Replies

Yikes! Aircraft operators have systems in place to prevent catastrophic accidents like this could have been. And in this case they had the system - and simply overrode it because it was creating a headache (presumably some software was saying in effect "DO NOT FLY THIS AIRCRAFT UNTIL YOU FIX X", and rather than find and fix the problem, somebody just thought X was a bit of red tape and canceled the alert.)

Heads should roll as the proper response. They had a system, the system would have been effective if followed, but the responsible people flat out didn't follow it because it was an inconvenience to them. Perish the thought of having to get out of their cushy seats to keep looking for a tool until it was found!

I have been in aviation going on 25 years now. The worst case I saw was someone left a pile of rags in the wing fuel tank that both the mechanic (A&P) and QA inspector BOTH signed off and used their stamps from the FAA to say the inspection had taken place.

There was a relief valve that kept lifting on a sample rack in a power plant. It kept lifting, removed, calibrated, replaced, lifting. After a year of this the right mechanic got on the job and said. Maybe it's just doing it's job..

he installed a pressure gauge on the pipe and found out the line pressure regulating valve was passing too much pressure. Why? Because the installed PRESSURE GAUGE was stuck!!!!!

The valve was a PITA to get to and was probably removed 3 or 4 times!! Everybody assumed the relief valve was bad because it was a common issue with this brand.

Yikes! Aircraft operators have systems in place to prevent catastrophic accidents like this could have been. And in this case they had the system - and simply overrode it because it was creating a headache (presumably some software was saying in effect "DO NOT FLY THIS AIRCRAFT UNTIL YOU FIX X", and rather than find and fix the problem, somebody just thought X was a bit of red tape and canceled the alert.)

The aerospace equivalent to putting black tape over your car's 'check engine' light.

When I was in the Air Force we had a physical "chit" system of tool tracking. You were assigned a ring of 10 "chits" with your name on them (they were literally dog tag blanks) and every time you took a tool out of the tool crib you left your chit in its place.

If everybody didn't turn in all of their chits at shift's end, nobody went home until the missing tool was found. If as in this case the tool was needed by the next shift, then someone from that shift swapped their chit for yours in the tool crib so you could get your chit back and go home.