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|
Attributes | |
ACN | 740097 |
Time | |
Date | 200704 |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Environment | |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B777 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : maintenance ground : maintenance |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
ASRS Report | 740097 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Factors | |
Maintenance | contributing factor : briefing performance deficiency : scheduled maintenance performance deficiency : unqualified personnel performance deficiency : non compliance with legal requirements performance deficiency : installation |
Supplementary | |
Problem Areas | Aircraft Maintenance Human Performance |
Primary Problem | Maintenance Human Performance |
Narrative:
This landing gear change had too many; as far as I'm concerned; non qualified mechanics working on it. As a system mechanic I work gear; engine; flight controls; etc; every day. On this gear change; over-time mechanics from the cabin; lower structures; etc; were used to partially assemble and install the gear. I came in to find one of the gear assembly partially assembled; at least through the portion of installing the center axle and harness installation; which would include the cross-wired steps that led to this tire failure at ZZZZ. I remember that during the course of this gear change; a lot of work that was performed by lesser experienced mechanics went unsigned for and the 'system' mechanics had to often 'catch up' on paperwork. Given the overtime hours that were expended during that time period on this gear buildup; both gear should have been fully assembled. I have seen that it is my sign off on the card and maintenance task that led to this connection of the #5 and #6 anti-skid harness and tire pressure indication that led to the improper anti-skid action that caused deflation of the #5 tire. But I know that I am fully aware of the need to properly install the harnesses for all anti-skid and tire pressure to ensure proper operation of the anti-skid system.
Original NASA ASRS Text
Title: A B777 ACFT EXPERIENCED MLG TIRE PRESSURE DEFLATION AFTER MLG CHANGE AND CENTER AXLE HARNESS INSTALLATION WAS CROSS-CONNECTED AT ANTI-SKID AND PRESS INDICATION.
Narrative: THIS LNDG GEAR CHANGE HAD TOO MANY; AS FAR AS I'M CONCERNED; NON QUALIFIED MECHS WORKING ON IT. AS A SYS MECH I WORK GEAR; ENG; FLT CTLS; ETC; EVERY DAY. ON THIS GEAR CHANGE; OVER-TIME MECHS FROM THE CABIN; LOWER STRUCTURES; ETC; WERE USED TO PARTIALLY ASSEMBLE AND INSTALL THE GEAR. I CAME IN TO FIND ONE OF THE GEAR ASSEMBLY PARTIALLY ASSEMBLED; AT LEAST THROUGH THE PORTION OF INSTALLING THE CTR AXLE AND HARNESS INSTALLATION; WHICH WOULD INCLUDE THE CROSS-WIRED STEPS THAT LED TO THIS TIRE FAILURE AT ZZZZ. I REMEMBER THAT DURING THE COURSE OF THIS GEAR CHANGE; A LOT OF WORK THAT WAS PERFORMED BY LESSER EXPERIENCED MECHS WENT UNSIGNED FOR AND THE 'SYS' MECHS HAD TO OFTEN 'CATCH UP' ON PAPERWORK. GIVEN THE OVERTIME HRS THAT WERE EXPENDED DURING THAT TIME PERIOD ON THIS GEAR BUILDUP; BOTH GEAR SHOULD HAVE BEEN FULLY ASSEMBLED. I HAVE SEEN THAT IT IS MY SIGN OFF ON THE CARD AND MAINT TASK THAT LED TO THIS CONNECTION OF THE #5 AND #6 ANTI-SKID HARNESS AND TIRE PRESSURE INDICATION THAT LED TO THE IMPROPER ANTI-SKID ACTION THAT CAUSED DEFLATION OF THE #5 TIRE. BUT I KNOW THAT I AM FULLY AWARE OF THE NEED TO PROPERLY INSTALL THE HARNESSES FOR ALL ANTI-SKID AND TIRE PRESSURE TO ENSURE PROPER OP OF THE ANTI-SKID SYS.
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.