#2 XFEED VALVE WAS LOCKED IN THE CLOSED RATHER THAN THE OPEN POS CAUSING FLT TO DIVERT TO AN ALTERNATE.

Date: 1993-03 · Aircraft: Large Transport; Low Wing; 3 Turbojet Eng

Anomalies: aircraft-equipment-problem-critical|deviation-discrepancy-procedural-far

Synopsis

#2 XFEED VALVE WAS LOCKED IN THE CLOSED RATHER THAN THE OPEN POS CAUSING FLT TO DIVERT TO AN ALTERNATE.

Narrative

I AM A LINE MAINT MECH. 5 MINS BEFORE DEP TIME THE FLC INFORMED LINE MAINT THAT THE #2 FUEL XFEED VALVE HAD FAILED. I PROCEEDED TO THE ACFT AND CALLED BACK LINE MAINT WITH DETAILS OF THE FAILURE. I LOOKED IN THE MEL AND SAW THAT THE ACFT COULD GO AS LONG AS THE XFEED VALVE WAS LOCKED IN THE OPEN POS. ANOTHER LINE MECH WAS DISPATCHED TO ASSIST ME AND I INFORMED HIM TO LOCK THE VALVE IN THE OPEN POS WHILE I BEGAN THE PROPER PAPERWORK. AFTER THE FINAL APPROVAL WAS GIVEN BY THE MAINT COORD CTR THE ITEM WAS PLACED ON A MAINT CARRY OVER AND THE ACFT WAS THEN PUSHED BACK. LATER I RECEIVED A CALL AT HOME INFORMING ME THAT THE ACFT HAD TO MAKE AN UNSCHEDULED LNDG IN MEMPHIS; TN; ON ITS WAY TO DENVER. THE MECHS IN MEMPHIS FOUND THE #2 FUEL XFEED VALVE LOCKED IN THE CLOSED POS. ALTHOUGH I DID NOT LOCK OUT THE VALVE I SIGNED OFF THE ITEM IN THE ACFT LOGBOOK AND ALSO SIGNED THE AIRWORTHINESS RELEASE. THERE ARE SEVERAL FACTORS WHICH I FEEL LED TO THIS ERROR; THE FIRST BEING THE GREAT DEAL OF PRESSURE THE COMPANY PLACES ON THE MECHS TO GET THE AIRPLANES OUT ON TIME. I BELIEVE THAT THIS LED ME TO ASSUME THAT THE WORK COMPLETED BY THE OTHER MECH WAS IN ACCORDANCE WITH THE MAINT MANUAL. I DID NOT WISH TO WASTE ANY TIME IN VERIFYING WORK WHICH HE ASSURED ME WAS DONE CORRECTLY. ANOTHER CONTRIBUTING FACTOR TO THE INCIDENT WAS THE MECH MISINTERPRETING THE MARKINGS ON THE VALVE. A LEVER ON THE VALVE IS SUPPOSED TO BE POSITIONED ON ONE SIDE OF THE VALVE OR THE OTHER. THE SIDE THAT IS LABELED OPEN HAS A SMALL ARROW POINTING TO THE OTHER SIDE OF THE VALVE AND THE SIDE LABELED CLOSED HAS A SMALL ARROW POINTING TO THE SIDE LABELED OPEN LEGEND. IF THE LEVER IS PLACED ON THE SIDE MARKED 'OPEN' THE VALVE IS ACTUALLY CLOSED AND VICE-VERSA. I FEEL THAT THIS SHOULD BE CORRECTED BECAUSE MISLEADING MARKINGS ON A VALVE COUPLED WITH TRYING TO AVOID A DELAY CREATES A POTENTIAL FOR THIS SIT TO REPEAT ITSELF MANY TIMES OVER.

Source: NASA Aviation Safety Reporting System (public domain). Reports are voluntary submissions and are not verified by NASA.