'Scathing' report on BA Maintenance practices
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Flywise was distributed not 'dumped' in the engineering crew room because as the editor I thought as engineers you may be interested. That is the only reason.
I was not coerced, but as a Licenced Aircraft Engineer, ex-OSE and Flight Engineer of 35 years in the company, I have a real belief in BA Engineers and want to share any safety related information that I put together in the magazine.
When it was the Air Safety Review I found the incidents useful, so believed others may feel the same.
I have tried to make it more reader friendly and any comments to make it better are well received.
If you do not want to read it, leave it to my engineering colleagues who do!
I was not coerced, but as a Licenced Aircraft Engineer, ex-OSE and Flight Engineer of 35 years in the company, I have a real belief in BA Engineers and want to share any safety related information that I put together in the magazine.
When it was the Air Safety Review I found the incidents useful, so believed others may feel the same.
I have tried to make it more reader friendly and any comments to make it better are well received.
If you do not want to read it, leave it to my engineering colleagues who do!
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Magman
Thanks for that....I did wonder why I had not seen the publication for ages. Please continue with this initiative.
This thread has been a bit of an eye opener to me...... which illustrates, at BA Engineering we need to improve.
This thread has been a bit of an eye opener to me...... which illustrates, at BA Engineering we need to improve.
We are constantly being told by the likes of Hand Solo and BHTSM how wonderful BA is and how everything is regulated to a perfect standard.
This report is truly frightening.
Thank God that our maintenance department is a long way from lowering themselves to BA standards.
This report is truly frightening.
Thank God that our maintenance department is a long way from lowering themselves to BA standards.
Usual disclaimers apply!
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Don't get me wrong magman, as it happens I often get a copy to read from the flight deck
Maybe I should change the 'dumped' to 'deposited'
Wasn't the original Air safety Review withdrawn from general viewing as it was felt that it was aimed at (and should only be seen by) the pilot/FE community only?
Maybe I should change the 'dumped' to 'deposited'
Wasn't the original Air safety Review withdrawn from general viewing as it was felt that it was aimed at (and should only be seen by) the pilot/FE community only?
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JW411,
What organisation do you work for?
This incident happened over two years ago.
BA have one of the most qualified group of engineering staff, licensed under the current EASA regulations.
Leaving panels off an aircraft is not unknown, but it should not happen.
I wonder why it is that engineering did not know what a potentially devestating effect, this omission could have such an impact on the control of the aircraft?
Bottom line is, come to work and do your job properly.
I bet the routine card that said the panels were fitted was certified by qualified staff.
The question is why did it happen?
B73
What organisation do you work for?
This incident happened over two years ago.
BA have one of the most qualified group of engineering staff, licensed under the current EASA regulations.
Leaving panels off an aircraft is not unknown, but it should not happen.
I wonder why it is that engineering did not know what a potentially devestating effect, this omission could have such an impact on the control of the aircraft?
Bottom line is, come to work and do your job properly.
I bet the routine card that said the panels were fitted was certified by qualified staff.
The question is why did it happen?
B73
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The aforementioned booklet distributed to the engineering staff was entitled EWS.
Unfortunately this is also the acronym for the new engineering computer system that we've been struggling with so it may well have been totally overlooked.
Also, the photograph on the front of this glossy booklet pictured an engineer from another company leak checking a running engine with no run guards in place.
Not ideal but certainly not the best way to start a booklet on safety.
There have been a couple of incidents recently, panels being missed is always serious but unfortantely the work packages are poorly documented and often ask for the same panels to be removed, refitted, removed, refitted several times over the course of a single check. We have asked time and time again over the last 10 - 15 years for this to be rectified but the company is unwilling to spend the money or manpower on the task.
The 757 oil debacle is inexcusable as there are strict instructions on refilling now and many procedures in place to stop it happening. It should not still be going on.
In my area of the engineering base we most definately feel the squeeze but standards are kept high by the men on the tools.
