FLT CREW OF B737 INADVERTENTLY ACTIVATED #2 IDG DISCONNECT SWITCH VICE EMER EXIT LIGHTS CTL SWITCH DURING COCKPIT SHUTDOWN CHKLIST CONDUCTED IN LOW LIGHT CONDITIONS.

Date: 2003-03 · Aircraft: B737 Undifferentiated or Other Model · Phase: ground

Anomalies: aircraft-equipment-problem-less-severe|deviation-discrepancy-procedural-published-material-policy

Synopsis

FLT CREW OF B737 INADVERTENTLY ACTIVATED #2 IDG DISCONNECT SWITCH VICE EMER EXIT LIGHTS CTL SWITCH DURING COCKPIT SHUTDOWN CHKLIST CONDUCTED IN LOW LIGHT CONDITIONS.

Narrative

AFTER ENG SHUTDOWN; DURING THE POSTFLT FLOW; CAPT OPENED THE GUARD AND FLIPPED THE SWITCH UP FOR THE #2 R CSD DISCONNECT. HIS INTENT WAS TO TURN OFF THE 'EMER EXIT LIGHTS;' WHICH IS A BLACK GUARDED SWITCH IN CLOSE PROX TO THE RED GUARDED CSD SWITCH. THE R ENG HAD BEEN SHUT DOWN DURING TAXI IN FOR SINGLE ENG PROCS. WE MADE A LOGBOOK ENTRY AND CALLED MAINT TO CHK THE CSD. ON THE RETURN FLT TO MIA WE STARTED THE R ENG FIRST TO ENSURE PROPER CSD OP. AFTER TKOF WE NOTICED A FAINT OIL SMELL IN THE COCKPIT. I CALLED THE FLT ATTENDANTS AND THEY SAID THEY COULD SMELL IT TOO. I TURNED OFF THE RECIRCULATION FANS FOR ABOUT 1 MIN TO AID IN DISSIPATION OF THE SMELL. WE CONCLUDED; DUE TO THE SHORT DURATION OF THE SMELL; THAT SOME OIL FROM THE 'ENG OR CSD' HAD CIRCULATED THROUGH THE AIR CONDITIONING SYS; AS THIS IS TYPICAL WITH ENG OR CSD OIL SVCING. THE REST OF THE FLT WAS UNEVENTFUL. IN THE B767; THE DEACTIVATION OF THE EMER EXIT LIGHTS WAS PART OF THE FO'S FLOW. A VERY JUSTIFIABLE REASON FOR THIS WAS GIVEN TO ME BY MY INSTRUCTORS DURING INITIAL QUALIFICATION. 'WHEN THE CAPT NEEDS TO USE THAT SWITCH DURING AN EVAC; WE DON'T WANT HIM TO FLIP IT IN THE WRONG DIRECTION DUE TO HABIT.' ALSO I BELIEVE FOR STANDARDIZATION REASONS; THE DEACTIVATION OF THIS SWITCH SHOULD BE AN FO ON DUTY ON ALL ACFT. IN THE HEAT OF THE BATTLE; IT IS HUMAN NATURE TO FALL BACK ON HABIT PATTERNS. SINCE IT IS GENERALLY THE CAPT WHO WILL COMMAND AN EVAC IT ALSO FOLLOWS THAT WE DON'T WANT THE CAPT TO HAVE TO USE THAT SWITCH UNLESS A SERIOUS SIT EXISTS. THERE ARE SAFETY WIRE HOLES ON THE CSD SWITCHES; AS WELL AS THE PAX OXYGEN SWITCH AND THE ALT FLAP SWITCH. BECAUSE THESE 4 SWITCHES ACTIVATE IRREVERSIBLE ACTIONS IN THE COCKPIT; I BELIEVE THAT THEY SHOULD BE SAFETY WIRED. SUPPLEMENTAL INFO FROM ACN 576876: WHEN THE ITEM 'EMER EXIT LIGHTS' WAS CALLED BY THE FO; I REACHED UP TO TURN THEM OFF PER THE CHKLIST. IN THE DARK I INADVERTENTLY LIFTED THE #2 ENG IDG GUARD; AND MOVED THE SWITCH TO THE DISCONNECT POS. IN THE B737; NONE OF THE SWITCH GUARDS ARE SAFETY WIRED. THE IDG SWITCH AND THE EMER EXIT LIGHT SWITCH ARE NEXT TO EACH OTHER AND; WHILE THE IDG SWITCH GUARD IS COLORED RED; THE DIFFERENCE IS NOT DISCERNABLE AT NIGHT IN A DARK COCKPIT. SINCE THE ENG HAD BEEN SHUT DOWN FOR APPROX 4 MINS AND STOPPED ROTATION; I DO NOT BELIEVE THE IDG WAS ACTUALLY DISCONNECTED BUT ATL MAINT WAS CALLED TO EXAMINE THE ENG AND THEY ACCOMPLISHED A MANUAL RESET TO ENSURE ELECTRICS WERE AVAILABLE WHEN THE ENG WAS STARTED.

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