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Attributes | |
ACN | 765002 |
Time | |
Date | 200712 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B757-200 |
Operating Under FAR Part | Part 121 |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance avionics : 18 maintenance technician : 5 |
ASRS Report | 765002 |
Events | |
Anomaly | aircraft equipment problem : less severe maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
Independent Detector | other other : 1 |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Factors | |
Maintenance | contributing factor : schedule pressure contributing factor : tooling performance deficiency : inspection performance deficiency : installation performance deficiency : scheduled maintenance performance deficiency : logbook entry |
Supplementary | |
Problem Areas | Aircraft Environmental Factor Maintenance Human Performance Chart Or Publication |
Primary Problem | Maintenance Human Performance |
Narrative:
While working aircraft X engineering order; I installed the wrong type rivet as a hole plug in a non-structural bracket. In my haste to complete my work on this aircraft and start on another; I did not pay due diligence to the fact that this engineering order was an airworthiness directive. I misinterped the rivet part number. When I saw the boeing aircraft corp rivet part number; I assumed that it was the same as a 'cr' type rivet; being a cherry-maximum type blind rivet. The incident was discovered the next day when I was asked where I got the type of rivets that were called for. I made this same mistake on 2 aircraft and on both the left and right wings. Callback conversation with reporter revealed the following information: reporter stated the specific rivet required as a hole plug are 7/32's diameter 'D' type fasteners that must be driven using a bucking bar on the tail side. The required fasteners are part of an airworthiness directive (ad) that requires the generator feeder cables from the engines to be repositioned lower on a bracket and better secured to prevent chafing of these power cables in the wing leading edge. These generator cables run between the engine pylon and the wing root on the fwd side of the wing fwd spar. The bracket holes requiring the plug rivets are in a difficult location in the wing leading edge where torque tubes; a large pneumatic supply duct and other electrical wire bundles are also located. All affected aircraft have had the incorrect rivet(south) replaced.
Original NASA ASRS Text
Title: A B757-200 AIRWORTHINESS DIRECTIVE REQUIRING A SPECIFIC TYPE RIVET TO BE USED AS A HOLE PLUG FOR A BRACKET PREVIOUSLY SECURING THE ENGINE GENERATOR FEEDER CABLES WAS NOT COMPLIED WITH.
Narrative: WHILE WORKING ACFT X ENGINEERING ORDER; I INSTALLED THE WRONG TYPE RIVET AS A HOLE PLUG IN A NON-STRUCTURAL BRACKET. IN MY HASTE TO COMPLETE MY WORK ON THIS ACFT AND START ON ANOTHER; I DID NOT PAY DUE DILIGENCE TO THE FACT THAT THIS ENGINEERING ORDER WAS AN AIRWORTHINESS DIRECTIVE. I MISINTERPED THE RIVET PART NUMBER. WHEN I SAW THE BOEING ACFT CORP RIVET PART NUMBER; I ASSUMED THAT IT WAS THE SAME AS A 'CR' TYPE RIVET; BEING A CHERRY-MAX TYPE BLIND RIVET. THE INCIDENT WAS DISCOVERED THE NEXT DAY WHEN I WAS ASKED WHERE I GOT THE TYPE OF RIVETS THAT WERE CALLED FOR. I MADE THIS SAME MISTAKE ON 2 ACFT AND ON BOTH THE L AND R WINGS. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: REPORTER STATED THE SPECIFIC RIVET REQUIRED AS A HOLE PLUG ARE 7/32'S DIAMETER 'D' TYPE FASTENERS THAT MUST BE DRIVEN USING A BUCKING BAR ON THE TAIL SIDE. THE REQUIRED FASTENERS ARE PART OF AN AIRWORTHINESS DIRECTIVE (AD) THAT REQUIRES THE GENERATOR FEEDER CABLES FROM THE ENGINES TO BE REPOSITIONED LOWER ON A BRACKET AND BETTER SECURED TO PREVENT CHAFING OF THESE POWER CABLES IN THE WING LEADING EDGE. THESE GENERATOR CABLES RUN BETWEEN THE ENGINE PYLON AND THE WING ROOT ON THE FWD SIDE OF THE WING FWD SPAR. THE BRACKET HOLES REQUIRING THE PLUG RIVETS ARE IN A DIFFICULT LOCATION IN THE WING LEADING EDGE WHERE TORQUE TUBES; A LARGE PNEUMATIC SUPPLY DUCT AND OTHER ELECTRICAL WIRE BUNDLES ARE ALSO LOCATED. ALL AFFECTED ACFT HAVE HAD THE INCORRECT RIVET(S) REPLACED.
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.