37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 590998 |
Time | |
Date | 200308 |
Day | Wed |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | MD-88 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance ground : parked |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | pilot : private pilot : atp |
Experience | maintenance technician : 12 |
ASRS Report | 590998 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 16 |
ASRS Report | 591210 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
Independent Detector | aircraft equipment other aircraft equipment : rudder warning light |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Factors | |
Maintenance | performance deficiency : installation performance deficiency : non compliance with legal requirements performance deficiency : logbook entry |
Supplementary | |
Problem Areas | Aircraft Maintenance Human Performance |
Primary Problem | Maintenance Human Performance |
Narrative:
While working aircraft Y inbound write-up 'unrestr rudder light fails to come on until below 144 KTS.' -- removed and replaced rudder limiter actuator assembly. -- Installed incorrect manufacturer part number Z effective for ships X through Z. Should have installed manufacturer part number X or Y. Effective for ships a-b. -- Adjustment test of rudder system maintenance manual 27-20-06-201-2 was used effective for a-b. -- There is visually no difference in the parts. -- The air carrier X repair shop for this part noticed the effectivity differences when repairing the removed assembly. -- The aircraft was returned to service with no other trouble from the rudder system. -- The aircraft was routed back for limiter assembly replacement upon the discovery of the ineffective assembly on the aircraft. On aug/fri/03, I was informed of the discrepancy on this date. Supplemental 591385: to my understanding, my company is currently working on solutions with the computer programs used for the M/M, ipc, and parts ordering system to aid in preventing this type of event from happening. In the future, I will personally require the ipc reference to be available during R11 ok to install inspections.
Original NASA ASRS Text
Title: AN MD88 WAS DISPATCHED IN NON COMPLIANCE WITH THE INCORRECT RUDDER LIMITER ACTUATOR INSTALLED.
Narrative: WHILE WORKING ACFT Y INBOUND WRITE-UP 'UNRESTR RUDDER LIGHT FAILS TO COME ON UNTIL BELOW 144 KTS.' -- REMOVED AND REPLACED RUDDER LIMITER ACTUATOR ASSEMBLY. -- INSTALLED INCORRECT MANUFACTURER PART NUMBER Z EFFECTIVE FOR SHIPS X THROUGH Z. SHOULD HAVE INSTALLED MANUFACTURER PART NUMBER X OR Y. EFFECTIVE FOR SHIPS A-B. -- ADJUSTMENT TEST OF RUDDER SYSTEM MAINT MANUAL 27-20-06-201-2 WAS USED EFFECTIVE FOR A-B. -- THERE IS VISUALLY NO DIFFERENCE IN THE PARTS. -- THE ACR X REPAIR SHOP FOR THIS PART NOTICED THE EFFECTIVITY DIFFERENCES WHEN REPAIRING THE REMOVED ASSEMBLY. -- THE ACFT WAS RETURNED TO SVC WITH NO OTHER TROUBLE FROM THE RUDDER SYS. -- THE ACFT WAS ROUTED BACK FOR LIMITER ASSEMBLY REPLACEMENT UPON THE DISCOVERY OF THE INEFFECTIVE ASSEMBLY ON THE ACFT. ON AUG/FRI/03, I WAS INFORMED OF THE DISCREPANCY ON THIS DATE. SUPPLEMENTAL 591385: TO MY UNDERSTANDING, MY COMPANY IS CURRENTLY WORKING ON SOLUTIONS WITH THE COMPUTER PROGRAMS USED FOR THE M/M, IPC, AND PARTS ORDERING SYS TO AID IN PREVENTING THIS TYPE OF EVENT FROM HAPPENING. IN THE FUTURE, I WILL PERSONALLY REQUIRE THE IPC REF TO BE AVAILABLE DURING R11 OK TO INSTALL INSPECTIONS.
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.