A B737-200 AT FL250 DECLARED AN EMER AND DIVERTED DUE TO A SEIZED #1 ENG CAUSED BY AN IMPROPERLY INSTALLED ACCESSORY DRIVE GEAR BOX.

Date: 1997-05 · Aircraft: B737-200

Anomalies: aircraft-equipment-problem-critical|deviation-discrepancy-procedural-far|deviation-discrepancy-procedural-published-material-policy|other-unspecified

Synopsis

A B737-200 AT FL250 DECLARED AN EMER AND DIVERTED DUE TO A SEIZED #1 ENG CAUSED BY AN IMPROPERLY INSTALLED ACCESSORY DRIVE GEAR BOX.

Narrative

ON MAY/XX/97; FLT XYZ WAS ENRTE FROM AAA CLBING THROUGH FL250 WHEN THE CREW FELT A VIBRATION IN THE THROTTLE QUADRANT. THE #1 ENG FILTER BYPASS LIGHT CAME ON 30 SECONDS AFTER THE QUADRANT SHAKE; THEN SHUT DOWN. THE CREW DECLARED AN EMER AND RETURNED SAFELY TO AAA. #1 ENG SERIAL NUMBER YYYY WAS REMOVED AND SENT TO XXX FOR TEAR DOWN. THE TEAR DOWN ANALYSIS REVEALED THAT THE OIL SUPPLY LINE FOR #2/3 BEARING WAS NOT POSITIONED IN THE LOWER PRESSURE BOX. THE TUBE WAS PARTIALLY BENT AND DISTORTED. ALL OIL WAS FLOWING BACK TO THE GEAR BOX AND NOT TO THE #2/3 SHAFT BEARINGS. THE ENG SEIZED DUE TO OIL STARVATION. ACR RECORDS INDICATE THAT ENG SERIAL NUMBER YYYY WAS IN ZZZ FOR IN-SHOP WORK. ALL MAINT RECORDS INDICATE THAT ZZZ MAINT PERSONNEL INSTALLED THE GEAR BOX ON MAY/XA/97. ACR MAINT MANUAL TASK ORIENTED DOCUMENT REQUIRES AN AIR PRESSURIZATION CHK OF THE BEARING PRESSURE FEED LINE AND SYS. THE PRESSURE CHK INSURES THE MECH THAT THE #2/3 OIL PRESSURE LINE IS INSTALLED CORRECTLY. IT APPEARS THAT ZZZ PERSONNEL DID NOT FOLLOW APPROPRIATE MANUAL PROCS FOR REPAIR. THE TASK ORIENTED DOCUMENT REQUIRES A SPECIFIC TRAINING AND QUALIFICATION FOR GEAR BOX REPLACEMENT. THE TRAINING AND QUALIFICATION INDICATES THAT ZZZ MAINT PERSONNEL ASSIGNED TO ENG SERIAL NUMBER YYYY WERE NOT QUALIFIED TO CHANGE THE GEAR BOX ON MAY/XA/97. MAINT PERFORMANCE OF THIS TYPE IS CONTRARY TO ACR MAINT MANUAL PROCS AND THE FARS.

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