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A B777 was dispatched in non compliance with a cargo door seal logbook item unanswered. Caused by a technician believing the item was previously deferred.
| Attributes | |
| ACN | 512793 |
| Time | |
| Date | 200104 |
| Day | Sun |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Aircraft 1 | |
| Controlling Facilities | tower : pvd.tower |
| Operator | common carrier : air carrier |
| Make Model Name | B777 Undifferentiated or Other Model |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : parked |
| Flight Plan | IFR |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : technician |
| Qualification | technician : airframe technician : powerplant |
| ASRS Report | 512793 |
| Events | |
| Anomaly | aircraft equipment problem : less severe maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : published procedure non adherence : far |
| Independent Detector | other other : person 1 |
| Resolutory Action | none taken : detected after the fact |
| Consequence | other |
| Factors | |
| Maintenance | performance deficiency : logbook entry performance deficiency : repair performance deficiency : inspection |
| Supplementary | |
| Problem Areas | Aircraft Chart Or Publication Maintenance Human Performance |
| Primary Problem | Maintenance Human Performance |
Narrative:
Aircraft damage took place at xyz on aircraft that arrived from eze, and I'm involved. At departure time, I was called upon to check a depressor seal at forward cargo door. I noted that the seal was slightly bent, and repositioned it to its normal confign. As a matter of precaution, I consulted the aircraft deferred item list and noticed that the depressor in question was an open item on aircraft deferred item list. Seeing this, I determined no further action was required. Further investigation on the depressor seal incident revealed that in the departure rush, there was a misunderstanding of the aircraft deferred item list -- the item on log looked like it was still open, but further down on aircraft deferred item list it mentioned a permanent repair was accomplished. All that indicates that a bent seal found by me was technically a new damage in the same place that was repaired before. Corrective action recommended: remove or cross permanent repairs from aircraft log aircraft deferred item list.
Original NASA ASRS Text
Title: A B777 WAS DISPATCHED IN NON COMPLIANCE WITH A CARGO DOOR SEAL LOGBOOK ITEM UNANSWERED. CAUSED BY A TECHNICIAN BELIEVING THE ITEM WAS PREVIOUSLY DEFERRED.
Narrative: ACFT DAMAGE TOOK PLACE AT XYZ ON ACFT THAT ARRIVED FROM EZE, AND I'M INVOLVED. AT DEP TIME, I WAS CALLED UPON TO CHK A DEPRESSOR SEAL AT FORWARD CARGO DOOR. I NOTED THAT THE SEAL WAS SLIGHTLY BENT, AND REPOSITIONED IT TO ITS NORMAL CONFIGN. AS A MATTER OF PRECAUTION, I CONSULTED THE ACFT DEFERRED ITEM LIST AND NOTICED THAT THE DEPRESSOR IN QUESTION WAS AN OPEN ITEM ON ACFT DEFERRED ITEM LIST. SEEING THIS, I DETERMINED NO FURTHER ACTION WAS REQUIRED. FURTHER INVESTIGATION ON THE DEPRESSOR SEAL INCIDENT REVEALED THAT IN THE DEP RUSH, THERE WAS A MISUNDERSTANDING OF THE ACFT DEFERRED ITEM LIST -- THE ITEM ON LOG LOOKED LIKE IT WAS STILL OPEN, BUT FURTHER DOWN ON ACFT DEFERRED ITEM LIST IT MENTIONED A PERMANENT REPAIR WAS ACCOMPLISHED. ALL THAT INDICATES THAT A BENT SEAL FOUND BY ME WAS TECHNICALLY A NEW DAMAGE IN THE SAME PLACE THAT WAS REPAIRED BEFORE. CORRECTIVE ACTION RECOMMENDED: REMOVE OR CROSS PERMANENT REPAIRS FROM ACFT LOG ACFT DEFERRED ITEM LIST.
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.