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A B757-200 during a maintenance check it was found the job cards for fuel quantity tank probe checks did not match the maintenance manual procedures and all safety procedures were omitted.
| Attributes | |
| ACN | 693871 |
| Time | |
| Date | 200604 |
| Local Time Of Day | 0601 To 1200 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Aircraft 1 | |
| Controlling Facilities | tower : mmsd.tower |
| Operator | common carrier : air carrier |
| Make Model Name | B757-200 |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : maintenance |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : lead technician |
| Qualification | technician : airframe technician : powerplant |
| ASRS Report | 693871 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | maintenance : technician |
| Events | |
| Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
| Independent Detector | other other : 1 |
| Resolutory Action | none taken : anomaly accepted |
| Consequence | other |
| Factors | |
| Maintenance | contributing factor : manuals contributing factor : work cards performance deficiency : inspection performance deficiency : testing performance deficiency : repair performance deficiency : scheduled maintenance |
| Supplementary | |
| Problem Areas | Maintenance Human Performance Aircraft Chart Or Publication Company |
| Primary Problem | Company |
| Situations | |
| Publication | Maint Manual Proc |
Narrative:
Work cards 1916; 5916 and 6916 has many safety warnings omitted; ie; use of megohmmeter; work card doesn't reflect fully the dangers associated with work card tasks; including equipment; ohmmeter; should include measuring sticks (in case card is issued with fuel indication MEL). I asked production control after outline issues were revealed the response was not acceptable. All one has to do is compare maintenance manual chapter 28-22-00-6 and see for ones self if this is only my imagination; I apologize. This is just a brief summary you will also notice other discrepancies as the instructions tell you to turn on the equipment several steps later; turn it on again. Callback conversation with reporter revealed the following information: the reporter stated the check job cards do not match the procedures in the maintenance manual for the same jobs pertaining to fuel quantity indicating system. Mainly the steps on the check job card omitted safety procedures as opening circuit breakers and tagging; the type of megohmmeter to be used on fuel probe wiring. The reporter states the danger that is present is the wrong selection of megohmmeter and the voltage output of the instrument. The type required is less than 10 volts but some megohmmeters can reach 250 volts and cause arcing which in a fuel tank atmosphere can result in an explosion. Management has been advised of this paperwork discrepancy but no action has been taken to correct this situation.
Original NASA ASRS Text
Title: A B757-200 DURING A MAINT CHK IT WAS FOUND THE JOB CARDS FOR FUEL QUANTITY TANK PROBE CHKS DID NOT MATCH THE MAINT MANUAL PROCS AND ALL SAFETY PROCS WERE OMITTED.
Narrative: WORK CARDS 1916; 5916 AND 6916 HAS MANY SAFETY WARNINGS OMITTED; IE; USE OF MEGOHMMETER; WORK CARD DOESN'T REFLECT FULLY THE DANGERS ASSOCIATED WITH WORK CARD TASKS; INCLUDING EQUIP; OHMMETER; SHOULD INCLUDE MEASURING STICKS (IN CASE CARD IS ISSUED WITH FUEL INDICATION MEL). I ASKED PRODUCTION CTL AFTER OUTLINE ISSUES WERE REVEALED THE RESPONSE WAS NOT ACCEPTABLE. ALL ONE HAS TO DO IS COMPARE MAINT MANUAL CHAPTER 28-22-00-6 AND SEE FOR ONES SELF IF THIS IS ONLY MY IMAGINATION; I APOLOGIZE. THIS IS JUST A BRIEF SUMMARY YOU WILL ALSO NOTICE OTHER DISCREPANCIES AS THE INSTRUCTIONS TELL YOU TO TURN ON THE EQUIP SEVERAL STEPS LATER; TURN IT ON AGAIN. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: THE RPTR STATED THE CHK JOB CARDS DO NOT MATCH THE PROCS IN THE MAINT MANUAL FOR THE SAME JOBS PERTAINING TO FUEL QUANTITY INDICATING SYS. MAINLY THE STEPS ON THE CHK JOB CARD OMITTED SAFETY PROCS AS OPENING CIRCUIT BREAKERS AND TAGGING; THE TYPE OF MEGOHMMETER TO BE USED ON FUEL PROBE WIRING. THE RPTR STATES THE DANGER THAT IS PRESENT IS THE WRONG SELECTION OF MEGOHMMETER AND THE VOLTAGE OUTPUT OF THE INST. THE TYPE REQUIRED IS LESS THAN 10 VOLTS BUT SOME MEGOHMMETERS CAN REACH 250 VOLTS AND CAUSE ARCING WHICH IN A FUEL TANK ATMOSPHERE CAN RESULT IN AN EXPLOSION. MGMNT HAS BEEN ADVISED OF THIS PAPERWORK DISCREPANCY BUT NO ACTION HAS BEEN TAKEN TO CORRECT THIS SITUATION.
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.