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An EMB145 was released for service after a modification where the incorrect rivets were installed at frame 52 right. Engineering drawing symbols blurry.
| Attributes | |
| ACN | 730277 |
| Time | |
| Date | 200702 |
| Local Time Of Day | 0601 To 1200 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Environment | |
| Light | Night |
| Aircraft 1 | |
| Operator | common carrier : air carrier |
| Make Model Name | EMB ERJ 145 ER&LR |
| Operating Under FAR Part | Part 121 |
| Flight Phase | ground : maintenance |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : inspector |
| Qualification | technician : inspection authority |
| ASRS Report | 730277 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | maintenance : technician |
| Qualification | technician : powerplant technician : airframe |
| ASRS Report | 730276 |
| Events | |
| Anomaly | aircraft equipment problem : critical maintenance problem : improper documentation maintenance problem : improper maintenance non adherence : far non adherence : published procedure |
| Independent Detector | other other : 2 |
| Resolutory Action | none taken : detected after the fact |
| Consequence | other other |
| Factors | |
| Maintenance | contributing factor : work cards contributing factor : engineering procedure performance deficiency : non compliance with legal requirements performance deficiency : installation performance deficiency : logbook entry performance deficiency : scheduled maintenance performance deficiency : inspection |
| Supplementary | |
| Problem Areas | Chart Or Publication Environmental Factor Maintenance Human Performance Aircraft |
| Primary Problem | Chart Or Publication |
| Situations | |
| Publication | Engineering Order |
Narrative:
Aircraft authority/authorized by manufacturer to remain in service provided the fasteners installed are inspected every 20 flight cycles and replaced within 100 flight cycles. During heavy weight modification order #1 step 26 frame 52 right side; the mechanic inadvertently installed the wrong rivet type fasteners. I did not know the wrong rivets were installed when I rii the final product. The engineering order picture is not very clear and somewhat hard to read. We realized this mishap while doing this engineering order on another heavy modification aircraft here at (sta).
Original NASA ASRS Text
Title: AN EMB145 WAS RELEASED FOR SVC AFTER A MODIFICATION WHERE THE INCORRECT RIVETS WERE INSTALLED AT FRAME 52 R. ENGINEERING DRAWING SYMBOLS BLURRY.
Narrative: ACFT AUTH BY MANUFACTURER TO REMAIN IN SVC PROVIDED THE FASTENERS INSTALLED ARE INSPECTED EVERY 20 FLT CYCLES AND REPLACED WITHIN 100 FLT CYCLES. DURING HVY WT MODIFICATION ORDER #1 STEP 26 FRAME 52 R SIDE; THE MECH INADVERTENTLY INSTALLED THE WRONG RIVET TYPE FASTENERS. I DID NOT KNOW THE WRONG RIVETS WERE INSTALLED WHEN I RII THE FINAL PRODUCT. THE ENGINEERING ORDER PICTURE IS NOT VERY CLR AND SOMEWHAT HARD TO READ. WE REALIZED THIS MISHAP WHILE DOING THIS ENGINEERING ORDER ON ANOTHER HVY MODIFICATION ACFT HERE AT (STA).
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.