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|
Attributes | |
ACN | 633047 |
Time | |
Date | 200409 |
Day | Thu |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Environment | |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B757-300 |
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 | technician : powerplant |
Experience | maintenance technician : 12 |
ASRS Report | 633047 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 6 |
ASRS Report | 633046 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance maintenance problem : improper documentation non adherence : far non adherence : published procedure |
Independent Detector | other other : 3 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | performance deficiency : installation performance deficiency : inspection performance deficiency : non compliance with legal requirements performance deficiency : logbook entry |
Supplementary | |
Problem Areas | Maintenance Human Performance Aircraft Chart Or Publication |
Primary Problem | Maintenance Human Performance |
Situations | |
Publication | Illustrated Parts Catalog |
Narrative:
My co-worker and I found the L1 and R1 door slides were within 30 days of their overhaul date. We took three part numbers from the old slides and went to the office to order them. I did not do the research at the computer or order the parts. However, when filling out the parts tags, I saw the part numbers from the old slide did not match the numbers on the new slide. Why, I don't know. I also didn't realize my mistake when I entered the non-routine in the computer program as I had to do a forced parts change. I have no excuses, and have taken full responsibility for my very serious oversights. Callback conversation with reporter revealed the following information: the reporter stated the problem should have been discovered when the part numbers were being loaded into the maintenance computer and a forced parts change transaction was required. The reporter said the part numbers from the removed slides were used to order the replacement slides and when stores delivered the slides, the part numbers were not checked. The slides delivered were for a B757-200. The reporter stated the slide installation went smoothly with no problems encountered. The reporter said the only difference noted was the part numbers and later found out the 300 model slide may be wider.
Original NASA ASRS Text
Title: A B757-300 WAS DISPATCHED IN NON COMPLIANCE WITH B757-200 ESCAPE SLIDES INSTALLED AT DOORS 1L AND 1R.
Narrative: MY CO-WORKER AND I FOUND THE L1 AND R1 DOOR SLIDES WERE WITHIN 30 DAYS OF THEIR OVERHAUL DATE. WE TOOK THREE PART NUMBERS FROM THE OLD SLIDES AND WENT TO THE OFFICE TO ORDER THEM. I DID NOT DO THE RESEARCH AT THE COMPUTER OR ORDER THE PARTS. HOWEVER, WHEN FILLING OUT THE PARTS TAGS, I SAW THE PART NUMBERS FROM THE OLD SLIDE DID NOT MATCH THE NUMBERS ON THE NEW SLIDE. WHY, I DON'T KNOW. I ALSO DIDN'T REALIZE MY MISTAKE WHEN I ENTERED THE NON-ROUTINE IN THE COMPUTER PROGRAM AS I HAD TO DO A FORCED PARTS CHANGE. I HAVE NO EXCUSES, AND HAVE TAKEN FULL RESPONSIBILITY FOR MY VERY SERIOUS OVERSIGHTS. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THE RPTR STATED THE PROB SHOULD HAVE BEEN DISCOVERED WHEN THE PART NUMBERS WERE BEING LOADED INTO THE MAINT COMPUTER AND A FORCED PARTS CHANGE TRANSACTION WAS REQUIRED. THE RPTR SAID THE PART NUMBERS FROM THE REMOVED SLIDES WERE USED TO ORDER THE REPLACEMENT SLIDES AND WHEN STORES DELIVERED THE SLIDES, THE PART NUMBERS WERE NOT CHECKED. THE SLIDES DELIVERED WERE FOR A B757-200. THE RPTR STATED THE SLIDE INSTALLATION WENT SMOOTHLY WITH NO PROBS ENCOUNTERED. THE RPTR SAID THE ONLY DIFFERENCE NOTED WAS THE PART NUMBERS AND LATER FOUND OUT THE 300 MODEL SLIDE MAY BE WIDER.
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.