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A B737-800 contract maintenance mechanic pulled wrong circuit breakers including both fuel lever circuit breakers while attempting to accomplish MEL procedure. Unable to start engines at pushback.
| Attributes | |
| ACN | 753912 |
| Time | |
| Date | 200709 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Environment | |
| Flight Conditions | VMC |
| Light | Daylight |
| Aircraft 1 | |
| Operator | common carrier : air carrier |
| Make Model Name | B737-800 |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : pushback |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | flight crew : captain oversight : pic |
| Experience | flight time last 90 days : 150 flight time type : 3500 |
| ASRS Report | 753912 |
| Person 2 | |
| Affiliation | other |
| Function | maintenance : technician |
| Events | |
| Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance maintenance problem : non compliance with mel non adherence : far non adherence : published procedure |
| Independent Detector | aircraft equipment other aircraft equipment : eng start failed |
| Resolutory Action | other |
| Consequence | other |
| Factors | |
| Maintenance | performance deficiency : non compliance with legal requirements |
| Supplementary | |
| Problem Areas | Aircraft Maintenance Human Performance |
| Primary Problem | Maintenance Human Performance |
Narrative:
Upon arriving at the aircraft maintenance person was completing an MEL on the HUD from a previous flight. After complete I called air carrier maintenance to clarify that it was done correctly. I was briefed by both the contract maintenance tech and air carrier maintenance that all was in order. After pushback during #1 engine start; no light-off occurred when I put the fuel lever to idle. I ran the QRH procedure and reattempted the start. Again no light-off. We towed back to the gate after checking that all circuit breakers were in; which they were. Upon closer inspection we found that the contract maintenance tech pulled the incorrect circuit breakers. He pulled the 4 circuit breakers directly below the correct ones; 2 being the fuel lever circuit breakers. We again called out maintenance and showed him what he did in error. Maintenance reaccomplished the MEL correctly under scrutiny from both me and my first officer. Air carrier maintenance was then called again to verify all maintenance procedures were done correctly. We performed an engine run per fom procedures and confirmed all maintenance paperwork was in order. The rest of the day went with no further issues. Contract maintenance should thoroughly brief crews on what they accomplished showing what they actually accomplished including circuit breakers pulled and paperwork completed.
Original NASA ASRS Text
Title: A B737-800 CONTRACT MAINT MECHANIC PULLED WRONG CIRCUIT BREAKERS INCLUDING BOTH FUEL LEVER CIRCUIT BREAKERS WHILE ATTEMPTING TO ACCOMPLISH MEL PROCEDURE. UNABLE TO START ENGINES AT PUSHBACK.
Narrative: UPON ARRIVING AT THE ACFT MAINT PERSON WAS COMPLETING AN MEL ON THE HUD FROM A PREVIOUS FLT. AFTER COMPLETE I CALLED ACR MAINT TO CLARIFY THAT IT WAS DONE CORRECTLY. I WAS BRIEFED BY BOTH THE CONTRACT MAINT TECH AND ACR MAINT THAT ALL WAS IN ORDER. AFTER PUSHBACK DURING #1 ENG START; NO LIGHT-OFF OCCURRED WHEN I PUT THE FUEL LEVER TO IDLE. I RAN THE QRH PROC AND REATTEMPTED THE START. AGAIN NO LIGHT-OFF. WE TOWED BACK TO THE GATE AFTER CHKING THAT ALL CIRCUIT BREAKERS WERE IN; WHICH THEY WERE. UPON CLOSER INSPECTION WE FOUND THAT THE CONTRACT MAINT TECH PULLED THE INCORRECT CIRCUIT BREAKERS. HE PULLED THE 4 CIRCUIT BREAKERS DIRECTLY BELOW THE CORRECT ONES; 2 BEING THE FUEL LEVER CIRCUIT BREAKERS. WE AGAIN CALLED OUT MAINT AND SHOWED HIM WHAT HE DID IN ERROR. MAINT REACCOMPLISHED THE MEL CORRECTLY UNDER SCRUTINY FROM BOTH ME AND MY FO. ACR MAINT WAS THEN CALLED AGAIN TO VERIFY ALL MAINT PROCS WERE DONE CORRECTLY. WE PERFORMED AN ENG RUN PER FOM PROCS AND CONFIRMED ALL MAINT PAPERWORK WAS IN ORDER. THE REST OF THE DAY WENT WITH NO FURTHER ISSUES. CONTRACT MAINT SHOULD THOROUGHLY BRIEF CREWS ON WHAT THEY ACCOMPLISHED SHOWING WHAT THEY ACTUALLY ACCOMPLISHED INCLUDING CIRCUIT BREAKERS PULLED AND PAPERWORK COMPLETED.
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.