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Safety Action

Summary

Local safety action

Engine/EEC manufacturer

On 25 October 2002, the engine manufacturer issued worldwide communication WW/20032/1/25-10-002 informing operators and airframe and engine technical representatives of the in-flight shutdown event and the fault codes witnessed.

On 27 November 2002, the engine manufacturer issued worldwide communication WW/20032/2/27 Nov. 02 updating the operators and airframe and engine technical representatives of the in-flight shutdown event investigation. That communique informed of the testing of the Fuel Metering Unit and EEC.

On 20 December 2002, the engine manufacturer issued Notice to Operators (NTO) number 54 advising operators of the in-flight shutdown events and of engine restart procedures in the event of an engine shutdown without abnormal engine indications. That communique also advised of harness installation procedures, review of the fault codes and recommended interrogation of the multi-function control display unit (MCDU) at intervals of 50 flight hours.

The engine manufacturer further advised that they will be incorporating a software upgrade of the EEC to version 7.0, which will include an improvement to remove the possibility for certain intermittent failures to trigger a 'health lane' degradation without triggering the corresponding maintenance message.

The Operator

Following the return to service of the aircraft after the 4 October 2002 event, the operator implemented a MCDU interrogation procedure on the incident aircraft for a period of three days. The MCDU stored fault codes were reviewed at the end of each day of flying. The procedure was similar to that subsequently recommended by the engine manufacturer in NTO 54 issued on 20 December 2002. The maintenance history of the right engine was also reviewed as far back as its installation on the aircraft, which occurred on 3 August 2002.

Following the 24 November 2002 event, the operator carried out similar actions as completed after the 4 October 2002 event. The maintenance history of the aircraft was reviewed as far back as the last A check in September 2002. The MCDU review procedure was expanded to cover all aircraft in the fleet. The operator initiated review procedure was superseded on 27 November 2002 by an interim health check procedure developed by the engine manufacturer. This procedure required MCDU fault codes to be reviewed after every 25 to 30 sectors.

Australian Civil Aviation Safety Authority

On 29 November 2002, the Australian Civil Aviation Safety Authority (CASA) issued a directive to the operator to review all fault codes at the end of each day's flying for the occurrence aircraft until further notice.

On 6 December 2002, CASA relaxed the MCDU review requirement for VH-VQC to every port with engineering support available.

On 16 January 2003, CASA issued a request to the operator requiring reviews additional to NTO 54. That action included a review of fault codes at the end of each day's flying for all operator aircraft, with the incident aircraft logged fault codes being reviewed after each sector where engineering support was available. They further expanded the review of fault codes after each sector where engineering support was available to include all operator B717 aircraft.

CASA has subsequently advised the ATSB that the operator has commenced the following program to ensure continued airworthiness of the fleet:

- The MCDU is to be interrogated for EEC faults after each flight into a manned port. Recurring faults identified in NTO 54 should result in replacement of the EEC.

- Fault codes and corrective actions are to be reported to CASA.

- EECs are to be modified per RRD SB-BR700-73-900316.

- One modified EEC is to be installed, in turn, on each aircraft in the fleet.

- Once a modified EEC has been installed, its reliability is to be monitored by continuing the MCDU interrogation after each flight to a manned port for two weeks. Once the reliability is established, MCDU interrogation can be extended to service check intervals.

- Modification of both the EECs, and confirmation of their reliability through MCDU interrogation described above constitutes the corrective actions after which the MCDU interrogations can revert to service check intervals.

- All EECs returned to the manufacturer are to be upgraded and the entire fleet is scheduled to be modified not later than the first quarter of 2004.

RECOMMENDATIONS

Recommendation 20030032

As a result of this investigation, the Australian Transport Safety Bureau recommends that the German Airworthiness Authority, Luftfahrt-Bundesamt issue an airworthiness directive to mandate compliance with Rolls-Royce Deutschland Ltd and Co KG Service Bulletin SB-BR700-73-900316.

Recommendation 20030037

As a result of this investigation, the Australian Transport Safety Bureau recommends that the United States Federal Aviation Administration liaise with the German Airworthiness Authority, Luftfahrt-Bundesamt to develop and issue an airworthiness directive to mandate compliance with Rolls-Royce Deutschland Ltd and Co KG Service Bulletin SB-BR700-73-900316.

 
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