Whose stupid idea was this Part 2

[Wader2]

Whose Stupid Idea Was this??
Just been reading the latest RN Cockpit, and saw the warning about OX 26/OM 15. So who had the bright idea of putting OM 15 in square can? An accident waiting to happen if ever there was one.

From May 2006 there was a three page sprited discussion about OX 26 and OM 15 in the same shaped can. The solution of course was red the label but . . .

The Summer 2007 of Aviate, p17 "Subsequently 1/2 litre of OM15 was put into each engine of a Tornado GR4."

A further 2.5 litres was unaccounted for.

Murphy is alive and well and living near you.

[peppermint_jam]

Some Genius obviously came up with that bright idea, om-15 used to be in a nice round tin and impossible to mix up. I did read somewhere that the world is expected to run out of om-15 in 3 or 4 years, there's only one refinery in Venezuela that produces the stuff and we're rapidly running out.

I can see a GEMS here, lets put the replacement oil in Pot Noodle tins or something, that way lineys can get it mixed up with their staple diet!

£25 please.....

[8-15fromOdium]

Venezuela?? Can't see that being a problem, why don't we just ask them to churn out a bit more seeing as we are on such good terms with them.

[Two's in]

So why do we bother incurring the cost of training technicians, if that training doesn't stretch to reading labels and verifying contents (the only thing that smells and looks like OM-15 is more OM-15) before replenishment actions? Murphy's all well and good, but basic engineering skills are paramount.

[4mastacker]

I seem to recall from my younger days there was a lot of fuss about OM15 and OX38 being in the same size, shaped and coloured tins and that the same risbridger(sp?) could be used for both products. The saga caused the chopping down of several pine forests to fuel the amount of paperwork the situation generated when the simplest solution was to have different shaped and coloured containers. It sounds like the trip round the great circle has been completed. Perhaps Chavez knows about OM15 and that's why he's kicking off about the Falklands.... the man has a cunning plan.

[splitbrain]

Long discussion about this on the Goat.
The baseline reason for the change was that the supplier decided that they would switch the shape of the tin, its as simple as that. This obviously keeps their costs down as producing/purchasing two different shaped tins is more expensive than one.
The technician training comment is valid up to a point. People make mistakes that they didn't intend to commit; you cannot train/order/threaten human nature out of humans, its been tried and it doesn't work. Anything that can make the liklihood of mistakes happening must be for the better; having two regularly used fluids in different shaped tins is one way of so doing.

[Pontius Navigator]

1.4G, it is called crewroom gossip and learning. Even though it was aired last year the lesson was clearly not learnt.

Now as mere aircrew I have no idea what the two are or do or the consequences but it is clearly something that you can ask the engineers. This is of course if you have any engineers in central London to ask.

[Unchecked]

Agreed. If this thread prompts one person to make sure that the engineers are well aware of the dangers of pumping, say, a helo reservoir full of OM38, and the consequences of not taking 5 seconds to read that can, then it can only be a good thing. I fancy a few copies of the poster that appeared in Aviate may just find themselves stuck to the trap doors of the hangar dunnies pretty soon.

[glad rag]

Absolutely, amazing the number of intelligent people who read about an incident such as this and say "I'd never do that"

Perhaps more like

"there for the grace........"

So the flyboys amongst us have never made a switch pigs or missed a call ??????????:ooh::ooh::ooh::ooh:

No one is infallible, however a good sized EGO helps you on the way.:E:E



aaaaagh shiplling

[r supwoods]

Savings were less than 40p a tin but they still changed 'em. So we have the costs of draining, flushing, EGRs, disposal and sampling costs to balance the equation.

Fortunately no short or long terms effects on engines - so far!

[Pontius Navigator]

Pontious, if you were current Aircrew you might know that one is engine oil and one is Hydraulic fluid. Well as someone said earlier why not just read the label. I guess when you open a tin of soup you check the label to see if it is the flavour you want.
Not sure if there are any engineers in central London but I can make some enquiries for you Pontious.

Actually current of not I was airframes not engines as the saying goes. As airframes I would certainly read the label and double check if I was doing a sooty job but it is self-evident that someone didn't. (Several times),:eek:

[TOPBUNKER]

Is it the blind or the stupid engineers/mechanics that should be catered for?

