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|
Attributes | |
ACN | 685249 |
Time | |
Date | 200601 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Environment | |
Flight Conditions | Mixed |
Light | Night |
Aircraft 1 | |
Operator | general aviation : corporate |
Make Model Name | B737-200 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance ground : takeoff roll |
Person 1 | |
Affiliation | company : corporate |
Function | flight crew : captain oversight : pic |
Qualification | pilot : cfi pilot : multi engine pilot : flight engineer pilot : commercial pilot : atp |
Experience | flight time last 90 days : 120 flight time total : 16300 flight time type : 6000 |
ASRS Report | 685249 |
Person 2 | |
Affiliation | company : corporate |
Function | flight crew : first officer |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
Independent Detector | aircraft equipment other aircraft equipment : leading edge slat warning other flight crewa other flight crewb |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : schedule pressure performance deficiency : non compliance with legal requirements performance deficiency : repair performance deficiency : inspection |
Supplementary | |
Problem Areas | Maintenance Human Performance Weather Aircraft Chart Or Publication |
Primary Problem | Maintenance Human Performance |
Narrative:
On friday's flight abc we were waiting in ZZZ for a fuel truck. We were informed that our normal vendor had returned to refill the truck and would be late. The next message was that the truck had broken down returning to the airport. A second vendor was called and sent to the airplane. It hooked up but was unable to pump fuel. The truck disconnected and left. The fueling process was being monitored by our ground handler/mechanic. My first officer and I were busy collecting WX and looking at alternatives from the cockpit. The WX in the area was marginal and deteriorating with blowing snow. Our destination; ZZZ1 was IFR. ZZZ2 was VFR with a good forecast. We did not have sufficient fuel for ZZZ1 so a decision was made to rerte the flight through ZZZ2 for fuel. We accomplished normal pre-start procedures and our ground marshaller gave us the cleared for start signal. This indicated that the area was clear and an external walkaround had been completed. After takeoff we had a cockpit indication that some of the slats had fully retracted. We cycled the flaps and they extended normally. Upon retraction we had the same indication. The airplane had no roll and an external view of the slats indicated they were up. The WX at our departure was questionable for a non precision approach; so we elected to continue to ZZZ2. The approach and landing in ZZZ2 was normal and on flap retraction taxiing in the slat indication cleared itself. A postflt inspection did not reveal any abnormalities. The airplane was fueled and we departed for ZZZ1. The flight was routine and we did not experience any faults with the flap/slat system. After shutdown I made a maintenance log entry advising that we had an indication problem with the slats that had cleared itself. It was intended as an advisory that the system was now performing normally but it should be monitored. Over the next few days I learned that the fuel door and affected slats were damaged. The damage was not readily visible from the ground with the slats retracted. We were later told that the unlatched door was mentioned to a mechanic by the fueler. The door was closed and latched so the mechanic let it go. This was not communicated to the crew. We all know that mistakes happen and we have safety processes to correct them. The door was overlooked and can be corrected so that it does not happen again. When it was discovered by the ground crew in ZZZ2 that the fuel door did not appear to be normal; it should have been communicated to the flight crew before departure. CRM relies on open communication between all personnel involved in the process. We must make certain that our ground crews are aware they are a key piece in this chain and must report any damage or suspected damage to the flight crew for further evaluation.
Original NASA ASRS Text
Title: A B737-200 WAS DISPATCHED WITH THE R WING FUELING PANEL DOOR NOT CLOSED AND LOCKED. LEADING EDGE WARNING INFLT AND DAMAGE TO SLAT AND FUELING PANEL DOOR WAS INCURRED.
