37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 928727 |
Time | |
Date | 201012 |
Place | |
Locale Reference | ZZZ.Airport |
State Reference | US |
Aircraft 1 | |
Make Model Name | MD-80 Series (DC-9-80) Undifferentiated or Other Model |
Flight Phase | Parked |
Person 1 | |
Function | Technician |
Qualification | Maintenance Airframe Maintenance Powerplant |
Experience | Maintenance Technician 18 |
Person 2 | |
Function | Technician |
Qualification | Maintenance Powerplant Maintenance Airframe |
Experience | Maintenance Technician 20 |
Events | |
Anomaly | Aircraft Equipment Problem Critical Deviation - Procedural Published Material / Policy |
Narrative:
Md-80 aircraft arrived with an inbound EPR problem. I [mechanic-a] was assigned with mechanic X to move the aircraft from the gate to the center of the hangar and to work on the aircraft with other mechanics on after-shift overtime. I pulled the 30-day [maintenance] history on the engines and found the aircraft had a long history of repeat discrepancies. After reviewing the history I determined the problem was with the PT2 EPR on the right engine [# 2]. So I planned on removing the right engine nose bullet to look at the PT2 tube under the bullet. After arriving at the aircraft I was informed aviation maintenance technician (amt) (mechanic X) was not working overtime and was replaced by amt Y who brought with him a maintenance manual card # 77-92-11 EPR troubleshooting. Both of us then proceeded to open the lower and upper engine cowls on the right engine while amt Z was doing the periodic service (ps) check on the aircraft. After discussing the discrepancy with amt Y; he wanted to see the inbound PIREP and talk to maintenance control. He went to the maintenance room to call maintenance control while I was inspecting the engine EPR lines and inlet nose bullet on the right engine for signs of leakage or obvious damage. When amt Y returned to the aircraft; I was getting tools ready to remove the nose bullet. That's when he told me that maintenance control wanted us to run-up both engines and to take engine parameter readings at different power levels and to report back to them our findings.I and other amts proceeded to close-up the engine cowls and prepare to move the aircraft out of the hangar to taxi the aircraft to the run-up area. I performed the md-80 ground handling checklist; including a visual walk around of the aircraft and inspected the engine cowlings and inlets from the ground as per the checklist. We started the engines and taxied to the airport run-up area on double bravo. After idling [engines] for several minutes and recording our initial parameter readings; I started to bring the engines up to the part power EPR rating when I heard what sounded like a compressor stall. I then immediately brought the engines back to idle and after discussing the sound I heard with other mechanics; we decided to shut the engines down and do an inlet inspection to verify we didn't suck something into the engines.I and amt Y went and inspected the left engine first and found no damage. We then looked at the right engine and saw major damage to the fan blades and inlet cowl. That's when I realized I had left my flashlight in the inlet when I was inspecting the nose bullet. I was upset at myself so I told amt Y to taxi the aircraft back to the hangar and after returning back to the hangar we informed the manager of what happened to the right engine. I told manager that it was human error and that I had a mental lapse and I forgot about the flashlight I had left in the inlet and that it was my intention to return and remove the inlet bullet; but when I went to get more tools I saw and talked to amt Y and he told me that maintenance control wanted us to run-up the aircraft. This change of course led me to make my mistake of forgetting about my flashlight that caused damage to the engine. I want everyone to know that I followed all written paperwork procedures and that there is no procedure in place to document the verification that the inlets are clear of tools or debris prior to starting engines after completing all work on the engines. I'm filing this report now because I want my air carrier to understand my error and maybe come up with a procedure that can be put in place to prevent someone else from making the same mistake that I made.
Original NASA ASRS Text
Title: FOD damage of the #2 engine on an MD-80 aircraft occurred when a Mechanic inadvertently left his flashlight at the inlet causing major damage to the Fan blades and Inlet cowl.
Narrative: MD-80 aircraft arrived with an inbound EPR problem. I [Mechanic-A] was assigned with Mechanic X to move the aircraft from the gate to the center of the hangar and to work on the aircraft with other mechanics on after-shift overtime. I pulled the 30-day [maintenance] history on the engines and found the aircraft had a long history of repeat discrepancies. After reviewing the history I determined the problem was with the PT2 EPR on the right engine [# 2]. So I planned on removing the right engine nose bullet to look at the PT2 tube under the bullet. After arriving at the aircraft I was informed Aviation Maintenance Technician (AMT) (Mechanic X) was not working overtime and was replaced by AMT Y who brought with him a Maintenance Manual Card # 77-92-11 EPR troubleshooting. Both of us then proceeded to open the lower and upper engine cowls on the right engine while AMT Z was doing the Periodic Service (PS) Check on the aircraft. After discussing the discrepancy with AMT Y; he wanted to see the inbound PIREP and talk to Maintenance Control. He went to the maintenance room to call Maintenance Control while I was inspecting the engine EPR lines and inlet nose bullet on the right engine for signs of leakage or obvious damage. When AMT Y returned to the aircraft; I was getting tools ready to remove the nose bullet. That's when he told me that Maintenance Control wanted us to run-up both engines and to take engine parameter readings at different power levels and to report back to them our findings.I and other AMTs proceeded to close-up the engine cowls and prepare to move the aircraft out of the hangar to taxi the aircraft to the run-up area. I performed the MD-80 Ground Handling Checklist; including a visual walk around of the aircraft and inspected the engine cowlings and inlets from the ground as per the Checklist. We started the engines and taxied to the airport run-up area on double Bravo. After idling [engines] for several minutes and recording our initial parameter readings; I started to bring the engines up to the Part Power EPR rating when I heard what sounded like a compressor stall. I then immediately brought the engines back to idle and after discussing the sound I heard with other mechanics; we decided to shut the engines down and do an inlet inspection to verify we didn't suck something into the engines.I and AMT Y went and inspected the left engine first and found no damage. We then looked at the right engine and saw major damage to the fan blades and inlet cowl. That's when I realized I had left my flashlight in the inlet when I was inspecting the nose bullet. I was upset at myself so I told AMT Y to taxi the aircraft back to the hangar and after returning back to the hangar we informed the Manager of what happened to the right engine. I told Manager that it was human error and that I had a mental lapse and I forgot about the flashlight I had left in the inlet and that it was my intention to return and remove the Inlet Bullet; but when I went to get more tools I saw and talked to AMT Y and he told me that Maintenance Control wanted us to run-up the aircraft. This change of course led me to make my mistake of forgetting about my flashlight that caused damage to the engine. I want everyone to know that I followed all written paperwork procedures and that there is no procedure in place to document the verification that the inlets are clear of tools or debris prior to starting engines after completing all work on the engines. I'm filing this report now because I want my Air Carrier to understand my error and maybe come up with a procedure that can be put in place to prevent someone else from making the same mistake that I made.
Data retrieved from NASA's ASRS site as of April 2012 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.