[Seldomfitforpurpose]

TB,

It's my guess that it's probably the really really over worked, heavily undermanned, constantly deployed, totally disillusioned and bitterly disappointed with no real leadership or light at the end of the tunnel engineers/mechanics that should be catered for :rolleyes:

[TOPBUNKER]

But they should still be able to read surely?
As should their supervisors. No level of overload/overtasking can be allowed to become a global excuse for incompetence - can it?

[Airborne Aircrew]

Silly question...

If one is _engine oil_ and the other is _hydraulic oil_, couldn't someone have decided that we'll call them... let's say:-

HFX. (X being whatever number you want), for the hydraulic fluid.

EOX, (See above for the value of X), for the engine oil...

Then, with the benefit of experience and the understanding that when a person is under pressure, (intentional pun), he doesn't need to know that OMX is hydraulic and OMY is engine... It'll be self explanatory... Despite the alarming similarity in the shape of the container - because there's a limited number of shapes...

Sorry... my mistake, that would be too easy, wouldn't it????

[The Helpful Stacker]

The designation of OM15/OX26 comes about though what they are ( O for oil) and what its base is (M stands for mineral oil, X meaning synthetic). Its all covered by the relevant Def-Stan regulations.

The strangest part about this whole "oh its was easier when the tins were different" is that lowly stackers manage to read the tins well enough to issue the correct stuff so surely the Cosford master race should be able to manage it.

[GreenKnight121]

"lowly stackers manage to read the tins well enough to issue the correct stuff"

Actually, they didn't.

They entered the stock number into their inventory computer (if it wasn't an electronically-generated request in the first place), went to the location shown, zapped the can with a bar-codereader to verify it (something the line hogs don't have) and sent it out if the light turned green.

That is, if their warehouse wasn't one of the fancy ones like the USAF has where punching the number in results in a robot getting the tin and dropping it into the shipping box without the supply puke even getting out of his chair.

[The Helpful Stacker]

Bar code readers in POL? Oh Sir you jest.

I have recently left her Britannic Majesties Royal Air Force and whilst such modern technology as bar code readers was trialled on a limited basis it has yet to enter wide-scale use.

As for being able to perform an issue without having to leave the office, such a thing is but a mere flight of fancy for an Air Force that strives to be person for person the best in the world.:rolleyes:

Nope, in Liz's Flying Club all POL issues are done the old fashioned way. Stacker with voucher puts down tea, jumps in vehicle and drives to relevant inflam store, drags boxes off the shelf and onto the vehicle, pops back for another cup of tea then delivers the required item some time after lunch.

[Seldomfitforpurpose]

Suppliers delivering.................any small amount of "Cred" you may have had swirled down the plug hole with that blatant untruth :rolleyes:

[The Helpful Stacker]

Well it all depends on which particular brand of LEANing you've had on your unit SFFP.

At Odious it was the "take everyones vehicles off them and put the onus on supply sections to move everything on unit", which doesn't really work as you end up with suppliers doing more driving then supplying which is odd as we actually have a trade set-up specifically for driving duties and you also have the situation whereby if a section needs something in a hurry they have to use their own private vehicles to go and get it.:ugh:

[GreenKnight121]

"if a section needs something in a hurry they have to use their own private vehicles to go and get it."


Been there, done that.

On midshift and needed a new sensor package for a DRS turret (A-6E) to go in a plane that was to fly after dawn... and supply had no truck available. :ugh:

As the shop was nearly a mile from supply, I couldn't very well wheel a maintenance cart down, load a 150lb piece of classified electro-optical avionics in and wheel it back, so... my Jeep Cherokee became a USMC vehicle for a few minutes. :ok:

When the higher-ups got in for day-shift, they said "good job, NEVER do it again!". :=

[4mastacker]

"Nope, in Liz's Flying Club all POL issues are done the old fashioned way. Stacker with voucher puts down tea, jumps in vehicle and drives to relevant inflam store, drags boxes off the shelf and onto the vehicle, pops back for another cup of tea then delivers the required item some time after lunch."

THS..Only two cups of tea and in your own section????? Geez, things have changed. Didn't you time your deliveries to coincide with other section's tea-breaks?

