37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 772542 |
Time | |
Date | 200802 |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B737-700 |
Operating Under FAR Part | Part 121 |
Person 1 | |
Affiliation | other |
Function | maintenance : technician |
Qualification | technician : powerplant technician : airframe |
Experience | maintenance avionics : 12 maintenance technician : 20 |
ASRS Report | 772542 |
Person 2 | |
Affiliation | company : air carrier |
Function | oversight : coordinator |
Events | |
Anomaly | maintenance problem : non compliance with mel 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 : briefing performance deficiency : testing performance deficiency : repair performance deficiency : logbook entry performance deficiency : fault isolation performance deficiency : non compliance with legal requirements |
Supplementary | |
Problem Areas | Maintenance Human Performance Aircraft Flight Crew Human Performance |
Primary Problem | Flight Crew Human Performance |
Narrative:
I work for air carrier X and we do contract maintenance for several acrs here in ZZZ. At approximately XA00 local time on feb/xx/08; I received a call from air carrier Y that their aircraft X had a filter bypass light displayed for the left engine. I contacted air carrier Y maintenance control; who had already spoke to the captain about the problem. Air carrier Y maintenance control had directed me to inspect and change the left engine oil filter and had faxed me all the maintenance manual information. They also supplied me with an oil filter kit from their stock. I replaced the left engine oil filter and found no contamination. We ran the engine and found no leaks. As per MEL the aircraft was dispatched. At approximately XE00 I received a call from air carrier Y maintenance control again; and I was asked which filter I had changed. I responded that it was the left engine oil scavenge filter; just like the maintenance manual procedures that they had faxed me earlier. At that time I was informed that the filter clogged light was for the fuel filter; not the oil filter. A different flight crew had discovered the discrepancy. The aircraft had been dispatched with the incorrect MEL used. While working under the guidance of air carrier Y maintenance control; I had assumed that they were correct in evaluating the actual problem and which MEL to use. The wording for the fuel filter bypass light on the P5-2 panel is vague. It does not indicate fuel or oil. The wording for the oil filter bypass light is detailed; specifying oil. I believe that the lens for the fuel filter bypass light should be modified to indicate fuel. This would remove all doubt about which filter is bypassing and prevent the same kind of error in the future.
Original NASA ASRS Text
Title: A CONTRACT MAINT MECHANIC; DUE TO A MISCOM; REPLACED THE #1 ENG OIL SCAVENGE FILTER ON A B737-700 AND DISPATCHED THE ACFT. IN ACTUALITY THE FUEL FILTER WAS CLOGGED.
Narrative: I WORK FOR ACR X AND WE DO CONTRACT MAINT FOR SEVERAL ACRS HERE IN ZZZ. AT APPROX XA00 LCL TIME ON FEB/XX/08; I RECEIVED A CALL FROM ACR Y THAT THEIR ACFT X HAD A FILTER BYPASS LIGHT DISPLAYED FOR THE L ENG. I CONTACTED ACR Y MAINT CTL; WHO HAD ALREADY SPOKE TO THE CAPT ABOUT THE PROB. ACR Y MAINT CTL HAD DIRECTED ME TO INSPECT AND CHANGE THE L ENG OIL FILTER AND HAD FAXED ME ALL THE MAINT MANUAL INFO. THEY ALSO SUPPLIED ME WITH AN OIL FILTER KIT FROM THEIR STOCK. I REPLACED THE L ENG OIL FILTER AND FOUND NO CONTAMINATION. WE RAN THE ENG AND FOUND NO LEAKS. AS PER MEL THE ACFT WAS DISPATCHED. AT APPROX XE00 I RECEIVED A CALL FROM ACR Y MAINT CTL AGAIN; AND I WAS ASKED WHICH FILTER I HAD CHANGED. I RESPONDED THAT IT WAS THE L ENG OIL SCAVENGE FILTER; JUST LIKE THE MAINT MANUAL PROCS THAT THEY HAD FAXED ME EARLIER. AT THAT TIME I WAS INFORMED THAT THE FILTER CLOGGED LIGHT WAS FOR THE FUEL FILTER; NOT THE OIL FILTER. A DIFFERENT FLT CREW HAD DISCOVERED THE DISCREPANCY. THE ACFT HAD BEEN DISPATCHED WITH THE INCORRECT MEL USED. WHILE WORKING UNDER THE GUIDANCE OF ACR Y MAINT CTL; I HAD ASSUMED THAT THEY WERE CORRECT IN EVALUATING THE ACTUAL PROB AND WHICH MEL TO USE. THE WORDING FOR THE FUEL FILTER BYPASS LIGHT ON THE P5-2 PANEL IS VAGUE. IT DOES NOT INDICATE FUEL OR OIL. THE WORDING FOR THE OIL FILTER BYPASS LIGHT IS DETAILED; SPECIFYING OIL. I BELIEVE THAT THE LENS FOR THE FUEL FILTER BYPASS LIGHT SHOULD BE MODIFIED TO INDICATE FUEL. THIS WOULD REMOVE ALL DOUBT ABOUT WHICH FILTER IS BYPASSING AND PREVENT THE SAME KIND OF ERROR IN THE FUTURE.
Data retrieved from NASA's ASRS site as of May 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.