 |
37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
An MD80 left engine #1 bearing seal plate was incorrectly installed. The job card and the maintenance manual procedure were confusing and incomplete.
| Attributes | |
| ACN | 703288 |
| Time | |
| Date | 200607 |
| 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 | MD-80 Series (DC-9-80) Undifferentiated or Other Model |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : maintenance |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : technician |
| ASRS Report | 703288 |
| Person 2 | |
| Affiliation | company : air carrier |
| ASRS Report | 70328 |
| Events | |
| Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : published procedure non adherence : far |
| Independent Detector | other other : 1 |
| Resolutory Action | none taken : detected after the fact |
| Consequence | other other |
| Factors | |
| Maintenance | contributing factor : work cards contributing factor : engineering procedure contributing factor : manuals performance deficiency : non compliance with legal requirements performance deficiency : installation performance deficiency : scheduled maintenance |
| Supplementary | |
| Problem Areas | Chart Or Publication Maintenance Human Performance Aircraft |
| Primary Problem | Chart Or Publication |
Narrative:
Installed #1 bearing seal plate on #1 engine incorrectly. Notified manager. Work card 72-91-11 step 11B; indicates to lube the seal seat 1D with engine oil and how to install it. Where in figures 6; 9; and 10 there is no indication of a 1D item or is there a call out for the seal seat. In maintenance manual 72-23-01-4 the wordage (seal plate) is used in steps 2.B.2. The design of the seal seat can easily be deceiving. It looks as though the aft face of the plate would be seated against the bearing race and forward face against the retaining nut; this made the build up confusing.
Original NASA ASRS Text
Title: AN MD80 L ENG #1 BEARING SEAL PLATE WAS INCORRECTLY INSTALLED. THE JOB CARD AND THE MAINT MANUAL PROC WERE CONFUSING AND INCOMPLETE.
Narrative: INSTALLED #1 BEARING SEAL PLATE ON #1 ENG INCORRECTLY. NOTIFIED MGR. WORK CARD 72-91-11 STEP 11B; INDICATES TO LUBE THE SEAL SEAT 1D WITH ENG OIL AND HOW TO INSTALL IT. WHERE IN FIGURES 6; 9; AND 10 THERE IS NO INDICATION OF A 1D ITEM OR IS THERE A CALL OUT FOR THE SEAL SEAT. IN MAINT MANUAL 72-23-01-4 THE WORDAGE (SEAL PLATE) IS USED IN STEPS 2.B.2. THE DESIGN OF THE SEAL SEAT CAN EASILY BE DECEIVING. IT LOOKS AS THOUGH THE AFT FACE OF THE PLATE WOULD BE SEATED AGAINST THE BEARING RACE AND FORWARD FACE AGAINST THE RETAINING NUT; THIS MADE THE BUILD UP CONFUSING.
Data retrieved from NASA's ASRS site as of January 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.