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|
Attributes | |
ACN | 515241 |
Time | |
Date | 200106 |
Day | Wed |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | airport : dfw.airport |
State Reference | TX |
Altitude | agl single value : 0 |
Environment | |
Flight Conditions | VMC |
Light | Night |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | A310 |
Operating Under FAR Part | Part 121 |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp pilot : flight engineer |
Experience | flight time last 90 days : 100 flight time total : 9000 flight time type : 1000 |
ASRS Report | 515241 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Events | |
Anomaly | aircraft equipment problem : critical non adherence : company policies non adherence : published procedure non adherence : far |
Independent Detector | other other : gnd 3 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : schedule pressure contributing factor : manuals contributing factor : briefing performance deficiency : non compliance with legal requirements |
Supplementary | |
Problem Areas | Flight Crew Human Performance Maintenance Human Performance Chart Or Publication |
Primary Problem | Company |
Situations | |
Publication | mel |
Narrative:
Approximately 1 day after our flight from dfw we were notified by our company that we departed with incompatible MEL's (power management control and N1 digital indication). Note: MEL states 'one or both may be inoperative provided power management control on the affected engine(south) operates normally.' cause: maintenance gave me a signal maintenance document stating that aircraft (ge CF6-80a3 engines) was airworthy, which it was not. In my review of the document, I failed to note the incompatibility between the 2 MEL's after researching them. Factors: multiple MEL's and previous write-ups to review, concern for previous overtemp and overspd of engines, concern for the elaborate autothrottle off procedure due to power management control problem, crew's late arrival at airport due to crew bus turning around and going back to hotel for another crew whose bus just broke down, new captain with approximately 100 hours of PIC in the A310/300, in review of MEL gauge remarks have the words 'one or both may be inoperative' and I may have keyed on this or I may have assumed #1 power management control inoperative since '2 N1 digital indication was inoperative which is permissible by the MEL. Note: the #2 N1 digital indication was written up by maintenance as intermittently inoperative but did actually work the entire flight. Recommendations: company should develop a computer program that shows/flags incompatible MEL's, maintenance needs to be more thorough, pilot needs to be more thorough, power management control section of MEL should reference the N1 digital gauge as being required.
Original NASA ASRS Text
Title: AN A310 FLC OPERATED THEIR ACFT WITHOUT ADHERING TO THE RESTRS WITHIN THEIR MEL FOR AN INOP DIGITAL N1 INDICATOR AND AN INOP PWR MGMNT CTL AT DFW, TX.
Narrative: APPROX 1 DAY AFTER OUR FLT FROM DFW WE WERE NOTIFIED BY OUR COMPANY THAT WE DEPARTED WITH INCOMPATIBLE MEL'S (PWR MGMNT CTL AND N1 DIGITAL INDICATION). NOTE: MEL STATES 'ONE OR BOTH MAY BE INOP PROVIDED PWR MGMNT CTL ON THE AFFECTED ENG(S) OPERATES NORMALLY.' CAUSE: MAINT GAVE ME A SIGNAL MAINT DOCUMENT STATING THAT ACFT (GE CF6-80A3 ENGS) WAS AIRWORTHY, WHICH IT WAS NOT. IN MY REVIEW OF THE DOCUMENT, I FAILED TO NOTE THE INCOMPATIBILITY BTWN THE 2 MEL'S AFTER RESEARCHING THEM. FACTORS: MULTIPLE MEL'S AND PREVIOUS WRITE-UPS TO REVIEW, CONCERN FOR PREVIOUS OVERTEMP AND OVERSPD OF ENGS, CONCERN FOR THE ELABORATE AUTOTHROTTLE OFF PROC DUE TO PWR MGMNT CTL PROB, CREW'S LATE ARR AT ARPT DUE TO CREW BUS TURNING AROUND AND GOING BACK TO HOTEL FOR ANOTHER CREW WHOSE BUS JUST BROKE DOWN, NEW CAPT WITH APPROX 100 HRS OF PIC IN THE A310/300, IN REVIEW OF MEL GAUGE REMARKS HAVE THE WORDS 'ONE OR BOTH MAY BE INOP' AND I MAY HAVE KEYED ON THIS OR I MAY HAVE ASSUMED #1 PWR MGMNT CTL INOP SINCE '2 N1 DIGITAL INDICATION WAS INOP WHICH IS PERMISSIBLE BY THE MEL. NOTE: THE #2 N1 DIGITAL INDICATION WAS WRITTEN UP BY MAINT AS INTERMITTENTLY INOP BUT DID ACTUALLY WORK THE ENTIRE FLT. RECOMMENDATIONS: COMPANY SHOULD DEVELOP A COMPUTER PROGRAM THAT SHOWS/FLAGS INCOMPATIBLE MEL'S, MAINT NEEDS TO BE MORE THOROUGH, PLT NEEDS TO BE MORE THOROUGH, PWR MGMNT CTL SECTION OF MEL SHOULD REF THE N1 DIGITAL GAUGE AS BEING REQUIRED.
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.