Maintenance Airframe; Maintenance Powerplant
Communication Breakdown; Workload; Time Pressure; Situational Awareness; Distraction; Confusion
Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy
Aircraft Aircraft Damaged; General Maintenance Action
Aircraft; Chart Or Publication; Company Policy; Human Factors; Logbook Entry; Procedure; Staffing; Manuals
April 2012; Maintenance Control called to advise me of an error on Logbook Page XXX01. This log page discrepancy [noted] that a Ramp Service Contract Provider reported the External Power Receptacle (EPR) door open when our B737-800; [Aircraft X]; came in. Subsequent inspection by a Line Maintenance Technician revealed that the landing on the aft edge [surface] of the door cut-out was damaged; making the door difficult to close. There is no quick Structural Repair Manual (SRM) repair for this condition; so Line Engineering provided Engineering Order XXX-77 to inspect; temporarily repair and defer a permanent repair to the next Heavy Maintenance Visit (HMV). Step-3 of the Engineering Order instructs the Technician to create a deferred item to accomplish a High Frequency Eddy Current (HFEC) inspection on the damaged area every 600 hours until a repair at the next Heavy Maintenance Visit (HMV). Log Page XXX01 was closed-out and the deferral was not initiated. Step-4 of the Engineering Order; the completion verification block; was accomplished by me. I missed the fact that the log page had not been deferred with the inspection and final repair instructions. I am not sure who discovered the error. I have no good answer for why this error occurred. Deferring an Engineering Order is a routine process that all of the people involved have accomplished frequently in the past. The only contributing factor that I can think of is the time of day when this error occurred. The discrepancy was discovered on day shift and subsequently turned over to swing shift. This is usually a very busy time as we are required to conduct a crew meeting; a [maintenance status] turnover meeting; and set for the oncoming shift. On the day in question; we tied into two aircraft with damage requiring structural work. The second item was damage around the ground air conditioning access door on Aircraft Y. Due to staffing limitations and the skill set required; the Airframe Technician who addressed the external power door on Aircraft X was also working on the ground air conditioning door on Aircraft Y. For my part; I was busy with all of the normal turnover and shift start-up processes as well as working with Line Engineering and the Airframe Technicians to accomplish repairs on Aircraft X and Y. This is in addition to communicating the status of the repairs to all other parties with a need to know such as Maintenance Control; flight crews and the Line Maintenance Operations Manager. Once I had been notified of the error; I looked to find the location of Aircraft X. It was due at ZZZ that night. The Maintenance Controller determined that Aircraft X had flown approximately 400-hours since the event occurred; so we had not over flown the 600-hour Inspection cycle. We discussed updating the log page or creating a new log page when the aircraft arrived that evening. Next I contacted the Aircraft Records Department to obtain copies of the original log page and Engineering Order. After reviewing the Engineering Order I was able to determine all other work specified by the Engineering Order had been accomplished; including the initial High Frequency Eddy Current Inspection. Later in the afternoon I attempted to contact the Maintenance Controller who brought this to my attention to go over the process used to correct the error. I was in favor of a new log page. The Maintenance Controller preferred a log page update. He was busy so I called the Maintenance Operations Manager. I told him that it was my intention to create a new log page that referred to the original closed-out log page. The new log page would be the pilot's [permanent] logbook page [second page] to establish the Inspection intervals and Heavy Maintenance repair requirement. The Maintenance Operations Manager agreed with this approach. When Aircraft X arrived; I went to the aircraft and initiated Log Page YYY88 to establish a pilot deferral and Terminating Action for the defect documented on the original Log Page XXX01. I contacted Maintenance Control with this information. A short time later Maintenance Control called me back to inform me that they were not happy with the new Log Page YYY88. They asked me to update the original log page; close-out the new Log page YYY88 on the second sheet. After much discussion; I was directed to void Log Page YYY88 and accomplish the second page update of Log Page XXX01. I voided Log Page YYY88 and updated Log Page XXX01 referring to Engineering Order XXX-77 [and to] accomplish an HFEC Inspection of the door [cut-out] landing every 600 flight hours until repair of the landing is accomplished at the next Heavy Maintenance Visit. The update was accomplished on the second page of Log Page #XXX01. One suggestion that occurred to me is an improvement to our Maintenance Tracking and Compliance software system. Include a pull down menu in the resolution block that requires you to choose the type of reference involved; that is: accomplishing an Engineering Order; Maintenance Procedure; Task Card ...etc. If an Engineering Order is indicated; then another menu would appear to ask if a deferral is required. If yes is selected; the program could be set-up to prevent closing the Log page without a permanent repair. This approach could prevent errors of this kind by forcing a review of the process as the Maintenance Tracking entry is accomplished..
A Line Maintenance Supervisor reports about his efforts to have a damaged External Power Receptacle (EPR) door cut-out landing on a B737-800 aircraft deferred on a new logbook page after an Engineering Order requiring the deferral had been missed weeks earlier. Maintenance Control disagreed and directed him to just update the original logbook page.