[Seldomfitforpurpose]

Just when you think you have heard every fishy supply tale there is, I mean the notion that suppliers delivered was hard enough to swallow but American Forces without enough vehicles............get the **** out of here :=

[ericferret]

Did a similar thing myself the other week, grabbed a tin of engine oil in a rush and topped up the tank.

Should have been Mobil Jet 2, I used Mobil 254.

Cans are identical in size and colouring.

Main reason for the error was rushing combined with the fact that I didn't know we had 254 on stock and in true human fashion I assumed. I didn't notice until I went to dispose of the the can.

In the civil world lots of fluids are supplied in standard us quart/litre cans.
The idea being they are sealed and can't be contaminated and waste is reduced.

Manufacturers have their own colours so identification is normally easier (normally)!!

However on a dark night with a crappy line van and cans rolling everywhere it has not been unheard of for a can of skydrol to go into an engine oil tank. That can really spoil your day as it attacks seals not designed for it.

I remember about 30 years ago going to top up a Gazelle engine from a correctly labelled can 0X ?? out of the oil store. and noticing that the can was not sealed I tipped a little on my hand to check and lo it was bright red OM15. Obviously someone had used an empty engine oil can to drain a hydraulic system and then had not disposed of it.

No amount of label reading will save you from that.

[GOLF_BRAVO_ZULU]

4mastacker. Perhaps the Air Force should store its packaged POL in the Naval Bases. Alternatively, the Air Force could install CRISP and RIDELS for automated accounting and picking. Very last Century; but so simple.

[Wader2]

Golf Bravo Zulu,

I suggest you read the original May 06 thread. It was the Navy that done it. As benfits the senior service the RAF is merely following tradition :}

[Mr-AEO]

I believe that the simplest solution to the OM-15 and OX-38 (et al) mix-up is to burn all the bloody OM-15 in the universe.

It's horrible stuff and clucking dangerous.

Bring in some nice self-contained Electro-Actuators instead; we may save a few lives in the process.

[cornish-stormrider]

The best reason for having two different cans/risbridgers is so that at stupid o' Fuc)(ing clock after not being able to sleep on nightshift you don't fill the steely warbird with the wrong fluid and it tentpegs into a mosque/hospital/school/town centre on the way to target with a major system failure.............

40p a can!!!!! only in this day and age.........

all it will take is for one accident and we can write off all of those 40p savings and much much more.

Will the class one ****** who thought up this brainwave please stand up and be counted. Bet he won't have to put his pension/liberty on the line that no-one ever makes a mistake with the can........

[r supwoods]

Lets look at it calmly.

Putting Hyd oil in an engine will not cause immediate damage and indeed much will be burnt away and diluted back to original strength on the next oil fill. Should an engine suffer ill effects, it will be due to repeated contamination and only then will bearing wear deteriorate gradually and noticeably. Sudden failure is unlikely. Most engines will operate on minimum oil quantities / qualities for some time.

Overheating a OM15 / OX26 mix may produce cockpit fumes which over a long term may cause health problems, in the short term, the smell would be apparent enough for oxygen to be called for.

The RAF has a "No Blame Culture" and should this be degraded many of the contamination confessions before flight would have been hushed up and no one would ever know.

[SirPeterHardingsLovechild]

Its quite easy to misread the can labels in the oil store when you've only got a cigarette lighter.

[GOLF_BRAVO_ZULU]

Wader2. Ah, but I did and, indeed, MightyGem did report from RN origin; but that was entirely due to an easy misread of the new tin shape. What GreenKnight reported was an issue discrepancy where store "A" was demanded but store "B" was picked. The Helpful Stacker explained how the Air Force mandraulic storekeeping process helps to achieve such an error.

In all fairness, I must admit that Naval Air Station stock held on OASIS could probably duplicate a similar discrepancy.

[Wader2]

The Helpful Stacker explained how the Air Force mandraulic storekeeping process helps to achieve such an error.


My expert advisor tells me that Can A is kept in one store at one loaction and Can B in another.

When issued forward to a ready use POL locker the two cans often finish up in the same store. The suppliers therefore are guiltless :)

[The Helpful Stacker]

The Helpful Stacker explained how the Air Force mandraulic storekeeping process helps to achieve such an error.


