37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 529875 |
Time | |
Date | 200111 |
Day | Wed |
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 | B737-400 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Experience | maintenance technician : 20 |
ASRS Report | 529875 |
Person 2 | |
Affiliation | company : air carrier |
Function | other personnel other |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
Independent Detector | other other : person 1 |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Factors | |
Maintenance | contributing factor : work cards contributing factor : engineering procedure performance deficiency : scheduled maintenance performance deficiency : installation |
Supplementary | |
Problem Areas | Company Chart Or Publication Maintenance Human Performance |
Primary Problem | Company |
Narrative:
Engineering order authority/authorized XXXX revision C dated aug/xa/01, I found at the end of the removal part of the engineering order I had incomplete paperwork for the installation of the valve. I started the installation and was told I would get a complete set of paperwork. I did the steps #1 and #2 of the installation and at that time the paperwork was removed from me to get a complete set. I finished the work by the time I received the complete set of paperwork. As I was stamping the work steps, I found that at the installation part of the work steps I was to remove a line (step #3 of the installation) and install a new line that was not part of the kit I was given. At that time I got the line and tried to install it. But I found that the line was a straight line and I would have to bend the line in a way that would cause the line to hit the lavatory tank and collapse at the bends as to impair the flow of water. So I used the original line that had a 90 degree end and has a gentle curve that would not hit the lavatory tank. This engineering order authority/authorized needs to be redone for specific aircraft not one to cover all aircraft. In some of the installations you have to do different steps.
Original NASA ASRS Text
Title: A B737-400 TECHNICIAN WORKING A WASTE WATER DRAIN VALVE MODIFICATION FOUND INCORRECT INSTRUCTIONS AND INCORRECT PARTS IN THE MODIFICATION KIT.
Narrative: ENGINEERING ORDER AUTH XXXX REVISION C DATED AUG/XA/01, I FOUND AT THE END OF THE REMOVAL PART OF THE ENGINEERING ORDER I HAD INCOMPLETE PAPERWORK FOR THE INSTALLATION OF THE VALVE. I STARTED THE INSTALLATION AND WAS TOLD I WOULD GET A COMPLETE SET OF PAPERWORK. I DID THE STEPS #1 AND #2 OF THE INSTALLATION AND AT THAT TIME THE PAPERWORK WAS REMOVED FROM ME TO GET A COMPLETE SET. I FINISHED THE WORK BY THE TIME I RECEIVED THE COMPLETE SET OF PAPERWORK. AS I WAS STAMPING THE WORK STEPS, I FOUND THAT AT THE INSTALLATION PART OF THE WORK STEPS I WAS TO REMOVE A LINE (STEP #3 OF THE INSTALLATION) AND INSTALL A NEW LINE THAT WAS NOT PART OF THE KIT I WAS GIVEN. AT THAT TIME I GOT THE LINE AND TRIED TO INSTALL IT. BUT I FOUND THAT THE LINE WAS A STRAIGHT LINE AND I WOULD HAVE TO BEND THE LINE IN A WAY THAT WOULD CAUSE THE LINE TO HIT THE LAVATORY TANK AND COLLAPSE AT THE BENDS AS TO IMPAIR THE FLOW OF WATER. SO I USED THE ORIGINAL LINE THAT HAD A 90 DEG END AND HAS A GENTLE CURVE THAT WOULD NOT HIT THE LAVATORY TANK. THIS ENGINEERING ORDER AUTH NEEDS TO BE REDONE FOR SPECIFIC ACFT NOT ONE TO COVER ALL ACFT. IN SOME OF THE INSTALLATIONS YOU HAVE TO DO DIFFERENT STEPS.
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.