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|
Attributes | |
ACN | 682860 |
Time | |
Date | 200512 |
Local Time Of Day | 1801 To 2400 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | general aviation : corporate |
Make Model Name | Gulfstream I (Large Turboprop) |
Flight Phase | ground : maintenance |
Flight Plan | IFR |
Person 1 | |
Affiliation | company other |
Function | maintenance : technician maintenance : inspector |
Qualification | technician : powerplant technician : inspection authority technician : airframe |
Experience | maintenance technician : 7 |
ASRS Report | 682860 |
Person 2 | |
Affiliation | company other |
Function | maintenance : lead 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 |
Factors | |
Maintenance | contributing factor : manuals contributing factor : work cards performance deficiency : non compliance with legal requirements performance deficiency : scheduled maintenance performance deficiency : logbook entry performance deficiency : inspection |
Supplementary | |
Problem Areas | Chart Or Publication Maintenance Human Performance Aircraft |
Primary Problem | Maintenance Human Performance |
Narrative:
When arriving at work on dec/tue/05 I was getting my turnover and work assignments when the lead told me about a rudder that was at another hangar which needed to be balanced. I had several projects in work; so assumed he would get with me when he wanted me. When called; I drove to hangar and met mechanic working this issue. We had several; but not all sheets of maintenance manual reference. He also had an experienced mechanic helping him set up balance beam; etc. I questioned them but they said the verbiage was confusing but figures were accurate. What I had of the verbiage was confusing; but setup for the most part represented what we actually had set up on the balance beam. They walked me through the procedure; we added one weight and since the signature paperwork was not there; disassembled the jig and both headed back to normal work place. Later; I was called to sign paperwork. I went and printed complete maintenance manual reference G-100 maintenance manual 51-60-00; and quickly reviewed it and signed paperwork prior to leaving for the night. I kept paperwork and after reading it several times more thoroughly; the next day became increasingly skeptical. I felt out one more experienced inspector; but he also was unsure of the process. The paperwork was done and at this point I felt we had a time proven process and no cause for immediate concern; but since paperwork was ambiguous and not followed to the letter; I am protecting myself as well as starting process of clarifying balancing process.
Original NASA ASRS Text
Title: A G100 TECHNICIAN TAKING THE TURNOVER ON A RUDDER BAL PROC FINDS THE WRITTEN INSTRUCTIONS CONFUSING BUT RELIED ON A TIME PROVEN PROCESS AND TECHNICAL EXPERIENCE. REQUESTED MANUAL REVISION CLARIFICATION.
Narrative: WHEN ARRIVING AT WORK ON DEC/TUE/05 I WAS GETTING MY TURNOVER AND WORK ASSIGNMENTS WHEN THE LEAD TOLD ME ABOUT A RUDDER THAT WAS AT ANOTHER HANGAR WHICH NEEDED TO BE BALANCED. I HAD SEVERAL PROJECTS IN WORK; SO ASSUMED HE WOULD GET WITH ME WHEN HE WANTED ME. WHEN CALLED; I DROVE TO HANGAR AND MET MECH WORKING THIS ISSUE. WE HAD SEVERAL; BUT NOT ALL SHEETS OF MAINT MANUAL REF. HE ALSO HAD AN EXPERIENCED MECH HELPING HIM SET UP BAL BEAM; ETC. I QUESTIONED THEM BUT THEY SAID THE VERBIAGE WAS CONFUSING BUT FIGURES WERE ACCURATE. WHAT I HAD OF THE VERBIAGE WAS CONFUSING; BUT SETUP FOR THE MOST PART REPRESENTED WHAT WE ACTUALLY HAD SET UP ON THE BAL BEAM. THEY WALKED ME THROUGH THE PROC; WE ADDED ONE WT AND SINCE THE SIGNATURE PAPERWORK WAS NOT THERE; DISASSEMBLED THE JIG AND BOTH HEADED BACK TO NORMAL WORK PLACE. LATER; I WAS CALLED TO SIGN PAPERWORK. I WENT AND PRINTED COMPLETE MAINT MANUAL REF G-100 MAINT MANUAL 51-60-00; AND QUICKLY REVIEWED IT AND SIGNED PAPERWORK PRIOR TO LEAVING FOR THE NIGHT. I KEPT PAPERWORK AND AFTER READING IT SEVERAL TIMES MORE THOROUGHLY; THE NEXT DAY BECAME INCREASINGLY SKEPTICAL. I FELT OUT ONE MORE EXPERIENCED INSPECTOR; BUT HE ALSO WAS UNSURE OF THE PROCESS. THE PAPERWORK WAS DONE AND AT THIS POINT I FELT WE HAD A TIME PROVEN PROCESS AND NO CAUSE FOR IMMEDIATE CONCERN; BUT SINCE PAPERWORK WAS AMBIGUOUS AND NOT FOLLOWED TO THE LETTER; I AM PROTECTING MYSELF AS WELL AS STARTING PROCESS OF CLARIFYING BALANCING PROCESS.
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.