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During a right-hand overwing slide replacement on a B767-300 aircraft; ten circuit breakers were pulled. Two circuit breakers were inadvertently pushed in by technician; which caused slide deployment during battery pack connection.
| Attributes | |
| ACN | 809398 |
| Time | |
| Date | 200810 |
| Local Time Of Day | 0001 To 0600 |
| Place | |
| Locale Reference | airport : zzz.airport |
| State Reference | US |
| Altitude | agl single value : 0 |
| Aircraft 1 | |
| Operator | common carrier : air carrier |
| Make Model Name | B767-300 and 300 ER |
| Operating Under FAR Part | Part 121 |
| Person 1 | |
| Affiliation | company : air carrier |
| Function | maintenance : technician |
| Qualification | technician : airframe technician : powerplant |
| ASRS Report | 809398 |
| Person 2 | |
| Affiliation | company : air carrier |
| Function | maintenance : technician |
| Qualification | technician : airframe technician : powerplant |
| ASRS Report | 809365 |
| Events | |
| Anomaly | maintenance problem : improper maintenance non adherence : published procedure non adherence : far |
| Independent Detector | other other : 1 2 3 |
| Resolutory Action | none taken : detected after the fact |
| Consequence | other Other |
| Factors | |
| Maintenance | contributing factor : briefing performance deficiency : non compliance with legal requirements performance deficiency : scheduled maintenance |
| Supplementary | |
| Problem Areas | Aircraft Maintenance Human Performance |
| Primary Problem | Maintenance Human Performance |
Narrative:
During overwing slide replacement; 10 circuit breakers were pulled. 2 circuit breakers were inadvertently pushed on by technicians working other job; which caused slide deployment during battery pack connection. Supplemental information from acn 809365: while working other items in the cockpit; I was asked to close 2 circuit breakers for another mechanic. This was due to my blocking his reach. I asked the mechanic if these were the correct circuit breakers before closing them. He indicated 'yes; I remember seeing emergency lights' -- nothing to give a hint these were slide activation breakers.
Original NASA ASRS Text
Title: DURING A RIGHT-HAND OVERWING SLIDE REPLACEMENT ON A B767-300 AIRCRAFT; TEN CIRCUIT BREAKERS WERE PULLED. TWO CIRCUIT BREAKERS WERE INADVERTENTLY PUSHED IN BY TECHNICIAN; WHICH CAUSED SLIDE DEPLOYMENT DURING BATTERY PACK CONNECTION.
Narrative: DURING OVERWING SLIDE REPLACEMENT; 10 CIRCUIT BREAKERS WERE PULLED. 2 CIRCUIT BREAKERS WERE INADVERTENTLY PUSHED ON BY TECHNICIANS WORKING OTHER JOB; WHICH CAUSED SLIDE DEPLOYMENT DURING BATTERY PACK CONNECTION. SUPPLEMENTAL INFO FROM ACN 809365: WHILE WORKING OTHER ITEMS IN THE COCKPIT; I WAS ASKED TO CLOSE 2 CIRCUIT BREAKERS FOR ANOTHER MECH. THIS WAS DUE TO MY BLOCKING HIS REACH. I ASKED THE MECH IF THESE WERE THE CORRECT CIRCUIT BREAKERS BEFORE CLOSING THEM. HE INDICATED 'YES; I REMEMBER SEEING EMER LIGHTS' -- NOTHING TO GIVE A HINT THESE WERE SLIDE ACTIVATION BREAKERS.
Data retrieved from NASA's ASRS site as of May 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.