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|
Attributes | |
ACN | 655249 |
Time | |
Date | 200504 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B757-200 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
ASRS Report | 655249 |
Person 2 | |
Affiliation | company : air carrier |
Function | maintenance : technician oversight : supervisor |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : published procedure non adherence : far |
Independent Detector | other other : 3 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | performance deficiency : testing performance deficiency : non compliance with legal requirements performance deficiency : logbook entry performance deficiency : inspection performance deficiency : installation |
Supplementary | |
Problem Areas | Aircraft Chart Or Publication Maintenance Human Performance |
Primary Problem | Maintenance Human Performance |
Narrative:
I was tasked to clear a deferral from aircraft X. The write-up was: call button and chimes at xx-abc inoperative. Button is broken. I went to the aircraft to see the situation of what the problem was. I investigated that the psu had to be changed due that we do not replace the call button only. I returned to the shop with the part number of the psu in question and looked it up in the ipc manual. Checked effectivity and proceeded to order a new one. Ordered new psu and looked up and printed maintenance manual reference for right&I of psu and oxygen generators. Gathered tools for removal and proceeded to the aircraft for removal. Dropped psu from ceiling. Pulled circuit breakers and proceeded with removal of psu. Then proceeded the right&I of oxygen generators in new psu per maintenance manual. Proceeded with tests and then put aircraft back to confign. During the signoff of the deferral in the corrective action block; I used the MEL reference of 25-20-18 instead of the correct maintenance manual reference of 25-23-01-04. It is to my knowledge that I installed oxygen generators in psu; but during c-chk the psu was dropped from ceiling and the oxygen generators were missing. If the oxygen generator are missing from this psu; it was an inadvertent mistake that I could have made. This was not an intentional act.
Original NASA ASRS Text
Title: A B757-200 PSU WAS REPLACED AT XX ABC FOR DAMAGE. AT A LATER CHK THE PSU'S WERE TESTED AND XX-ABC OXYGEN CANISTERS WERE FOUND MISSING.
Narrative: I WAS TASKED TO CLR A DEFERRAL FROM ACFT X. THE WRITE-UP WAS: CALL BUTTON AND CHIMES AT XX-ABC INOP. BUTTON IS BROKEN. I WENT TO THE ACFT TO SEE THE SIT OF WHAT THE PROB WAS. I INVESTIGATED THAT THE PSU HAD TO BE CHANGED DUE THAT WE DO NOT REPLACE THE CALL BUTTON ONLY. I RETURNED TO THE SHOP WITH THE PART NUMBER OF THE PSU IN QUESTION AND LOOKED IT UP IN THE IPC MANUAL. CHKED EFFECTIVITY AND PROCEEDED TO ORDER A NEW ONE. ORDERED NEW PSU AND LOOKED UP AND PRINTED MAINT MANUAL REF FOR R&I OF PSU AND OXYGEN GENERATORS. GATHERED TOOLS FOR REMOVAL AND PROCEEDED TO THE ACFT FOR REMOVAL. DROPPED PSU FROM CEILING. PULLED CIRCUIT BREAKERS AND PROCEEDED WITH REMOVAL OF PSU. THEN PROCEEDED THE R&I OF OXYGEN GENERATORS IN NEW PSU PER MAINT MANUAL. PROCEEDED WITH TESTS AND THEN PUT ACFT BACK TO CONFIGN. DURING THE SIGNOFF OF THE DEFERRAL IN THE CORRECTIVE ACTION BLOCK; I USED THE MEL REF OF 25-20-18 INSTEAD OF THE CORRECT MAINT MANUAL REF OF 25-23-01-04. IT IS TO MY KNOWLEDGE THAT I INSTALLED OXYGEN GENERATORS IN PSU; BUT DURING C-CHK THE PSU WAS DROPPED FROM CEILING AND THE OXYGEN GENERATORS WERE MISSING. IF THE OXYGEN GENERATOR ARE MISSING FROM THIS PSU; IT WAS AN INADVERTENT MISTAKE THAT I COULD HAVE MADE. THIS WAS NOT AN INTENTIONAL ACT.
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.