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Attributes | |
ACN | 811124 |
Time | |
Date | 200811 |
Local Time Of Day | 0601 To 1200 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Altitude | agl single value : 0 |
Environment | |
Flight Conditions | IMC |
Light | Dawn |
Aircraft 1 | |
Operator | common carrier : air carrier |
Make Model Name | A320 |
Operating Under FAR Part | Part 121 |
Flight Phase | ground : pushback |
Flight Plan | IFR |
Person 1 | |
Affiliation | company : air carrier |
Function | flight crew : first officer |
Qualification | pilot : atp |
ASRS Report | 811124 |
Person 2 | |
Affiliation | company : air carrier |
Function | flight crew : captain oversight : pic |
Qualification | pilot : atp |
ASRS Report | 811125 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance non adherence : published procedure |
Independent Detector | aircraft equipment other aircraft equipment : ecam |
Consequence | other |
Supplementary | |
Problem Areas | Flight Crew Human Performance Maintenance Human Performance Company |
Primary Problem | Ambiguous |
Narrative:
Preflted aircraft normally for first flight of the day. Station was late with paperwork; there was a catering issue; and we were hurrying to push on time. During pushback as we started engine #1; received an ECAM -- brake: antiskid nosewheel steering fault with the action 'brakes; limit to 1000 psi.' by this time we had reached the taxiway; and the tug driver asked us to set brakes. Captain set brakes and advised the driver to remain on the headset. I checked the QRH abnormal and emergency procedures; noted nothing pertinent. Captain suggested I check the computer reset section; which I did. Located a small box simply called 'bscu' with a reference to fom. Looked up this section; it instructed us to reset the antiskid nosewheel switch. We did this; with no effect. There is a note in this flight manual section regarding circuit breakers; but the message this note referenced was not the message we had. It mentions 'brake: bscu 1(2) fault or system 1(2) fault' only. Our message did not match this; so I told the captain there was nothing else to do. We were blocking an active taxiway with an aircraft behind us; and the captain elected to have the tug pull us back in to the gate. A mechanic met the aircraft and; after conferring with maintenance control; discovered 4 circuit breakers out on the aft breaker panel. Row M; above the jumpseat. They were labeled 'brake system #1 and system #2 indicator and control.' once the breakers were reset; the fault cleared and the bite tests were good. Mechanic signed the book; and we departed; rest of flight was normal. Because maintenance was performed on the aircraft overnight; it seems likely that the mechanic who did the daily check left these 4 breakers in the pulled position. I do not believe they 'popped.' this means that both the captain and I must have missed them during our cockpit preparation. Although not any excuse; there were a couple of factors that 'helped' this to occur. 1) the paper was late to the aircraft; and we were feeling rushed. In addition; a few mins prior to scheduled push; the flight attendant informed us of a catering issue; so we waited for that to be resolved before pushing a few mins late. During this time we were working quickly and probably did not pay close enough attention to the circuit breaker panel on preflight. 2) the 4 circuit breakers in question are grouped together on the bottom row of the aft panel. There is a collared breaker immediately to the left; and very close to the right of these breakers. There are additional collared breakers in the vicinity. Most of the collars on these breakers are white; which makes it difficult to see the white band on the pulled breakers -- especially in the dark; surrounded by other breakers. 3) the bscu reset procedure is incomplete; and difficult to find. You have to figure out it is a bscu problem; find it in the QRH; then refer to the flight manual which doesn't reference the exact message we had displayed. It then says that you 'can' try resetting breakers in certain cases; but doesn't say how to do that; which breakers to reset; or where they are. Obviously; we need to be more careful and pay more attention while preflting the circuit breaker panels. Beyond that; I suggest we change the color of the large collars on unused breakers to black. Thus; any white bands on popped or pulled breakers would be the only white on the panel; and would be very obvious -- even in the dark. That aft breaker panel is a mish-mash of pulled breakers; collars; empty spots; and other stuff; and can be difficult to properly preflight. In addition; the section on bscu resets could be modified to contain a more complete list of messages that could be generated by this fault; and where the breakers are to reset it.
Original NASA ASRS Text
Title: A320 CREW RECEIVES ECAM--BRAKE: ANTI SKID NWS FAULT DURING PUSH BACK. MAINTENANCE DISCOVERS 4 CIRCUIT BREAKERS IN A ROW HAD BEEN LEFT OUT BY MECHANICS DOING ROUTINE MAINTENANCE.
