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Attributes | |
ACN | 534509 |
Time | |
Date | 200201 |
Day | Thu |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | MD-80 Series (DC-9-80) Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance ground : parked |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : powerplant technician : airframe technician : inspection authority |
Experience | maintenance technician : 10 |
ASRS Report | 534509 |
Person 2 | |
Affiliation | company : air carrier |
Qualification | technician : fcc technician : airframe technician : powerplant |
Experience | maintenance technician : 8.5 |
ASRS Report | 534510 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance maintenance problem : improper documentation non adherence : published procedure non adherence : far |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : schedule pressure performance deficiency : scheduled maintenance performance deficiency : inspection performance deficiency : logbook entry performance deficiency : non compliance with legal requirements performance deficiency : testing |
Supplementary | |
Problem Areas | Maintenance Human Performance Aircraft Chart Or Publication Environmental Factor |
Primary Problem | Maintenance Human Performance |
Narrative:
This letter is in regards to my possibly leaving a couple of circuit breakers pulled and tagged after performing an engine/APU fire bottle squib inspection. On jan/thu/02, I carried out an ron (remain overnight) check on one of our MD80 aircraft. This was my second MD80 ron check of the night. As part of the check, I was required to inspect/replace the engine/APU fire bottle squibs. In this case, all 6 squibs had to be replaced with new, and functionally tested. Myself, another mechanic, and 2 quality control inspectors carried out the functional test in accordance with the MD80 maintenance manual section 26-20. Myself and one of the quality control inspectors went through the functional test in the cockpit step by step, while the other mechanic and second quality control inspector verified the proper results on the test equipment back in the tail where the fire bottles are located. This test required us to pull the fire bottle circuit breakers numerous times while also pulling the discharge handles. In addition to this, we had to go outside the aircraft and open a panel by the APU and further test that system. Upon returning to the cockpit, the quality control inspector read the last of the maintenance manual tests which (I believed) required us to clean up the cockpit (ie, reset circuit breakers and return all switches and handles to their normal position). I believed I had accomplished this last step primarily because this was a procedure that neither the other mechanic, the quality control inspector nor I had performed before, so we went through the check slowly step by step in accordance with the maintenance manual. However, it may be I still missed resetting 2 circuit breakers. After the functional test, I had to climb back into the tail of the airplane, in a very confined space, and disconnect all the test equipment, reconnect the squib cannon plugs, then safety them appropriately so quality control would buy them off. I rushed to round up my tools, clean up the area and depart the airplane to finish the paperwork. When the logbook was finished, I ran it back out to the airplane, where I discovered they had already closed the passenger door and pulled the jetway. I had to reach out and hand the pilot the logbook through his sliding window. This last action precluded me from carrying out a predep check on the aircraft, which would have given me an opportunity to get back into the cockpit and doublechk the circuit breakers.
Original NASA ASRS Text
Title: AN MD80 WAS DISPATCHED IN NON COMPLIANCE WITH THE APU FIRE BOTTLE CIRCUIT BREAKERS PULLED AND LOCKED OPEN FOR MAINT.
Narrative: THIS LETTER IS IN REGARDS TO MY POSSIBLY LEAVING A COUPLE OF CIRCUIT BREAKERS PULLED AND TAGGED AFTER PERFORMING AN ENG/APU FIRE BOTTLE SQUIB INSPECTION. ON JAN/THU/02, I CARRIED OUT AN RON (REMAIN OVERNIGHT) CHK ON ONE OF OUR MD80 ACFT. THIS WAS MY SECOND MD80 RON CHK OF THE NIGHT. AS PART OF THE CHK, I WAS REQUIRED TO INSPECT/REPLACE THE ENG/APU FIRE BOTTLE SQUIBS. IN THIS CASE, ALL 6 SQUIBS HAD TO BE REPLACED WITH NEW, AND FUNCTIONALLY TESTED. MYSELF, ANOTHER MECH, AND 2 QUALITY CTL INSPECTORS CARRIED OUT THE FUNCTIONAL TEST IN ACCORDANCE WITH THE MD80 MAINT MANUAL SECTION 26-20. MYSELF AND ONE OF THE QUALITY CTL INSPECTORS WENT THROUGH THE FUNCTIONAL TEST IN THE COCKPIT STEP BY STEP, WHILE THE OTHER MECH AND SECOND QUALITY CTL INSPECTOR VERIFIED THE PROPER RESULTS ON THE TEST EQUIP BACK IN THE TAIL WHERE THE FIRE BOTTLES ARE LOCATED. THIS TEST REQUIRED US TO PULL THE FIRE BOTTLE CIRCUIT BREAKERS NUMEROUS TIMES WHILE ALSO PULLING THE DISCHARGE HANDLES. IN ADDITION TO THIS, WE HAD TO GO OUTSIDE THE ACFT AND OPEN A PANEL BY THE APU AND FURTHER TEST THAT SYS. UPON RETURNING TO THE COCKPIT, THE QUALITY CTL INSPECTOR READ THE LAST OF THE MAINT MANUAL TESTS WHICH (I BELIEVED) REQUIRED US TO CLEAN UP THE COCKPIT (IE, RESET CIRCUIT BREAKERS AND RETURN ALL SWITCHES AND HANDLES TO THEIR NORMAL POS). I BELIEVED I HAD ACCOMPLISHED THIS LAST STEP PRIMARILY BECAUSE THIS WAS A PROC THAT NEITHER THE OTHER MECH, THE QUALITY CTL INSPECTOR NOR I HAD PERFORMED BEFORE, SO WE WENT THROUGH THE CHK SLOWLY STEP BY STEP IN ACCORDANCE WITH THE MAINT MANUAL. HOWEVER, IT MAY BE I STILL MISSED RESETTING 2 CIRCUIT BREAKERS. AFTER THE FUNCTIONAL TEST, I HAD TO CLB BACK INTO THE TAIL OF THE AIRPLANE, IN A VERY CONFINED SPACE, AND DISCONNECT ALL THE TEST EQUIP, RECONNECT THE SQUIB CANNON PLUGS, THEN SAFETY THEM APPROPRIATELY SO QUALITY CTL WOULD BUY THEM OFF. I RUSHED TO ROUND UP MY TOOLS, CLEAN UP THE AREA AND DEPART THE AIRPLANE TO FINISH THE PAPERWORK. WHEN THE LOGBOOK WAS FINISHED, I RAN IT BACK OUT TO THE AIRPLANE, WHERE I DISCOVERED THEY HAD ALREADY CLOSED THE PAX DOOR AND PULLED THE JETWAY. I HAD TO REACH OUT AND HAND THE PLT THE LOGBOOK THROUGH HIS SLIDING WINDOW. THIS LAST ACTION PRECLUDED ME FROM CARRYING OUT A PREDEP CHK ON THE ACFT, WHICH WOULD HAVE GIVEN ME AN OPPORTUNITY TO GET BACK INTO THE COCKPIT AND DOUBLECHK THE CIRCUIT BREAKERS.
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.