Just my tuppence worth. Safety is MY first priority but not always the company as a whole.
Unfortunately this is also the acronym for the new engineering computer system that we've been struggling with so it may well have been totally overlooked.
Also, the photograph on the front of this glossy booklet pictured an engineer from another company leak checking a running engine with no run guards in place.
Not ideal but certainly not the best way to start a booklet on safety.
There have been a couple of incidents recently, panels being missed is always serious but unfortantely the work packages are poorly documented and often ask for the same panels to be removed, refitted, removed, refitted several times over the course of a single check. We have asked time and time again over the last 10 - 15 years for this to be rectified but the company is unwilling to spend the money or manpower on the task.
The 757 oil debacle is inexcusable as there are strict instructions on refilling now and many procedures in place to stop it happening. It should not still be going on.
In my area of the engineering base we most definately feel the squeeze but standards are kept high by the men on the tools.
Just my tuppence worth. Safety is MY first priority but not always the company as a whole.
Thought police antagonist
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BOAC 73, This is NOT a personal attack, but would you mind please, offering an insight concerning your discipline within engineering as an occupation ? I ask this because, being a former engineer, your posts don't quite make sense in terms of your statements--notably your comments re the failure to re-fit panels and the adverse effect on the controls as a result--this is basic stuff after all. Actually, your posts speak volumes because if you are, as you say, within BA Engineering and cannot, or could not, see the problems within the organisation then clearly this fact alone serves to confirm the problems that exist.
With regard to the Air Safety Review--as was--I have to say that when I came across a copy, it was always a first rate magazine--there again I have always read FS mags with interest anyway--being "thick" ( as defined by a "manager" ) and having a life long interest in all aspects of aviation. However ( and here I apologise in advance if I have the wrong magazine ) I seem to recall reading an article about the Airbus fleet--( the original ex B.Cal ones ) in which two young ladies gushed on about how excited they were to be joining the fleet--albeit in a non-flying capacity and that they were coming from engineering but "don't worry, we are not a couple of oily rags". The fact the magazine actually printed these comments is the point here. The word "culture"has been mentioned once or twice on this thread and this was a classical example I feel as to how engineers were perceived. That said, being ridiculed by a "manager" for reading the mag in the first place also speaks volumes for the engineering "management" does it not ?. There is a relevance in this post conerning the event in question and that relevance concerns the lack of management skills within the organisation and the resultant effects of promoting people who are / would be unwilling to challenge or question the perceived status quo as to how standards are maintained. Diversity of opinion is not a welcome asset I feel.
With regard to the Air Safety Review--as was--I have to say that when I came across a copy, it was always a first rate magazine--there again I have always read FS mags with interest anyway--being "thick" ( as defined by a "manager" ) and having a life long interest in all aspects of aviation. However ( and here I apologise in advance if I have the wrong magazine ) I seem to recall reading an article about the Airbus fleet--( the original ex B.Cal ones ) in which two young ladies gushed on about how excited they were to be joining the fleet--albeit in a non-flying capacity and that they were coming from engineering but "don't worry, we are not a couple of oily rags". The fact the magazine actually printed these comments is the point here. The word "culture"has been mentioned once or twice on this thread and this was a classical example I feel as to how engineers were perceived. That said, being ridiculed by a "manager" for reading the mag in the first place also speaks volumes for the engineering "management" does it not ?. There is a relevance in this post conerning the event in question and that relevance concerns the lack of management skills within the organisation and the resultant effects of promoting people who are / would be unwilling to challenge or question the perceived status quo as to how standards are maintained. Diversity of opinion is not a welcome asset I feel.
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However, outmoded working practices also contribute---ever seen 6, yes 6 people attempt to change a 737 mainwheel ?
Delta arrived from SNN a while back, and the crew changes at DUB.
