37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 798660 |
Time | |
Date | 200807 |
Local Time Of Day | 0001 To 0600 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Environment | |
Light | Night |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B737-700 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : parked ground : maintenance |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : inspector |
ASRS Report | 798660 |
Events | |
Anomaly | aircraft equipment problem : critical 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 : tooling performance deficiency : testing performance deficiency : scheduled maintenance |
Supplementary | |
Problem Areas | Aircraft Maintenance Human Performance |
Primary Problem | Maintenance Human Performance |
Narrative:
On jul/xa/08 a B737-700 came to ZZZ for maintenance on an overnight maintenance. The aircraft arrived about XA00. It had a first departure about XG50. Workload planning sent a work card to inspect all the fuel nozzles on #2 engine due to the fact that the engine was at the engine shop and one of the shop mechanics that installed the fuel nozzles did not tighten or safety them on 15 engines at air carrier. My job was to inspect as mechanic removed sleeve covers; checked tightness; and the ones that were loose -- retighten tools and safetied. The ones that were loose needed to leak check with a pressure gauge. We found out that after we start the job the company never sent the tooling. So we decided to leak check the engine. We would run the engine with the core cowls open to perform leak test. This is not a boeing procedure but it worked. The job was completed and signed off. The next night at work; maintenance and engineering called and wanted to know how we did the job without pressure tooling. I explained to him. He told me what we did was ok. But all the other stations that were assigned that work card; all these engines would have to be redone. I'm writing the NASA report to protect me in case the company or FAA were to get involved about engine run or test procedures. Work card was rewritten on jul/xa/08. Callback conversation with reporter revealed the following information: reporter stated when mechanics removed the shroud (sleeve) to expose the coupling nut on the fuel line to the fuel nozzle; to verify the coupling nut is properly tightened; they can; and have torn the o-rings under the shroud. This creates additional problems for not containing fuel leakage if the coupling nuts were loose and leaking. There are twenty fuel nozzles on the cfm 56 engine. Ten primary nozzles are fed fuel through the primary manifold and ten secondary nozzles through the secondary manifold.
Original NASA ASRS Text
Title: AN INSPECTOR AND MECHANIC WORKING B737-700; DECIDED TO RUN THE CFM-56-7 ENGINES TO PERFORM A FUEL LEAK CHECK OF THE ENG FUEL NOZZLES AND MANIFOLDS. JOB CARD REQUIRED USE OF PRESSURE TOOLING; WHICH WAS NOT AVAILABLE.
Narrative: ON JUL/XA/08 A B737-700 CAME TO ZZZ FOR MAINT ON AN OVERNIGHT MAINT. THE ACFT ARRIVED ABOUT XA00. IT HAD A FIRST DEP ABOUT XG50. WORKLOAD PLANNING SENT A WORK CARD TO INSPECT ALL THE FUEL NOZZLES ON #2 ENG DUE TO THE FACT THAT THE ENG WAS AT THE ENG SHOP AND ONE OF THE SHOP MECHS THAT INSTALLED THE FUEL NOZZLES DID NOT TIGHTEN OR SAFETY THEM ON 15 ENGS AT ACR. MY JOB WAS TO INSPECT AS MECH REMOVED SLEEVE COVERS; CHKED TIGHTNESS; AND THE ONES THAT WERE LOOSE -- RETIGHTEN TOOLS AND SAFETIED. THE ONES THAT WERE LOOSE NEEDED TO LEAK CHK WITH A PRESSURE GAUGE. WE FOUND OUT THAT AFTER WE START THE JOB THE COMPANY NEVER SENT THE TOOLING. SO WE DECIDED TO LEAK CHK THE ENG. WE WOULD RUN THE ENG WITH THE CORE COWLS OPEN TO PERFORM LEAK TEST. THIS IS NOT A BOEING PROC BUT IT WORKED. THE JOB WAS COMPLETED AND SIGNED OFF. THE NEXT NIGHT AT WORK; MAINT AND ENGINEERING CALLED AND WANTED TO KNOW HOW WE DID THE JOB WITHOUT PRESSURE TOOLING. I EXPLAINED TO HIM. HE TOLD ME WHAT WE DID WAS OK. BUT ALL THE OTHER STATIONS THAT WERE ASSIGNED THAT WORK CARD; ALL THESE ENGS WOULD HAVE TO BE REDONE. I'M WRITING THE NASA RPT TO PROTECT ME IN CASE THE COMPANY OR FAA WERE TO GET INVOLVED ABOUT ENG RUN OR TEST PROCS. WORK CARD WAS REWRITTEN ON JUL/XA/08. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO: REPORTER STATED WHEN MECHANICS REMOVED THE SHROUD (SLEEVE) TO EXPOSE THE COUPLING NUT ON THE FUEL LINE TO THE FUEL NOZZLE; TO VERIFY THE COUPLING NUT IS PROPERLY TIGHTENED; THEY CAN; AND HAVE TORN THE O-RINGS UNDER THE SHROUD. THIS CREATES ADDITIONAL PROBLEMS FOR NOT CONTAINING FUEL LEAKAGE IF THE COUPLING NUTS WERE LOOSE AND LEAKING. THERE ARE TWENTY FUEL NOZZLES ON THE CFM 56 ENG. TEN PRIMARY NOZZLES ARE FED FUEL THROUGH THE PRIMARY MANIFOLD AND TEN SECONDARY NOZZLES THROUGH THE SECONDARY MANIFOLD.
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.