37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 652394 |
Time | |
Date | 200503 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B737-400 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : inspector |
ASRS Report | 652394 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation non adherence : far non adherence : published procedure |
Independent Detector | other other : 1 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : engineering procedure contributing factor : schedule pressure contributing factor : work cards performance deficiency : non compliance with legal requirements |
Supplementary | |
Problem Areas | Maintenance Human Performance Aircraft Chart Or Publication |
Primary Problem | Maintenance Human Performance |
Narrative:
I was informed by supervisor that there was a possibility of a missed rii on aircraft X. The east&east door was stuck in its tracks and would not open fully or close. The technician removed the door and I inspected the area for damage. With my findings; I generated several log pages for the damage I found. Because the damage was outside of the maintenance manual limits; engineering support was requested. After several hours; we received a preliminary engineering authority/authorized directing the repair. During the repair; it was discovered that the engineering authority/authorized did not cover us for all the discrepancies; so a revised engineering authority/authorized was written. The engineering authority/authorized directed us to install the door for a 1-TIME revenue flight to ZZZ1 where the door was to be repaired and addressed the other log pages. I bought back the rii required step on the engineering authority/authorized for the door. All this time the flight crew was running out of time (we were told less than 10 mins remained) and the plane was being loaded with passenger as the technician was trying to get the log pages signed and deferred. A log page was never generated stating the engineering authority/authorized had been completed; also the engineering authority/authorized could not be completed because of the last step needing a supervisor to verify the completion of the engineering authority/authorized.
Original NASA ASRS Text
Title: A B737-400 E&E COMPARTMENT DOOR WAS REPAIRED PER AN ENGINEERING AUTH BUT SUPVR SIGNOFF FOR COMPLETION WAS MISSED.
Narrative: I WAS INFORMED BY SUPVR THAT THERE WAS A POSSIBILITY OF A MISSED RII ON ACFT X. THE E&E DOOR WAS STUCK IN ITS TRACKS AND WOULD NOT OPEN FULLY OR CLOSE. THE TECHNICIAN REMOVED THE DOOR AND I INSPECTED THE AREA FOR DAMAGE. WITH MY FINDINGS; I GENERATED SEVERAL LOG PAGES FOR THE DAMAGE I FOUND. BECAUSE THE DAMAGE WAS OUTSIDE OF THE MAINT MANUAL LIMITS; ENGINEERING SUPPORT WAS REQUESTED. AFTER SEVERAL HRS; WE RECEIVED A PRELIMINARY ENGINEERING AUTH DIRECTING THE REPAIR. DURING THE REPAIR; IT WAS DISCOVERED THAT THE ENGINEERING AUTH DID NOT COVER US FOR ALL THE DISCREPANCIES; SO A REVISED ENGINEERING AUTH WAS WRITTEN. THE ENGINEERING AUTH DIRECTED US TO INSTALL THE DOOR FOR A 1-TIME REVENUE FLT TO ZZZ1 WHERE THE DOOR WAS TO BE REPAIRED AND ADDRESSED THE OTHER LOG PAGES. I BOUGHT BACK THE RII REQUIRED STEP ON THE ENGINEERING AUTH FOR THE DOOR. ALL THIS TIME THE FLT CREW WAS RUNNING OUT OF TIME (WE WERE TOLD LESS THAN 10 MINS REMAINED) AND THE PLANE WAS BEING LOADED WITH PAX AS THE TECHNICIAN WAS TRYING TO GET THE LOG PAGES SIGNED AND DEFERRED. A LOG PAGE WAS NEVER GENERATED STATING THE ENGINEERING AUTH HAD BEEN COMPLETED; ALSO THE ENGINEERING AUTH COULD NOT BE COMPLETED BECAUSE OF THE LAST STEP NEEDING A SUPVR TO VERIFY THE COMPLETION OF THE ENGINEERING AUTH.
Data retrieved from NASA's ASRS site as of January 2009 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.