Actually experience has shown that the introduction of IT stock holding has made it far easier to make errors that have greater consequences down the line than with a manual system. POETS day corner cutting to get work cleared for an easy stack is much easier to on USASII than its was on the old F1640M's as there are far fewer checks in place on the 'improved' system. Of course doing paperwork manually is time consuming which is the flip side to accuracy.

My expert adviser tells me that Can A is kept in one store at one loaction and Can B in another.


Not necessarily. OM15/OX26 can be stored in the same inflams store as they have the same primary and subsidiary hazards. Indeed at Odious they were stored opposite each other in the same bulk store. Luckily they have large labels on the front that are easy for any fool to read, oh err.....

[cornish-stormrider]

OX 26, big and square, not red fluid

OM 15 round and smaller, red fluid. Tastes like strawberries :}

[Two's in]

Putting Hyd oil in an engine will not cause immediate damage and indeed much will be burnt away and diluted back to original strength on the next oil fill.

But putting OX-26 into a hydraulic system will definitely get you to the scene of the accident first, especially with rotary. Still waiting to see a good alternative to opening your eyes and engaging your highly trained brain...

[splitbrain]

Still waiting to see a good alternative to opening your eyes and engaging your highly trained brain...

Its not a question of finding an alternative to proper training and a professional attitude towards ones work, its a question of recognising that there are times when people do things they didn't intend to. Ever been to the supermarket and picked up a bottle of diet cola when you meant to get full fat? Or one brand of beans when you meant to get another? Well, perhaps you haven't, but many will admit that they have done this because the packaging looks similar. And why aren't the flight deck/cockpit switches for the flaps/landing gear and avionics all mixed up with, and the same shape as the weapons switches?
No amount of training or telling people to open their eyes will stop people from making simple, yet potentially catastrophic errors if the component parts of a screw-up are all in place. Similar shaped tins of different oils, and a harrased tradesman are two such component parts, remove one and you stop the screw-up don't you?
Make sure all tradesmen are working under conditions that ensure they always engage their brains in every situation, not least very familiar ones...yeah right, good luck :rolleyes:
Change the shape of the cans of oil so that tradesmen are given a chance to spot the fact that they may be about to put the wrong oil in the wrong system....sounds good to me.

Or, to put it another way..
In an episode of the Simpsons Marge becomes addicted to gambling in the Monty Burns casino. When Homer finally gets her to realise she has a problem she tells him she needs professional help. Homers solution is a lot simpler...
"Oh no thats too expensive, just don't do it again".

Ultimately, when you have a couple of jets 'hangarised' with contaminated systems because of wrong oil poisoning, what the tradesman should have done becomes irrelevant; what they did do was put the wrong oil in.

[Pontius Navigator]

Actually experience has shown that the introduction of IT stock holding has made it far easier to make errors that have greater consequences down the line than with a manual system. ...

Do you mean as in chocolate brown paint as opposed to sage green?

A La Nimrod?:}

[petop]

Im putting my head above the wall now but i can answer the question to why the oil container was changed etc by asking the person that buys it!
Trouble is, and until i get back into work tomorrow ill confirm, its probably a civvy who never has been near an aircraft.

[Mandator]

So the wheel has turned full circle! In the late 60s/early 70s we used to get OM15 and OX26 in cans of the same shape and colour (remember the old oblong-style gallon cans?) although if I remember rightly the shade of green might have been slightly different slightly lighter on the OX26 cans. Progress?

[The Helpful Stacker]

Surely this is a problem of training rather than one of different shaped tins? Nearly every POL product that comes in 5 litre quantities comes in the same 5 litre container yet the only regular mix up you hear of is that of OM15/OX26.

When I worked in POL I would never assume that just because a tanker that had arrived to deliver fuel had Avtur markings on it and all the paperwork agreed that the product inside was Avtur that it was. I and my colleagues QA'd every single fuel load that arrived because not only did we have professionalism in the task in hand, no matter how monotonous it may be, but we fully understood the logistical and legal repercussions if we messed up.

BTW, the reason for the change of the containers is cost but the cost cutting is ultimately down to the container manufacturers themselves. The containers are a standard UN approved type and although the old round ones are still acceptable under UN regulations the civil sector won't use them as they take up more room during shipping (and hence cost more to move) than the rectangular ones. As a result of these market forces it would be incredibly cost prohibitive (more than the 40p per can quoted earlier I believe) to produce them just for military usage.

