MEDA-Result-Form

MEDAResultsFormRevisioni122May2009MaintenanceErrorDecisionAid(MEDA)ResultsFormSectionI--GeneralInformationReference#:_______________Interviewer’sName:_________________________Airline:_______________________________________Interviewer’sTelephone#:____________________StationofError:________________________________DateofInvestigation:____/____/____AircraftType:__________________________________DateofEvent:____/____/____EngineType:__________________________________TimeofEvent:__:__ampmReg.#:_____________________ShiftofError:______________________________FleetNumber:__________________TypeofMaintenance(Circle):ATA#:____________1.Line--IfLine,whattype?_________________AircraftZone:__________________________________2.Base--IfBase,whattype?________________Ref.#ofpreviousrelatedevent:_______________DateChangesImplemented:____/____/____SectionII--EventPleaseselecttheevent(checkallthatapply)1.OperationsProcessEvent()a.FlightDelay__days__hrs.__min.()e.AirTurn-Back()2.AircraftDamageEvent()b.FlightCancellation()f.Diversion()3.PersonalInjuryEvent()c.GateReturn()g.Other(explainbelow)()4.Rework()d.In-FlightShutDown()5.AirworthinessControl()6.OtherEvent(explainbelow)Describetheincident/degradation/failure(e.g.,couldnotpressurize)thatcausedtheevent.SectionIII--MaintenanceErrorPleaseselectthemaintenanceerror(s)thatcausedtheevent:1.InstallationError()3.RepairError(e.g.,componentor)7.PersonalInjuryError()a.Equipment/partnotinstalledstructuralrepair)()a.Slip/trip/fall()b.Wrongequipment/partinstalled()a.Incorrect()b.Caughtin/on/between()c.Wrongorientation()b.Unapproved()c.Struckby/against()d.Improperlocation()c.Other(explainbelow)()d.HazardContacted(e.g.electricity,()e.Incompleteinstallationhotorcoldsurfaces,andsharp()f.Extrapartsinstalled4.FaultIsolation/Test/InspectionErrorsurfaces)()g.Accessnotclosed()a.Didnotdetectfault()e.Hazardoussubstanceexpose(e.g.,()h.System/equipmentnot()b.NotfoundbyfaultisolationToxicornoxioussubstances)reactivated/deactivated()c.Notfoundbyoperational/()f.Hazardousthermalenvironment()i.Damagedoninstallationfunctionaltestexposure(heat,cold,orhumidity)()j.Crossconnection()d.Notfoundbyinspection()g.Other(explainbelow)()k.Mis-rigging(controls,doors,etc.)()e.Accessnotclosed()l.Other(explainbelow)()f.System/equipmentnot8.MaintenanceControlfailuredeactivated/reactivated()a.Scheduledtaskomitted/late2.ServicingError()g.Other(explainbelow)()b.Incorrectlycontrolleddeferred()a.Notenoughfluiddefect()b.Toomuchfluid5.ForeignObjectDamage()c.Incorrectlydeferreddefect()c.Wrongfluidtype()a.Materialleftinaircraft/engine()d.Airworthinessdatainterpretation()d.Requiredservicingnotperformed()b.Debrisonramp()e.Technicallogoversight()e.Accessnotclosed()c.Debrisfallingintoopensystems()f.AirworthinessDirectiveoverrun()f.System/equipmentnot()d.Other(explainbelow)()g.Modificationcontrolreactivated/deactivated()h.MELinterpretation()g.Other(explainbelow)6.Airplane/EquipmentDamage()i.Configurationcontrol()a.Tools/equipmentusedimproperly()j.Recordscontrol()b.Defectivetools/equipmentused()k.Componentrobberycontrol()c.Struckby/against()l.Other(explainbelow)()d.Pulled/pushed/droveinto()e.Other(explainbelow)()9.Other(explainbelow)Describethespecificmaintenanceerror(e.g.,autopressurecontrollerinstalledinwronglocation).MEDAResultsFormRevisioni222May2009SectionIV--ContributingFactorsChecklistA.Information(e.g.,workcards,maintenancemanuals,servicebulletins,maintenancetips,non-routines,IPC,etc.)__1.Notunderstandable__6.Incorrectlymodifiedmanufacturer'sMM/SB__2.Unavailable/inaccessible__7.Informationnotused__3.Incorrect__8.Inadequate__4.Toomuch/conflictinginformation__9.Uncontrolled__5.Updateprocessistoolong/complicated__10.Other(explainbelow)Describespecificallyhowtheselectedinformationfactor(s)contributedtothesystemfailure.B.Equipment/Tools/SafetyEquipment__1.Unsafe__6.Inappropriateforthetask__11.Notused__2.Unreliable__7.Cannotuseinintendedenvironment__12.Incorrectlyused__3.Layoutofcontrolsordisplays__8.Noinstructions__13.Inaccessible__4.Mis-calibrated__9.Toocomplicated__14.Other(explainbelow)__5.Unavailable__10.IncorrectlylabeledDescribespecificallyhowselectedequipment/tools/safetyequipmentfactor(s)contributedtothesystemfailure.C.AircraftDesign/Configuration/Parts__1.Complex__4.Partsunavailable__7.Notused__2.Inaccessible__5.Partsincorrectlylabeled__8.Notuserfriendly__3.Aircraftconfigurationvariability__6.Easytoinstallincorrectly__9.Other(explainbelow)Describespecificallyhowtheselectedaircraftdesign/configuration/partsfactor(s)contributedtosystemfailure.D.Job/Task__1.Repetitive/monotonous__3.Newtaskortaskchange__5.Other(explainbelow)__2.Complex/confusing__4.DifferentfromothersimilartasksDescribespecificallyhowtheselectedjob/taskfactor(s)contributedtothesystemfailure.E.TechnicalKnowledge/Skills__1.Skills__4.Airlineprocessknowledge__7.Teamworkskills__2.Taskknowledge__5.Aircraftsystemknowledge__8.Computingskills__3.Taskplanning__6.Englishlanguageproficiency__9.Other(explainbelow)Describespecificallyhowtheselectedtechnicalknowledge/skillsfactor(s)co