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|
Attributes | |
ACN | 804738 |
Time | |
Date | 200809 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | B737-800 |
Flight Phase | ground : maintenance |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 9 |
ASRS Report | 804738 |
Events | |
Anomaly | aircraft equipment problem : critical non adherence : far non adherence : published procedure |
Independent Detector | aircraft equipment other aircraft equipment : overheat warning |
Resolutory Action | none taken : detected after the fact |
Consequence | other |
Factors | |
Maintenance | contributing factor : briefing contributing factor : manuals performance deficiency : scheduled maintenance performance deficiency : non compliance with legal requirements performance deficiency : installation performance deficiency : inspection performance deficiency : testing |
Supplementary | |
Problem Areas | Chart Or Publication Maintenance Human Performance Aircraft |
Primary Problem | Maintenance Human Performance |
Narrative:
The replacement of a #2 engine hptacc valve on a B737-800 was turned over to me. I was shown what was left on the installation and proceeded with the install. After the installation was complete; another mechanic and I performed the maintenance manual required checks. Everything worked; the logbook was signed off and the aircraft was returned to service. The aircraft needed to do a repos ferry flight and during climb out; the crew reported an engine overheat light warning on the #2 engine. The crew throttled back and the light extinguished. Upon returning to the gate; we opened the #2 engine and after some searching we found that 1 duct near the engine combustion section was not tightened down completely. This was a duct that was put into place by the previous mechanic but never tightened down by me. I overlooked it during the install and subsequent inspection that I did before we closed the engine. The duct was torqued and safety wired and after a takeoff power run in which no defects or overheats were noted; the aircraft was returned to service.
Original NASA ASRS Text
Title: MECHANIC REPORTS A B737-800 FLT CREW HAD AN AIR TURNBACK DUE TO #2 ENGINE ENGINE OVERHEAT LIGHT WARNING ON; DURING CLIMB OUT; AFTER REPLACEMENT OF A HIGH PRESSURE TURBINE ACTIVE CLEARANCE CONTROL (HPTACC) VALVE.
Narrative: THE REPLACEMENT OF A #2 ENG HPTACC VALVE ON A B737-800 WAS TURNED OVER TO ME. I WAS SHOWN WHAT WAS LEFT ON THE INSTALLATION AND PROCEEDED WITH THE INSTALL. AFTER THE INSTALLATION WAS COMPLETE; ANOTHER MECH AND I PERFORMED THE MAINT MANUAL REQUIRED CHKS. EVERYTHING WORKED; THE LOGBOOK WAS SIGNED OFF AND THE ACFT WAS RETURNED TO SVC. THE ACFT NEEDED TO DO A REPOS FERRY FLT AND DURING CLBOUT; THE CREW RPTED AN ENG OVERHEAT LIGHT WARNING ON THE #2 ENG. THE CREW THROTTLED BACK AND THE LIGHT EXTINGUISHED. UPON RETURNING TO THE GATE; WE OPENED THE #2 ENG AND AFTER SOME SEARCHING WE FOUND THAT 1 DUCT NEAR THE ENG COMBUSTION SECTION WAS NOT TIGHTENED DOWN COMPLETELY. THIS WAS A DUCT THAT WAS PUT INTO PLACE BY THE PREVIOUS MECH BUT NEVER TIGHTENED DOWN BY ME. I OVERLOOKED IT DURING THE INSTALL AND SUBSEQUENT INSPECTION THAT I DID BEFORE WE CLOSED THE ENG. THE DUCT WAS TORQUED AND SAFETY WIRED AND AFTER A TKOF PWR RUN IN WHICH NO DEFECTS OR OVERHEATS WERE NOTED; THE ACFT WAS RETURNED TO SVC.
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.