Perhaps a reusable round shaped shroud to fit over in-use cans could be fabricated locally in-lieu of training folk to read the label. You can use that for a GEMS suggestion for free if you like.

[splitbrain]

Surely this is a problem of training rather than one of different shaped tins?

As my previous attempts (within this thread) at addressing this very point appear to be invisible, i'll ask you this.

How EXACTLY will training prevent someone from making a simple human error they didn't intend to make?

Because if you, or anyone else who thinks that 'training and read the label' are the solution can tell me, then I'm off to become a multi-millionaire.

[Blacksheep]

...the civil sector won't use them (i.e. round tins)as they take up more room during shipping S'funny. All the cans of engine oil that I ever poured into an engine were round and opened by punching triangle shaped holes into opposite sides of the lid with a key that had another end that was useful for opening bottles. Oddly enough, I noticed the chap topping up the hydraulics was using exactly the same key to open his cans of hydraulic fluid.

But we're civilians so what the **** do we know? :hmm:

[The Helpful Stacker]

I'm sure that if a member of a non-technical trade caused damage/unserviceability of an expensive piece of kit through not reading the label of an required for its use the book would well and truly be thrown at them.

One of the many tasks I've had during my service was blending AL48 into F35 to make F34 FSII. Unfortunately the AL48 itself comes in green 205lt drums that look exactly the same as every other green 205lt drum in use, the only thing differentiating them being a small white label with the product details on it. Now considering the majority of blending operations are carried out in operational areas (such as Iraq where all F34 in theatre has been blended to spec by the grubby mitts of a humble stacker) where the workload is high, hours long, temperatures extreme and a whole host of other factors effect human performance it does make you wonder how come they can manage to read the labels correctly whereas it seems quite a task for better paid and apparently more 'skilled' personnel.

I'm sorry, whilst I agree that different shaped/coloured tins could prevent mix up between OX26/OM15 this doesn't account for the fact that other fluids which also come in green rectangular tins aren't also regularly mixed up. Ultimately its a lackadaisical attitude towards working practises and being blasé over the little things that causes these errors, errors who's consequences would have previously been hammered home in personnel when their colleagues who committed them were 'trade charged' for their actions. Unfortunately the no blame culture is a double edged sword. Being nice about errors means that people admit their mistakes but without the threat of serious repercussions some people won't buck up their act.
The other side to this is if mistakes are being made over such a simple issue as using the correct fluids to service an aircraft what other more technical mistakes are lurking within the aircraft of the RAF's fleet?

Yes I have made mistakes before but admittingly there are very few that a stacker can make that directly affect flight safety but this in itself is reflected in our length of trade training and ultimately our level of pay, something that many in the more technical trades crow on about with regularity when the 'threat' of less lofty trades being bumped up to their level of pay is mentioned (see the vitriolic posts on E-Goat with reference to the MT trade pay increase for example). Earn that pay, do the job right and read the label.

[The Helpful Stacker]

S'funny. All the cans of engine oil that I ever poured into an engine were round and opened by punching triangle shaped holes into opposite sides of the lid with a key that had another end that was useful for opening bottles. Oddly enough, I noticed the chap topping up the hydraulics was using exactly the same key to open his cans of hydraulic fluid.

But we're civilians so what the **** do we know?

For your benefit then, ...the civil sector increasingly won't use them as they take up more room during shipping.

I'm not going to argue this point, the bare facts are round tins take up more room than rectangular ones on a standard shipping pallet and hence cost more to move about as shipping costs in marine and the road freight industry is generally based on size of loads not weight. If you are still using round ones then you are paying more for the product than if you were using rectangular tins

[philrigger]

;)
LACK OF SUPERVISION AND TRAINING !!!!!








'We knew how to whinge but we kept it in the NAAFI bar.'

[Pontius Navigator]

there are very few that a stacker can make that directly affect flight safety.

Had an interesting Murphy several years ago with could have started anywhere in the supply chain.

F4 out of the shed, linney's did the compass swing but no why could they swing the standby compass. They changed the compass; no deal.

They called me in and, by a stroke of luck we had Alan Snowball from the Greenwich Observatory (I think -what a job for a flt lt). Anyway he had a little gizmo, a magnet in a plastic gimballed cradle.

He checked the F4 canopy arch and found that it was magnetic. he checked further and found the windscreen securing screws were magnetised, or at least some of them.