Narrative: ON FRIDAY'S FLT ABC WE WERE WAITING IN ZZZ FOR A FUEL TRUCK. WE WERE INFORMED THAT OUR NORMAL VENDOR HAD RETURNED TO REFILL THE TRUCK AND WOULD BE LATE. THE NEXT MESSAGE WAS THAT THE TRUCK HAD BROKEN DOWN RETURNING TO THE ARPT. A SECOND VENDOR WAS CALLED AND SENT TO THE AIRPLANE. IT HOOKED UP BUT WAS UNABLE TO PUMP FUEL. THE TRUCK DISCONNECTED AND LEFT. THE FUELING PROCESS WAS BEING MONITORED BY OUR GND HANDLER/MECH. MY FO AND I WERE BUSY COLLECTING WX AND LOOKING AT ALTERNATIVES FROM THE COCKPIT. THE WX IN THE AREA WAS MARGINAL AND DETERIORATING WITH BLOWING SNOW. OUR DEST; ZZZ1 WAS IFR. ZZZ2 WAS VFR WITH A GOOD FORECAST. WE DID NOT HAVE SUFFICIENT FUEL FOR ZZZ1 SO A DECISION WAS MADE TO RERTE THE FLT THROUGH ZZZ2 FOR FUEL. WE ACCOMPLISHED NORMAL PRE-START PROCS AND OUR GND MARSHALLER GAVE US THE CLRED FOR START SIGNAL. THIS INDICATED THAT THE AREA WAS CLR AND AN EXTERNAL WALKAROUND HAD BEEN COMPLETED. AFTER TKOF WE HAD A COCKPIT INDICATION THAT SOME OF THE SLATS HAD FULLY RETRACTED. WE CYCLED THE FLAPS AND THEY EXTENDED NORMALLY. UPON RETRACTION WE HAD THE SAME INDICATION. THE AIRPLANE HAD NO ROLL AND AN EXTERNAL VIEW OF THE SLATS INDICATED THEY WERE UP. THE WX AT OUR DEP WAS QUESTIONABLE FOR A NON PRECISION APCH; SO WE ELECTED TO CONTINUE TO ZZZ2. THE APCH AND LNDG IN ZZZ2 WAS NORMAL AND ON FLAP RETRACTION TAXIING IN THE SLAT INDICATION CLRED ITSELF. A POSTFLT INSPECTION DID NOT REVEAL ANY ABNORMALITIES. THE AIRPLANE WAS FUELED AND WE DEPARTED FOR ZZZ1. THE FLT WAS ROUTINE AND WE DID NOT EXPERIENCE ANY FAULTS WITH THE FLAP/SLAT SYS. AFTER SHUTDOWN I MADE A MAINT LOG ENTRY ADVISING THAT WE HAD AN INDICATION PROB WITH THE SLATS THAT HAD CLRED ITSELF. IT WAS INTENDED AS AN ADVISORY THAT THE SYS WAS NOW PERFORMING NORMALLY BUT IT SHOULD BE MONITORED. OVER THE NEXT FEW DAYS I LEARNED THAT THE FUEL DOOR AND AFFECTED SLATS WERE DAMAGED. THE DAMAGE WAS NOT READILY VISIBLE FROM THE GND WITH THE SLATS RETRACTED. WE WERE LATER TOLD THAT THE UNLATCHED DOOR WAS MENTIONED TO A MECH BY THE FUELER. THE DOOR WAS CLOSED AND LATCHED SO THE MECH LET IT GO. THIS WAS NOT COMMUNICATED TO THE CREW. WE ALL KNOW THAT MISTAKES HAPPEN AND WE HAVE SAFETY PROCESSES TO CORRECT THEM. THE DOOR WAS OVERLOOKED AND CAN BE CORRECTED SO THAT IT DOES NOT HAPPEN AGAIN. WHEN IT WAS DISCOVERED BY THE GND CREW IN ZZZ2 THAT THE FUEL DOOR DID NOT APPEAR TO BE NORMAL; IT SHOULD HAVE BEEN COMMUNICATED TO THE FLT CREW BEFORE DEP. CRM RELIES ON OPEN COM BTWN ALL PERSONNEL INVOLVED IN THE PROCESS. WE MUST MAKE CERTAIN THAT OUR GND CREWS ARE AWARE THEY ARE A KEY PIECE IN THIS CHAIN AND MUST RPT ANY DAMAGE OR SUSPECTED DAMAGE TO THE FLT CREW FOR FURTHER EVALUATION.
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.