Narrative: PREFLTED ACFT NORMALLY FOR FIRST FLT OF THE DAY. STATION WAS LATE WITH PAPERWORK; THERE WAS A CATERING ISSUE; AND WE WERE HURRYING TO PUSH ON TIME. DURING PUSHBACK AS WE STARTED ENG #1; RECEIVED AN ECAM -- BRAKE: ANTISKID NOSEWHEEL STEERING FAULT WITH THE ACTION 'BRAKES; LIMIT TO 1000 PSI.' BY THIS TIME WE HAD REACHED THE TXWY; AND THE TUG DRIVER ASKED US TO SET BRAKES. CAPT SET BRAKES AND ADVISED THE DRIVER TO REMAIN ON THE HEADSET. I CHKED THE QRH ABNORMAL AND EMER PROCS; NOTED NOTHING PERTINENT. CAPT SUGGESTED I CHK THE COMPUTER RESET SECTION; WHICH I DID. LOCATED A SMALL BOX SIMPLY CALLED 'BSCU' WITH A REF TO FOM. LOOKED UP THIS SECTION; IT INSTRUCTED US TO RESET THE ANTISKID NOSEWHEEL SWITCH. WE DID THIS; WITH NO EFFECT. THERE IS A NOTE IN THIS FLT MANUAL SECTION REGARDING CIRCUIT BREAKERS; BUT THE MESSAGE THIS NOTE REFERENCED WAS NOT THE MESSAGE WE HAD. IT MENTIONS 'BRAKE: BSCU 1(2) FAULT OR SYS 1(2) FAULT' ONLY. OUR MESSAGE DID NOT MATCH THIS; SO I TOLD THE CAPT THERE WAS NOTHING ELSE TO DO. WE WERE BLOCKING AN ACTIVE TXWY WITH AN ACFT BEHIND US; AND THE CAPT ELECTED TO HAVE THE TUG PULL US BACK IN TO THE GATE. A MECH MET THE ACFT AND; AFTER CONFERRING WITH MAINT CTL; DISCOVERED 4 CIRCUIT BREAKERS OUT ON THE AFT BREAKER PANEL. ROW M; ABOVE THE JUMPSEAT. THEY WERE LABELED 'BRAKE SYS #1 AND SYS #2 INDICATOR AND CONTROL.' ONCE THE BREAKERS WERE RESET; THE FAULT CLRED AND THE BITE TESTS WERE GOOD. MECH SIGNED THE BOOK; AND WE DEPARTED; REST OF FLT WAS NORMAL. BECAUSE MAINT WAS PERFORMED ON THE ACFT OVERNIGHT; IT SEEMS LIKELY THAT THE MECH WHO DID THE DAILY CHK LEFT THESE 4 BREAKERS IN THE PULLED POSITION. I DO NOT BELIEVE THEY 'POPPED.' THIS MEANS THAT BOTH THE CAPT AND I MUST HAVE MISSED THEM DURING OUR COCKPIT PREPARATION. ALTHOUGH NOT ANY EXCUSE; THERE WERE A COUPLE OF FACTORS THAT 'HELPED' THIS TO OCCUR. 1) THE PAPER WAS LATE TO THE ACFT; AND WE WERE FEELING RUSHED. IN ADDITION; A FEW MINS PRIOR TO SCHEDULED PUSH; THE FLT ATTENDANT INFORMED US OF A CATERING ISSUE; SO WE WAITED FOR THAT TO BE RESOLVED BEFORE PUSHING A FEW MINS LATE. DURING THIS TIME WE WERE WORKING QUICKLY AND PROBABLY DID NOT PAY CLOSE ENOUGH ATTN TO THE CIRCUIT BREAKER PANEL ON PREFLT. 2) THE 4 CIRCUIT BREAKERS IN QUESTION ARE GROUPED TOGETHER ON THE BOTTOM ROW OF THE AFT PANEL. THERE IS A COLLARED BREAKER IMMEDIATELY TO THE L; AND VERY CLOSE TO THE R OF THESE BREAKERS. THERE ARE ADDITIONAL COLLARED BREAKERS IN THE VICINITY. MOST OF THE COLLARS ON THESE BREAKERS ARE WHITE; WHICH MAKES IT DIFFICULT TO SEE THE WHITE BAND ON THE PULLED BREAKERS -- ESPECIALLY IN THE DARK; SURROUNDED BY OTHER BREAKERS. 3) THE BSCU RESET PROC IS INCOMPLETE; AND DIFFICULT TO FIND. YOU HAVE TO FIGURE OUT IT IS A BSCU PROB; FIND IT IN THE QRH; THEN REFER TO THE FLT MANUAL WHICH DOESN'T REFERENCE THE EXACT MESSAGE WE HAD DISPLAYED. IT THEN SAYS THAT YOU 'CAN' TRY RESETTING BREAKERS IN CERTAIN CASES; BUT DOESN'T SAY HOW TO DO THAT; WHICH BREAKERS TO RESET; OR WHERE THEY ARE. OBVIOUSLY; WE NEED TO BE MORE CAREFUL AND PAY MORE ATTN WHILE PREFLTING THE CIRCUIT BREAKER PANELS. BEYOND THAT; I SUGGEST WE CHANGE THE COLOR OF THE LARGE COLLARS ON UNUSED BREAKERS TO BLACK. THUS; ANY WHITE BANDS ON POPPED OR PULLED BREAKERS WOULD BE THE ONLY WHITE ON THE PANEL; AND WOULD BE VERY OBVIOUS -- EVEN IN THE DARK. THAT AFT BREAKER PANEL IS A MISH-MASH OF PULLED BREAKERS; COLLARS; EMPTY SPOTS; AND OTHER STUFF; AND CAN BE DIFFICULT TO PROPERLY PREFLT. IN ADDITION; THE SECTION ON BSCU RESETS COULD BE MODIFIED TO CONTAIN A MORE COMPLETE LIST OF MESSAGES THAT COULD BE GENERATED BY THIS FAULT; AND WHERE THE BREAKERS ARE TO RESET IT.
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.