Then he went to the storage bins and found some of the screws in there were also magnetic. There all looked the same but somehow some were ferous and some were not.

Murphy once again.

[JamesA]

As an Ex-member of Mrs. Windsor's Flying Circus, I would like to add my tuppence worth to this thread.
As a trainee I and the others were taught, under threat of death or worse, before you unscrew the cap - check the contents. All aviation liquids came in 1,(square) 5, 50, (both round) Imp Gall containers, be it oil - hydraulic - vegetable mineral or synthetic, engine, lubricating, de-icing fluid or whatever. If I recall correctly, the only 'commercially' labelled product was Racasan. All containers were the same shape, mistakes were made e.g. the wrong hydraulic fluid being added to a system.
Later in my service, I spent time as a trade examiner and when testing a young lad, I asked 'You are servicing a hydraulic system requiring OM-15 and you find a gallon can marked OM-15 in the hangar. It is half full with a red fluid but has no cap. Would you use it?' This was a standard question and the expected answer 'No, because it could be contaminated.' The answer I received was 'No, because you said it was half full. That means I would be adding air to the system and I would then have to bleed it.' I carried on with the test and asked him at the end how long was his training and what had he been taught about fluid contamination. He looked at me as though he was seeing water burn. OK 18 weeks is a lot less than three years, but I am certain flight safety was never overlooked.
I have to agree with everyone who puts the oil mix up down to insufficient training. It has nothing to do with suppliers. At the end of the day it is the man/woman who actually does the pouring who carries the can, (no pun intended).
Also as 'The 'tiffy' says in civvy street, all our cans are round except for the 1US gall cans of Skydrol. And, for the man who says it is due to transport costs the round quart cans are shipped in - you've guessed - square boxes. Every manufacturer has a different colour, not every product, but they do have their own identity printed on the can.
My only advice is spend an extra few seconds reading the label. It might not just be the saving of a promising career - just think of the life/lives you have saved and, not the 40 pence and an on-time departure.

[TalkTorqueTorc]

I'm afraid I have to disagree about lack of training.

I'm currently involved with teaching Lineys at a front line base and evey time it comes to teaching how to do oils we repeatedly stress TO READ WHAT IT SAYS ON THE TIN.

I don't think you can necissarily tie it down to a single cause. A combination of habit and complacency. 'If it's in this location it must be OX-26'

I've yet to hear of OX-26 being put into a system instead of OM-15. If anyone knows differently I'd like to know about it.

[Wader2]

Why tins?

Milk does not come in tins.

Car oils do not come in tins.

Translucent, recyclable plastic would be lighter, is moulded to whatever shape and could be manufactured in sealed once-only sizes.

Just send my cheque to . . .

[ZH875]

Fire hazard, probably because the plastic cans melt at a much lower temperature than a tin.

[GOLF_BRAVO_ZULU]

About 11 years ago, as I remember it, MoD(N) let a contract for oil in Trade Standard packaging. The Contractor supplied the said oil in plastic containers; and very stylish they were too. When the oil was stacked in the conventional manner in the stowage, the ones at the bottom deformed to such an extent that the stacks began to collapse. We went back to metal containers.

Sitting here in the relative comfort of a not overly warm office, I'm finding it hard to understand how it is difficult to read a label with O-160 and OX-26 or H-515 and OM-15 (as appropriate) marked in 1 inch high digits (as per DEFSTAN 05-52 Part 1). If the problem was the 1 litre tin, then that's very understandable as it isn't subject to the same labelling/marking standard.

[Wader2]

GBZ, 5 litre and only 1.5 litres remaining after the one litre 'incident'.

Not sure whether the first 2.5 litres was used orrectly and neither were the engineers which was why they had to check all the jets.

[petop]

The reason for the change of can was due to the original "round" can manufacturer ceased trading and the change of supplier of OM15 used square cans. This was looked into and the upshot is "read the label".
I suppose its a bit like which nozzle you pull out when you fill your car up? Diesel or Petrol???!!!

[ericferret]

I remember when the S76 was first operated on the North Sea. The Allison C30 engine was prone to coking and turbine failures were a regular occurence.

Bond helicopters ran a trial to see which oil produced the lowest level of carbon deposits in the turbine bearings.

