AND REPLACE TIRE AND BRAKE. TIRE AND BRAKE INSTALLATION COMPLETED, WAS SIGNED OFF, OPS CHKED GOOD, AND EVERYTHING WAS NORMAL. I WAS NOTIFIED THAT OUR PLANE HAD LANDED IN MINNEAPOLIS, MN, FROM OUR HANGAR MGR MR Y THAT A R-HAND OUTBOARD TIRE ON ACFT X WAS LISTING 30 DEGS AND WAS A POSSIBLE BEARING FAILURE. UPON RETURNING TO WORK FOR NEXT SHIFT, I WAS TOLD THAT A BRAKE SLEEVE FOR SAID ACFT HAD NOT BEEN INSTALLED, AND MISSING SLEEVE WAS FOUND ON BRAKE THAT WAS REMOVED. WHAT I HAVE BEEN TOLD IS THAT THE DAMAGE WAS CAUSED BY MISSING SLEEVE DURING INSTALLATION.

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.