Line engineers did arrival walk round, and there was 2 minutes of frantic activity. Wheel was jacked up, turned 90 degress so that the "hole" down to the canvas was now on the ground, and the jack lowered again, to a comment of "it only needs to do one more landing, they can change that back at base in Atlanta".
They were "safe" in the knowledge that the outbound crew were not due to report for another hour, so there was no chance of them being seen by the crew during an early walk round!
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From my experience,
If you had a panel that had a serious contribution to the airworthiness of the aircraft you would be pointed to this by the AMM.
In recent years, this would result in a verification check at least.
Hope you see my point..... I have a sprog who is CC.... and I believe "it" is perfectly safe as long as we do our jobs properly!
B73.
If you had a panel that had a serious contribution to the airworthiness of the aircraft you would be pointed to this by the AMM.
In recent years, this would result in a verification check at least.
Hope you see my point..... I have a sprog who is CC.... and I believe "it" is perfectly safe as long as we do our jobs properly!
B73.
BOAC read the *&876 $% report!
Christ on a Crutch! What a mess. And as far as a reading of the report can tell the management response is ........more management, renaming LAE's as "supervisors", and expanding the size of the quality control empire which didn't and can't pick up behavioural issues in the first place! My guess is that the net result will be that LAE's will have more paperwork and even less time to devote to technical matters. Reading between the lines, it seems obvious that BA needs more LAE's, but the "work smarter not harder" brigade will not allow it.
There is no bloody way to tell if the system is fixed either! Do BA techs still batch stamp job cards? I will not make an obvious observation otherwise it will probably be deleted by a moderator.
The bits that made my blood boil the most are here. If they do not make your blood boil BOAC, you should not be working in the airline industry. If anyone had behaved this way at AN they would have been sacked. Furthermore, and although it is not relevent to this thread, how is it possible that anyone could accurately determine maintenance costs under such a system?
"By certifying for the fitment of the panels, a task that he had not performed
himself, the technician exceeded the scope of his company authorisation.
However, the investigation determined that his was not an isolated case. The
lack of discipline in certifying for work in a timely manner meant that it was not
unusual for individuals to be in a position where they would be asked to certify
for a task performed by someone else, who had gone off shift without certifying
for the work completed. Faced with this problem, rather than incur potential
delays in production, maintenance staff would attempt to verify that a task had
been completed before certifying for it themselves."
"However basic the error may appear with hindsight, such errors cannot be
entirely eliminated from human performance and aviation history is filled with
accidents caused by fundamental errors caused by misinterpretation or relying
on assumption. It is recognised in the aviation industry that human error cannot
be entirely eliminated and where an error could prove critical, systems and
procedures are put in place to capture it or mitigate its effects. Examples of this
include the cross-checking of instrument settings by both pilots, or duplicate
inspections in maintenance on flight critical systems."
"Quality compliance audits are not
particularly effective in identifying behavioural issues that have the potential to
compromise standards of airworthiness, as they look at the outputs of the
processes and not necessarily how they are performed. These issues can only be
understood through spending a suitable amount of time in the maintenance
environment and working with staff to understand the factors that influence their
working practices. It is therefore not surprising that the Quality Engineers were
unaware of the actual practices in use on the shop floor and the detrimental
effect that such practices might have on airworthiness control."
"61
This was not a conscious, deliberate
compromise of standards, but rather an invisible erosion of standards based on
the more pressing need to 'get the job done' in as expedient a fashion as possible,
which is a natural trait of engineers. The implications on standards of
airworthiness of adopting certain procedures and methods are not always
obvious at first sight and an awareness that standards might be compromised
requires a certain degree of training, experience and awareness of airworthiness
issues in general. Without a continual focus on airworthiness standards, through
training, effective supervision and adequate quality monitoring, it is inevitable
that staff will deviate from best practices."
"Since the incident, Safety Services as a department has been expanded
to include Corporate Quality and has been renamed as Corporate
Safety & Quality."
