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A B737-700 left engine was discovered to have the retaining ring pins missing during a fan blade lubrication.
| Attributes | |
| ACN | 597405 |
| Time | |
| Date | 200310 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Aircraft 1 | |
| Operator | common carrier : air carrier |
| Make Model Name | B737-700 |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : maintenance |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : technician |
| Qualification | technician : airframe technician : powerplant |
| ASRS Report | 597405 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | maintenance : inspector |
| Qualification | technician : powerplant technician : airframe |
| ASRS Report | 597943 |
| Events | |
| Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
| Independent Detector | other other : person 2 |
| Resolutory Action | none taken : detected after the fact |
| Consequence | other other |
| Factors | |
| Maintenance | contributing factor : work cards contributing factor : schedule pressure performance deficiency : installation performance deficiency : non compliance with legal requirements performance deficiency : scheduled maintenance performance deficiency : inspection |
| Supplementary | |
| Problem Areas | Aircraft Chart Or Publication Maintenance Human Performance |
| Primary Problem | Maintenance Human Performance |
Narrative:
On oct/thu/03, I was performing a #1 engine fan blade lube and inspection and found the retaining ring pins were missing. Last night, my supervisor informed me that I had complied with this similar inspection in march of 2003 on this same aircraft. To my knowledge, the pins were installed at that time. Callback conversation with reporter revealed the following information: the reporter stated the engine fan blade lubrication is a critical job and, when performed, is closely watched by an inspector as each procedure is completed. The reporter said in the months between the initial fan lubrication in march of 2003 and the lubrication in october of 2003 the fan section was opened for a fan blade balance job and this is where the retaining ring pins may have been left out. The reporter stated this may be hard to prove as the signoff for the work was 'fan balance accomplished' with no details.
Original NASA ASRS Text
Title: A B737-700 L ENG WAS DISCOVERED TO HAVE THE RETAINING RING PINS MISSING DURING A FAN BLADE LUBRICATION.
Narrative: ON OCT/THU/03, I WAS PERFORMING A #1 ENG FAN BLADE LUBE AND INSPECTION AND FOUND THE RETAINING RING PINS WERE MISSING. LAST NIGHT, MY SUPVR INFORMED ME THAT I HAD COMPLIED WITH THIS SIMILAR INSPECTION IN MARCH OF 2003 ON THIS SAME ACFT. TO MY KNOWLEDGE, THE PINS WERE INSTALLED AT THAT TIME. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THE RPTR STATED THE ENG FAN BLADE LUBRICATION IS A CRITICAL JOB AND, WHEN PERFORMED, IS CLOSELY WATCHED BY AN INSPECTOR AS EACH PROC IS COMPLETED. THE RPTR SAID IN THE MONTHS BTWN THE INITIAL FAN LUBRICATION IN MARCH OF 2003 AND THE LUBRICATION IN OCTOBER OF 2003 THE FAN SECTION WAS OPENED FOR A FAN BLADE BALANCE JOB AND THIS IS WHERE THE RETAINING RING PINS MAY HAVE BEEN LEFT OUT. THE RPTR STATED THIS MAY BE HARD TO PROVE AS THE SIGNOFF FOR THE WORK WAS 'FAN BAL ACCOMPLISHED' WITH NO DETAILS.
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.