37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 645167 |
Time | |
Date | 200412 |
Day | Sun |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B767-300 and 300 ER |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : parked |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
ASRS Report | 645167 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
ASRS Report | 645168 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance maintenance problem : improper documentation non adherence : company policies 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 | contributing factor : work cards contributing factor : schedule pressure contributing factor : manuals performance deficiency : installation performance deficiency : non compliance with legal requirements performance deficiency : logbook entry |
Supplementary | |
Problem Areas | Chart Or Publication Aircraft Maintenance Human Performance |
Primary Problem | Maintenance Human Performance |
Narrative:
Installed brake #XXXX ordered by other maintenance personnel. Instead of installing brake #YYYY, had no knowledge that this aircraft was a post engineering change order XXX. Aircraft had arrived from hangar to gate with severe hydraulic brake leak. Changed brake and did not notice any difference between old brake and new brake. Parts need to be more clearly identifiable, insufficient time to verify brake part number.
Original NASA ASRS Text
Title: A B767-300 WAS DISPATCHED WITH THE INCORRECT BRAKE INSTALLED IN #8 POS.
Narrative: INSTALLED BRAKE #XXXX ORDERED BY OTHER MAINT PERSONNEL. INSTEAD OF INSTALLING BRAKE #YYYY, HAD NO KNOWLEDGE THAT THIS ACFT WAS A POST ENGINEERING CHANGE ORDER XXX. ACFT HAD ARRIVED FROM HANGAR TO GATE WITH SEVERE HYD BRAKE LEAK. CHANGED BRAKE AND DID NOT NOTICE ANY DIFFERENCE BTWN OLD BRAKE AND NEW BRAKE. PARTS NEED TO BE MORE CLRLY IDENTIFIABLE, INSUFFICIENT TIME TO VERIFY BRAKE PART NUMBER.
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.