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A B767-300ER was dispatched in non compliance with the left nose gear wheel and tire assembly missing the outer wheel spacer.
| Attributes | |
| ACN | 524880 |
| Time | |
| Date | 200109 |
| Day | Fri |
| Local Time Of Day | 1801 To 2400 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Environment | |
| Light | Night |
| Aircraft 1 | |
| Operator | common carrier : air carrier |
| Make Model Name | B767-300 and 300 ER |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : maintenance ground : parked |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : lead technician |
| Experience | maintenance lead technician : 3 maintenance technician : 12 |
| ASRS Report | 524880 |
| Events | |
| Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
| Independent Detector | other other : 1 |
| Resolutory Action | none taken : detected after the fact |
| Consequence | other other other |
| Factors | |
| Maintenance | contributing factor : manuals contributing factor : lighting performance deficiency : non compliance with legal requirements performance deficiency : inspection performance deficiency : installation |
| Supplementary | |
| Problem Areas | Chart Or Publication Maintenance Human Performance Aircraft |
| Primary Problem | Maintenance Human Performance |
Narrative:
On fri/sep/01 at approximately XA50 hours replaced left nose tire on shop X. The outer spacer apparently was fused to the outer bearing and was unseen. It was incorrectly assumed that this aircraft effectively required no outer spacer. (The otter spacer was not installed with replacement wheel assembly) one factor contributing was poor lighting on the hanger pad. Another was the confusing maintenance manual written to differentiate the aircraft types and their use of an outer wheel spacer. (Some B767 types use the spacer, some do not.)
Original NASA ASRS Text
Title: A B767-300ER WAS DISPATCHED IN NON COMPLIANCE WITH THE LEFT NOSE GEAR WHEEL AND TIRE ASSEMBLY MISSING THE OUTER WHEEL SPACER.
Narrative: ON FRI/SEP/01 AT APPROX XA50 HOURS REPLACED LEFT NOSE TIRE ON SHOP X. THE OUTER SPACER APPARENTLY WAS FUSED TO THE OUTER BEARING AND WAS UNSEEN. IT WAS INCORRECTLY ASSUMED THAT THIS ACFT EFFECTIVELY REQUIRED NO OUTER SPACER. (THE OTTER SPACER WAS NOT INSTALLED WITH REPLACEMENT WHEEL ASSEMBLY) ONE FACTOR CONTRIBUTING WAS POOR LIGHTING ON THE HANGER PAD. ANOTHER WAS THE CONFUSING MAINT MANUAL WRITTEN TO DIFFERENTIATE THE ACFT TYPES AND THEIR USE OF AN OUTER WHEEL SPACER. (SOME B767 TYPES USE THE SPACER, SOME DO NOT.)
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.