Christ on a Crutch! What a mess. And as far as a reading of the report can tell the management response is ........more management, renaming LAE's as "supervisors", and expanding the size of the quality control empire which didn't and can't pick up behavioural issues in the first place! My guess is that the net result will be that LAE's will have more paperwork and even less time to devote to technical matters. Reading between the lines, it seems obvious that BA needs more LAE's, but the "work smarter not harder" brigade will not allow it.
There is no bloody way to tell if the system is fixed either! Do BA techs still batch stamp job cards? I will not make an obvious observation otherwise it will probably be deleted by a moderator.
The bits that made my blood boil the most are here. If they do not make your blood boil BOAC, you should not be working in the airline industry. If anyone had behaved this way at AN they would have been sacked. Furthermore, and although it is not relevent to this thread, how is it possible that anyone could accurately determine maintenance costs under such a system?
"By certifying for the fitment of the panels, a task that he had not performed
himself, the technician exceeded the scope of his company authorisation.
However, the investigation determined that his was not an isolated case. The
lack of discipline in certifying for work in a timely manner meant that it was not
unusual for individuals to be in a position where they would be asked to certify
for a task performed by someone else, who had gone off shift without certifying
for the work completed. Faced with this problem, rather than incur potential
delays in production, maintenance staff would attempt to verify that a task had
been completed before certifying for it themselves."
"However basic the error may appear with hindsight, such errors cannot be
entirely eliminated from human performance and aviation history is filled with
accidents caused by fundamental errors caused by misinterpretation or relying
on assumption. It is recognised in the aviation industry that human error cannot
be entirely eliminated and where an error could prove critical, systems and
procedures are put in place to capture it or mitigate its effects. Examples of this
include the cross-checking of instrument settings by both pilots, or duplicate
inspections in maintenance on flight critical systems."
"Quality compliance audits are not
particularly effective in identifying behavioural issues that have the potential to
compromise standards of airworthiness, as they look at the outputs of the
processes and not necessarily how they are performed. These issues can only be
understood through spending a suitable amount of time in the maintenance
environment and working with staff to understand the factors that influence their
working practices. It is therefore not surprising that the Quality Engineers were
unaware of the actual practices in use on the shop floor and the detrimental
effect that such practices might have on airworthiness control."
"61
This was not a conscious, deliberate
compromise of standards, but rather an invisible erosion of standards based on
the more pressing need to 'get the job done' in as expedient a fashion as possible,
which is a natural trait of engineers. The implications on standards of
airworthiness of adopting certain procedures and methods are not always
obvious at first sight and an awareness that standards might be compromised
requires a certain degree of training, experience and awareness of airworthiness
issues in general. Without a continual focus on airworthiness standards, through
training, effective supervision and adequate quality monitoring, it is inevitable
that staff will deviate from best practices."
"Since the incident, Safety Services as a department has been expanded
to include Corporate Quality and has been renamed as Corporate
Safety & Quality."
Last edited by Sunfish; 16th Dec 2005 at 19:46.
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From Fargoo "The 757 oil debacle is inexcusable as there are strict instructions on refilling now and many procedures in place to stop it happening. It should not still be going on."
Servicing is not the problem!! Has any one heard of other Airlines with RR B757 with oil smell problems.... I do not think so (I am prepared to be advised otherwise )
BA engines are over hauled by GE in Wales, and they have had a number of quality problems over the last couple of years or so ( Remember the -524 problems?) That is where I believe the problems lie.
Servicing is not the problem!! Has any one heard of other Airlines with RR B757 with oil smell problems.... I do not think so (I am prepared to be advised otherwise
)BA engines are over hauled by GE in Wales, and they have had a number of quality problems over the last couple of years or so ( Remember the -524 problems?) That is where I believe the problems lie.
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Keel Beam
I have handled LY and their 757's are filled to the very top of the tank. They have not had this problem to my knowledge.
Le Pen
Maybe its on page 3.... Who Can We Blame!
