EMS HELI PLT NOTES THAT MAINT INSTALLED THE WRONG AUTOFLT CONTROLLER SYS ANNUNCIATOR PANEL.

Date: 2002-05 · Aircraft: Helicopter

Anomalies: aircraft-equipment-problem-less-severe|deviation-discrepancy-procedural-far|deviation-discrepancy-procedural-maintenance|deviation-discrepancy-procedural-published-material-policy|other-mx-installed-the-wrong-annunciator-or-panel-on-the-afcs-system-plt-acepted-and-flew-acft-in-this-condition

Synopsis

EMS HELI PLT NOTES THAT MAINT INSTALLED THE WRONG AUTOFLT CONTROLLER SYS ANNUNCIATOR PANEL.

Narrative

MISLABELED CAUTION ANNUNCIATOR SEGMENT LIGHTS ARE VERY DIFFICULT TO DISCOVER IN THE ACFT X. 2 MECHS WERE CONSULTED PRIOR TO FLT. VERBAL CONCURRENCE WAS RECEIVED AS TO SAFETY OF FLT AND ACFT AIRWORTHINESS. SPECIFICALLY; THE AUTOPLT ON THE HELI HAD AN INHERENT INDICATION MALFUNCTION -- THE AUTOFLT CONTROLLER SYS SEGMENT LIGHT WOULD NOT ILLUMINATE. TO CORRECT THE PROB; THE ANNUNCIATOR PANEL WAS CHANGED OUT DURING THE 600 HR INSPECTION. SUBSEQUENT TO THE CHANGE; THE OLD PANEL'S SEGMENT LIGHT CONFIGN WAS NOT COMPARED TO THE NEW PANELS CONFIGN TO CORRECT ANY DISPARITY IN THE DISPLAY. THIS SHOULD HAVE BEEN ACCOMPLISHED BY THE INSTALLING MECH IN THE DUE COURSE OF THEIR RESPONSIBILITIES. APPROX 4 DAYS AFTER THE INSTALLATION; A SEGMENT LIGHT WAS DISCOVERED THAT WAS NOT PRESENT WITH THE OLD PANEL'S CONFIGN. THIS ANOMALY WAS EXPRESSLY POINTED OUT TO BOTH MECHS. THEIR REPLY WAS THAT THE NEW ANNUNCIATOR PANEL WAS THE CORRECT PART NUMBER AND THEY WOULD LOOK INTO THE DISPARITY. APPROX 17 DAYS LATER; 2 SEGMENT LIGHTS WERE DISCOVERED LABELED INCORRECTLY. MECHS PROCEEDED TO OBSERVE; DISCUSS; AND SUGGEST CAUSE AND EFFECT OF THE SYS IRREGULARITY WITH MYSELF. A THOROUGH DISCUSSION ENSUED ON WHICH SYS HAD THE MISLABELED SEGMENT; AND IF THE SPECIFIC SYS TRIGGERED THE ANNUNCIATOR PANEL (EVEN THOUGH MISLABELED); PROPER CORRECTIVE ACTION WOULD FOLLOW. AT THAT TIME WE ALL AGREED THE ACFT WAS AIRWORTHY. AN OPERATIONAL FLT WAS FLOWN WITHOUT CORRECTING THE DISPARITY IN THE SEGMENT LIGHTS. IN HINDSIGHT; ALTHOUGH THE ACFT WAS AIRWORTHY; AFTER DISCOVERING THE MISLABELED SEGMENT; I SHOULD HAVE PUT THE ACFT OTS PRIOR TO FLT. ADDITIONALLY; THIS IMMEDIATE CORRECTIVE RELABELING ACTION SHOULD HAVE BEEN SUGGESTED BY THE MECHS.

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