A B737-300 #2 ENG AFT MOUNT ISOLATOR ASSEMBLY WAS UNDER TORQUED. AN 'INCH' POUND CALIBRATED TORQUE WRENCH WAS USED INSTEAD OF A 'FOOT' POUND.
Synopsis
A B737-300 #2 ENG AFT MOUNT ISOLATOR ASSEMBLY WAS UNDER TORQUED. AN 'INCH' POUND CALIBRATED TORQUE WRENCH WAS USED INSTEAD OF A 'FOOT' POUND.
Narrative
ACFT X HAD A 12000 CYCLE PYLON INSPECTION SCHEDULED ON THE R-HAND PYLON. THE WORK WAS PERFORMED PER COMPANY PROCS. THIS PROC STIPULATES 'FLUORESCENT-PENETRANT INSPECT THE AFT CONE; BOLT OR REMOVE AND REPLACE WITH NEW OR OVERHAULED.' A NEW AFT ENG MOUNT ISOLATOR WAS INSTALLED. I OBSERVED A MECH VERIFY THE STEP OF THE MAINT PROC CHKING THE SELF-LOCKING FEATURE OF THE THRUST LINK MOUNT (18 INCH/LBS) AND THEN PROCEEDED TO OBSERVE THE MECH TORQUE THE AFT MOUNT ISOLATOR. I ASKED HIM IF HE SET THE TORQUE WRENCH TO 31 FT/LBS (PER COMPANY PROCS). HE REPLIED THAT HE DID SO. THE MECH WHO CHKED THE BREAK-AWAY TORQUE ON THE AFT THRUST-LINK BARREL-NUTS FOR 18 INCH/LBS; SET THE TORQUE WRENCH USED ON THE SAME TOOLBOX. I WATCHED THE MECH TORQUE THE ISOLATOR IN THE PRESCRIBED MANNER AND HEARD THE AUDIBLE CLICK WHEN THE TORQUE WAS REACHED. JUST AFTER ASKING THE MECH IF HE SET THE TORQUE WRENCH TO 31 FT/LBS; ANOTHER MECH WORKING ON THE ENG ASKED ME IF I WAS DONE INSPECTING THE FORWARD PART OF THE PYLON AND I REPLIED THAT I DID SO. TODAY A MECH APCHED ME AND SAID THAT HE LAID DOWN THE INCH-LB TORQUE WRENCH ON THE TOOLBOX AND HE WASN'T SURE WHICH TORQUE WRENCH WAS USED; THE INCH-LB OR THE FT-LB. HE CONTACTED THE MECH WHO WAS AT HOME ON HIS DAY OFF; AND WAS NOT SURE AS TO WHICH TORQUE WRENCH HE USED. I WAS DISTR BY THE OTHER MECH ASKING ME A QUESTION; AND JUST ASKED VERBALLY IF THE TORQUE WAS SET AT 31 FT-LBS AND DID NOT VISUALLY VERIFY IT. THIS COULD RESULT IN AN UNDER-TORQUE FOR THE ISOLATOR MOUNT BOLTS. AS SOON AS I FOUND OUT I CONTACTED MY SUPVR WHO CONTACTED MAINT CTL AND INFORMED THEM OF THE POTENTIAL PROB; AND THEY PROCEEDED TO TAKE THE ACFT OTS UNTIL THE SITUATION IS RECTIFIED. AS PREVIOUSLY STATED; COMPANY MAINT PROC STIPULATES THAT 'THE AFT-CONE BOLT SHOULD BE FLUORESCENT-PENETRANT INSPECTED OR REMOVED AND REPLACED WITH A NEW OR OVERHAULED UNIT.' A NON-ROUTINE CARD WAS NOT USED; THINKING THAT THIS PROC COVERS THE INSTALLATION. MY SUPVR INFORMED ME THAT A NON-ROUTINE CARD SHOULD HAVE BEEN USED TO COVER THE INSTALLATION INSTEAD OF THE COMPANY MAINT FORM. IN RETROSPECT; I SHOULD NOT HAVE TRUSTED THE MECH WHEN HE VERBALLY ASSURED ME THAT THE TORQUE WAS SET AT 31 FT LBS; AND SHOULD HAVE VISUALLY CHKED THE TORQUE-WRENCH. I REALIZE THE RAMIFICATIONS OF THIS EVENT AND THE TROUBLE CAUSED TO THE COMPANY AND A POTENTIALLY UNSAFE SITUATION. I TOOK ALL THE STEPS I COULD TO REMEDY THE SITUATION; AND IN THE FUTURE; I WILL NOT LET DISTRS INTERFERE WITH PERFORMING A VERBAL AND VISUAL CHK OF THE TORQUE WRENCH. SUPPLEMENTAL INFO FROM ACN 750430: ACFT #2 ENG 12K INSPECTION. I USED WRONG TORQUE UNIT FOR AFT ENG ISOLATION MOUNT BOLTS. INSTEAD OF USING 'LBS;' I USED 'INCHES' FOR THE TORQUE AMOUNT. THIS HAPPENED DUE TO LACK OF COM. I ALSO DISCOVERED ONE MORE PROB. THERE IS NO DOCUMENT/NR'S WRITTEN UP FOR THIS ISOLATION MOUNT. AFTER ALL THE JOBS WE HAVE COMPLETED FOR THIS ENG; I CHKED ALL PAPERWORK; EXCEPT THE AFT ENG ISOLATION MOUNT WHICH WASN'T DOCUMENTED. SUPPLEMENTAL INFO FROM ACN 749987: I CAME TO WORK AT NIGHT AND OVERHEARD THAT THE AFT CONE BOLT ISOLATOR HAD BEEN UNDER TORQUED. I ALSO HEARD THAT THERE WAS NEVER AN NRC WROTE TO REPLACE THE AFT CONE BOLT.
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Source: NASA Aviation Safety Reporting System (public domain). Reports are voluntary submissions and are not verified by NASA.