PLM
Servicing is not the problem!! Has any one heard of other Airlines with RR B757 with oil smell problems.... I do not think so (I am prepared to be advised otherwise )
Le Pen
What pages are the "Engineering Related Section" (BA's words not mine) on??
PLM
BOAC, professional engineer and part of the management of an 1100 strong maintenance division that didn't do the sort of things that BA stands accused of doing. That good enough for you?
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I think Fargoo pretty much summates matters with the comments re the paperwork and the fact that in 10-15 years it has not been updated due to costs----that, and the fact that BA's beloved Omega system--if it's still around that is ?--was regarded as near perfection--when the reverse was true !----I recall that for an APU health monitoring check about 90% of the cards were basically "how to start the apu". A complete waste of time when all you needed was to record the relevant parameters under various loads. As for the contradictions with regard to removal./ refit and removal of panels--this applies to just about every fleet and frankly is a recipe for distaster in itself.
BOAC 73----er, could you tell me please, which panels are not relevant to airworthiness then ? I know that there are certain panels which are not deemed critical, but even then the penalty for leaving them off is sufficient to incur a reduced operational capability---but nowhere have I ever seen in an AMM the fact that "please don't leave these panels off by accident because it sort of causes a problem or two"---which is what you imply in your post. Just what is your engineering discipline please?
Mine was Mil. / Civil Line / Hangar and Casualty plus some bay work and ad hoc flying spannering before you ask.
BOAC 73----er, could you tell me please, which panels are not relevant to airworthiness then ? I know that there are certain panels which are not deemed critical, but even then the penalty for leaving them off is sufficient to incur a reduced operational capability---but nowhere have I ever seen in an AMM the fact that "please don't leave these panels off by accident because it sort of causes a problem or two"---which is what you imply in your post. Just what is your engineering discipline please?
Mine was Mil. / Civil Line / Hangar and Casualty plus some bay work and ad hoc flying spannering before you ask.
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Slight Thread creep but...
In a recent high profile accident where a switch was left in a "wrong" position by an engineer, the AMM had simply said: "Return aircraft to initial condition".
Now I had always thought that that might mean to uncollar and reset all circuit breakers, return all switches to their "normal" positions and leave the airplane as the pilots would normally expect to find it. However Boeing has now (in their infinite wisdom) come out with an S.I.L. (I believe) as well as an amendment to the AMM saying specifically that this potentially (and actually now) lethal switch should be positioned to AUTO.
That would seem (also because of what's specifically said in the covering letter to the AMM amdt) to be a liability admission by Boeing that the AMM was wrong before (by not specifying said switch uniquely). That will possibly open up Boeing to all sorts of litigation and liability.
So were they right or unwise to have said & done this? How many other unopened cans of worms does that leave them with? They may have simply been being wise and conscionable after the event and recognizing it as an area ("cleanup") where some engineers are not as punctilious as others, but their act has already given rise to some libel lawsuits..... by the "switch-leavers".
I personally thought that they'd been unwise to say what was said in the covering letter.
Now I had always thought that that might mean to uncollar and reset all circuit breakers, return all switches to their "normal" positions and leave the airplane as the pilots would normally expect to find it. However Boeing has now (in their infinite wisdom) come out with an S.I.L. (I believe) as well as an amendment to the AMM saying specifically that this potentially (and actually now) lethal switch should be positioned to AUTO.
That would seem (also because of what's specifically said in the covering letter to the AMM amdt) to be a liability admission by Boeing that the AMM was wrong before (by not specifying said switch uniquely). That will possibly open up Boeing to all sorts of litigation and liability.
So were they right or unwise to have said & done this? How many other unopened cans of worms does that leave them with? They may have simply been being wise and conscionable after the event and recognizing it as an area ("cleanup") where some engineers are not as punctilious as others, but their act has already given rise to some libel lawsuits..... by the "switch-leavers".
I personally thought that they'd been unwise to say what was said in the covering letter.