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|
Attributes | |
ACN | 537373 |
Time | |
Date | 200202 |
Day | Mon |
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 | Medium Large Transport, Low Wing, 2 Turbojet Eng |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance ground : parked |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | other personnel |
Qualification | other |
ASRS Report | 537373 |
Person 2 | |
Affiliation | company : air carrier |
Function | oversight : supervisor |
Events | |
Anomaly | maintenance problem : improper maintenance maintenance problem : improper documentation non adherence : published procedure non adherence : far non adherence : company policies |
Independent Detector | other other : person 2 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : schedule pressure performance deficiency : inspection performance deficiency : logbook entry performance deficiency : unqualified personnel performance deficiency : non compliance with legal requirements |
Supplementary | |
Problem Areas | Maintenance Human Performance Aircraft |
Primary Problem | Maintenance Human Performance |
Narrative:
At approximately XA30Z, the ZZZ maintenance called on the X line to ZZZ1 ramp to advise aircraft X on flight abc was not airworthy due to a problem with work performed by a non qualified mechanic. Maintenance advised the aircraft was OTS and the flight could not legally depart. At that time, there was no out- time displayed in the file indicating the flight was still at the gate, but that he had called the FAA tower to instruct them not to let the flight take off. Several mins after this call, this flight took off in spite of the ZZZ instructions to hold it at ZZZ1. Several factors contributed to the confusion which resulted in the flight not being stopped. The primary problem for dispatch appears to be that out-time was not sent to dispatch computer when the flight left the gate which gave me the false impression that it was still at the gate when actually it had pushed. Secondly, the ZZZ1 ramp indicated they would hold the flight when actually it had left the gate already. Third, the ramp indicated they had communication to the FAA ZZZ1 tower that the flight should not be allowed to depart. In hindsight, I should not have trusted their communication which was not effective enough to accomplish having the FAA withhold the takeoff clearance. Even though the ZZZ1 ramp manager stated that he had called the FAA, I should have called them myself to ensure that takeoff clearance was withheld.
Original NASA ASRS Text
Title: A DISPATCHER RPTS A MEDIUM LARGE TRANSPORT WAS DISPATCHED IN NON COMPLIANCE DUE TO WORK ACCOMPLISHED BY AN UNQUALIFIED TECHNICIAN.
Narrative: AT APPROX XA30Z, THE ZZZ MAINT CALLED ON THE X LINE TO ZZZ1 RAMP TO ADVISE ACFT X ON FLT ABC WAS NOT AIRWORTHY DUE TO A PROB WITH WORK PERFORMED BY A NON QUALIFIED MECH. MAINT ADVISED THE ACFT WAS OTS AND THE FLT COULD NOT LEGALLY DEPART. AT THAT TIME, THERE WAS NO OUT- TIME DISPLAYED IN THE FILE INDICATING THE FLT WAS STILL AT THE GATE, BUT THAT HE HAD CALLED THE FAA TWR TO INSTRUCT THEM NOT TO LET THE FLT TAKE OFF. SEVERAL MINS AFTER THIS CALL, THIS FLT TOOK OFF IN SPITE OF THE ZZZ INSTRUCTIONS TO HOLD IT AT ZZZ1. SEVERAL FACTORS CONTRIBUTED TO THE CONFUSION WHICH RESULTED IN THE FLT NOT BEING STOPPED. THE PRIMARY PROB FOR DISPATCH APPEARS TO BE THAT OUT-TIME WAS NOT SENT TO DISPATCH COMPUTER WHEN THE FLT LEFT THE GATE WHICH GAVE ME THE FALSE IMPRESSION THAT IT WAS STILL AT THE GATE WHEN ACTUALLY IT HAD PUSHED. SECONDLY, THE ZZZ1 RAMP INDICATED THEY WOULD HOLD THE FLT WHEN ACTUALLY IT HAD LEFT THE GATE ALREADY. THIRD, THE RAMP INDICATED THEY HAD COM TO THE FAA ZZZ1 TWR THAT THE FLT SHOULD NOT BE ALLOWED TO DEPART. IN HINDSIGHT, I SHOULD NOT HAVE TRUSTED THEIR COM WHICH WAS NOT EFFECTIVE ENOUGH TO ACCOMPLISH HAVING THE FAA WITHHOLD THE TKOF CLRNC. EVEN THOUGH THE ZZZ1 RAMP MGR STATED THAT HE HAD CALLED THE FAA, I SHOULD HAVE CALLED THEM MYSELF TO ENSURE THAT TKOF CLRNC WAS WITHHELD.
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.