All six aircraft were operated on different oils, supplied in us quart sized cans and all operating from the same hangar, what fun.


Boeing uses Skydrol in the 737 hydraulic system but it uses Aeroshell 41 (OM 15 equivalent) in the flap gearbox's.

The possibilities for error are endless.

Many helicopters use the same oil in engines and transmissions, others have something different for transmissions. The B0 105 uses engine oil as a hydraulic fluid for the rotorbrake.

[splitbrain]

It is incredible just how much 'point missing' is going on here. Of course techies should take the time to identifyt the contents of a can of fluid and I'm most certainly not advocating excusing deliberate negligence which should be punished accordingly, but what about when the guy is not being deliberately negligent, what about when he/she just makes a simple error because of the circumstances of the situation?
When one bears in mind how many seperate replenishment activities are carried out daily, the number of screw-ups made is quite small, so it is not a frequent occurence as had been suggested. This means that technician training must be working, and that 99.99% of the time lineys are taking the time to read the labels and identify the contents.
Its the other 0.01% of the time when the over-simplistic 'my advice is read to the label' doesn't work. And you can repeat it as many times as you like until you are blue in the face, read the label, read the label, read the label, it won't overcome the inherent psychological and physiological imperfections that are part of the human make-up. Perhaps Helpful Stacker has managed to carry out blending operations successfully without cross contamination every time, but then again, I have managed to put the right oil in the right system every time. What does that prove? It proves that both I and THS have never had the misfortune of having the ingredients for a screw-up fall into place all at the wrong time. I'll tell you this though, I do know of stackers who have put the wrong bolts in the wrong bin in stores because they misread the NATO number or the bin number.
Deliberate negligence or purposeful stupidty? Well one things for sure, just telling them 'my advice is read the label' :ugh::ugh::ugh: didn't work for them.

[cornish-stormrider]

Splitbrain, Well Said :D:D:D

As the eng rumour mill is knackered am I right in understanding Aunty Bettys flying club is thinking/going/gone down the route of techies and lineys aka FLEM's again?????

if so then square can/ round can for replens might be a good idea. With recruitment and retention such a problem and the lowering of standards across the board then I think that project "Prison or Serve" won't be far away...................................

In my crystal ball I see..............????

[MightyHunter AGE]

We had an 'incident' here at ISK where an AMM put OM15 into the engines but that is because this particular AMM is maybe a tad slow on the uptake (recruitment issue?).

You cannot legislate for stupidity but there are also plenty of times where HF comes into play.

As for the argument of 'throw the book at him', when was the last time a heavy landing which subsequently causes an untold number of man hours wasted fixing the jet (and then lack of flying hours for other crews) or whoops I seem to have taxied the jet into a building ever resulted in 'lets throw the book at him'?
(I can give plenty of other 'incidents' from the flying side from the past 21 years if you so desire)

Whats good for the goose...........................

[Kengineer-130]

There are some very stupid comments on this thread ( eh, unhelpful stacker :}), why erode the flight safty barriers we have built up over the years? :ugh:
We always strive to do the job 100% correctly,I would hope everyone in every trade does, and stupid comments such as "read the label then" & "Stackers don't play a major role in flight safty" show a basic lack of understanding of human factors and flight in general........ as someone said on the previous page, aircraft flightdecks have taken years and years to evolve, hence why emergancy systems are all black and yellow striped, important switches are in a red gate, flap systems have guards, undercarridge systems have lights, warning horns and controls shaped like wheels in a lot of aircraft. It has been evolved over years of painful lessons learnt, crew landed with no gear down, incorrect engine shut down, etc etc etc. Everything is made to make decisions and actions easier to take in times of very stessful/ high workload situations..
The basic fact is that we always find better ways to screw up, make something idiot proof and all you get is a better class of idiot. We all make mistakes, thats why aircraft have redundant systems, ejector seats, and all manor of other equiptment that is used in an emergency... cars have seatbelts and airbags......No one plans an accident do they?? The whole issue of the round can debate is that if all the normal systems fail, the safty net is there as a last chance to prevent cross contamination....
Imangine an engine and prop change On the C-130K. After the Cx, you need to refil the engine oil and the prop oil. The engine takes OX27, and the prop takes OM15, it used to be easy to see the difference in the oil cans just by looking at them, and 99.9% it is nigh on impossible to make a mistake due to reading the label, shape of can etc. Now imagine at dark O'clock on your 10th or 11th nightshift in a row ( not unheard of in theatre), in crap weather, maybe handing the job over to someone else, the oil cans get mixed up due to someone moving staging or whatever reason, and seeing the sqaure can of OX27, in a rush, under pressure, and probably complacent ( happens to everyone) due to having done the job 1000's of times before, you grab the can of oil (which happens to be the new square shape OM15) and start to put it in the engine. As its dark, wet, etc etc, you don't notice the colour until it is too late..... Could have easily been avoided in one simple solution, a different shape can...
Same as the old coloured 731 system, RED= U/S Green= S at a glance, I wager many items have been put back into stock U/S, or even fitted to A/C due to the removal of the simple colour code system :ugh:
Do we not learn our lessons? There is an old saying that there are no new accidents, just new victims :ugh:

[The Helpful Stacker]

So having a different shaped can would mean you don't have to look at the label right?

What about checking the re-test dates? In the past whilst carrying out POL locker checks I've often discovered sections holding out date stock as still in use, indeed when I pointed this out cans of oil (some of which were out of date up to 12 months) were actually being used. To compound this one section at my last unit was found using OM15 that had been quarantined, even though they had been sent a memo advising them to return it as waste which they had returned signed and stamped as done.

Would a round tin stop out of date/quarantined product being used? No, it just makes it easier to carry on regardless of the state of the product held within.

I know, its terribly unhelpful of me to point out that there are far more things to look at on a can of oil than just what type it is before you use it.
Sorry, I feel we must agree to disagree on this matter. I'm obviously of the opinion that highly trained and well paid personnel should be able to read a simple label (which contains information important to flight safety other than just what the product is) whereas you seem to believe that shape saves all and bugger the age of the product within because that'd involve reading something, a task far beneath someone who is busy and they should be excused for not doing it.

[Kengineer-130]

point, yet again, well and truley missed :ugh::ugh::ugh:

[stevef]

Here's a little story - make of it what you will:
Quite a few years back, an Airworthiness Directive was issued regarding a certain model of piston-engined Piper aircraft. The instruction was to remove the 'Turbo' sticker (or badge, I forget which) from the cowling. The reason: a fueller had filled the tanks with jetfuel, surmising that Turbo meant turbine instead of turbo-charged...

Re the hydraulic/engine oil can debate: In almost 30 years I've never made a mistake with the two but I have made other errors whilst dog-tired, so I'll hold on apportioning blame.

[splitbrain]

I'm obviously of the opinion that highly trained and well paid personnel should be able to read a simple label (which contains information important to flight safety other than just what the product is) whereas you seem to believe that shape saves all and bugger the age of the product within because that'd involve reading something, a task far beneath someone who is busy and they should be excused for not doing it.

Without wishing to kick the pants out of this topic...

THS, you appear to be taking this personally (in the trade sense) but it is not a techie attack on the supplier trade, I am sure that the switch in oil can shape was delivered as a fait accomplis by the manufacturer, i.e. take it or leave it.
Nonetheless, the comments I have cited above are made in the face of clear statements to the contrary, i.e. you seem insistent that we are looking for excuses for screw ups borne for negligence - nothing could be further from the truth. I certainly made it pretty plain in my previous post that nobody would ever condone using the shape of a can as a substitute for reading the label and properly verifying its contents. Or that lazy, slovenly practice could be excused because of the shape of a tin.
Oil can shape simply represented another safety net in the prevention of flight safety incidents that has now been taken away, that is ALL I (and I'm sure 130K Eng) am saying.
You appear to believe that simply telling people to read the label on the cans will achieve a 100% success rate under all working conditions and in all environments. Can I have the secret to your technique please, because there are millions of pounds to be made in the field of accident and error prevention in all fields not just aircraft engineering.

[glad rag]

Totally agree.

On ALL the flying units I have worked (as opposed to operated :} ) on, it was the logistics specialist attached to that unit's task to ensure ALL POL was within date, of the correct type for type, and answering to all those nice quality standards.

It was up to the techi to pick up the right shaped tin. And they also managed to read read the labels, and surprisingly a number of logistic specialists were charged due to their oversights.....

so there you go.