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A B747-400 was dispatched in non compliance with the incorrect MEL reference used for cargo door referral.
| Attributes | |
| ACN | 497243 |
| Time | |
| Date | 200102 |
| Day | Fri |
| Local Time Of Day | 0601 To 1200 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Environment | |
| Light | Daylight |
| Aircraft 1 | |
| Operator | common carrier : air carrier |
| Make Model Name | B747-400 |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : maintenance ground : parked |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : lead technician |
| Qualification | technician : airframe technician : powerplant |
| Experience | maintenance lead technician : 10 maintenance technician : 33 |
| ASRS Report | 497243 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | oversight : supervisor |
| Qualification | technician : airframe technician : powerplant |
| Events | |
| Anomaly | aircraft equipment problem : critical maintenance problem : non compliance with mel non adherence : far non adherence : published procedure |
| Independent Detector | other other : person 1 |
| Resolutory Action | none taken : detected after the fact |
| Consequence | other |
| Factors | |
| Maintenance | contributing factor : manuals performance deficiency : fault isolation performance deficiency : logbook entry |
| Supplementary | |
| Problem Areas | Maintenance Human Performance Chart Or Publication Aircraft |
| Primary Problem | Maintenance Human Performance |
Narrative:
Maintenance was notified by ramp that the aft cargo door green indication light did not work. The bulb was replaced but did not help. I looked up in the index for doors (chapter 52) for indication problem. The reference was 52180. The thing about reference 52180 is that there are 3 of them: 1) 52180 -- door indication system. 2) 52180 -- cargo doors, entry doors and/or upper deck doors. 3) 52180 -- EICAS indication. The #2 is the reason I used this MEL reference (MEL 5273F placard 1125). I made the mistake of not reading the full statement under 52180 when I turned to the page to defer the door item. I thought I could defer the door per the #2 of the 52180 reference. I did not realize that all of 52180 was for EICAS only items. I made a mistake. But I think the MEL should be changed to indicate EICAS messages only for reference 52180. The maintenance of the MEL was followed, door stripes aligned and the cockpit light indication was ok.
Original NASA ASRS Text
Title: A B747-400 WAS DISPATCHED IN NON COMPLIANCE WITH THE INCORRECT MEL REF USED FOR CARGO DOOR REFERRAL.
Narrative: MAINT WAS NOTIFIED BY RAMP THAT THE AFT CARGO DOOR GREEN INDICATION LIGHT DID NOT WORK. THE BULB WAS REPLACED BUT DID NOT HELP. I LOOKED UP IN THE INDEX FOR DOORS (CHAPTER 52) FOR INDICATION PROB. THE REF WAS 52180. THE THING ABOUT REF 52180 IS THAT THERE ARE 3 OF THEM: 1) 52180 -- DOOR INDICATION SYS. 2) 52180 -- CARGO DOORS, ENTRY DOORS AND/OR UPPER DECK DOORS. 3) 52180 -- EICAS INDICATION. THE #2 IS THE REASON I USED THIS MEL REF (MEL 5273F PLACARD 1125). I MADE THE MISTAKE OF NOT READING THE FULL STATEMENT UNDER 52180 WHEN I TURNED TO THE PAGE TO DEFER THE DOOR ITEM. I THOUGHT I COULD DEFER THE DOOR PER THE #2 OF THE 52180 REF. I DID NOT REALIZE THAT ALL OF 52180 WAS FOR EICAS ONLY ITEMS. I MADE A MISTAKE. BUT I THINK THE MEL SHOULD BE CHANGED TO INDICATE EICAS MESSAGES ONLY FOR REF 52180. THE MAINT OF THE MEL WAS FOLLOWED, DOOR STRIPES ALIGNED AND THE COCKPIT LIGHT INDICATION WAS OK.
Data retrieved from NASA's ASRS site as of July 2007 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.