Preliminary report
Preliminary report released 19 February 2008
On 7 January 2008, a Boeing Company 747 438 aircraft, registered VH-OJM, was being operated on a scheduled international regular public transport service between London, England and Bangkok, Thailand. The aircraft had 346 passengers and 19 crew on board, including four flight crew.
At about 0837 UTC, while the aircraft was at about 21,000 feet on descent to Bangkok International Suvarnabhumi Airport, the customer service manager (CSM) notified the flight crew that a substantial water leak had occurred in the forward galley.
Between approximately 0840 and 0852, cockpit indications showed a number of electrical bus and system failures that indicated alternating current (AC) buses 2, 1 and 3 were not powered. The status of AC bus 4 appeared normal and some systems were powered by batteries.
The captain's primary flight display, navigation display, and some other instruments were available in a degraded mode. Standby instruments and the aircraft's instrument landing system were also available. The crew conducted an approach to runway 01 Right in day visual meteorological conditions and the aircraft landed at 0907.
On 11 January 2008, the aircraft manufacturer issued a Multi Operator Message to operators of 747 400 series aircraft, containing advice and instructions for the inspection and repair of main equipment centre drip shields. The manufacturer is preparing an inspection and repair alert service bulletin on the same subject that is scheduled for release by May 2008.
On 11 January 2008, the aircraft operator issued a Cabin Standing Order and a Flight Standing Order requiring cabin and flight crews to treat and report abnormal water accumulation in galley areas.
Summary
On 7 January 2008, a Boeing Company 747-438 aircraft, registered VH-OJM, was being operated on a scheduled international regular public transport service between London, England and Bangkok, Thailand. The aircraft had 346 passengers and 19 crew on board, including four flight crew. On descent to Bangkok International Airport, the customer service manager notified the flight crew that a substantial water leak had occurred in the forward galley.
The cockpit indications progressively showed a number of electrical power-related malfunctions, and many of the aircraft's communication, navigation, monitoring and flight guidance systems were affected. A number of flight and navigation display and other instruments were available in degraded mode and the standby instruments and instrument landing system were also available. The aircraft's engines and hydraulic and pneumatic systems were largely unaffected and an approach was made to Bangkok in day visual meteorological conditions.
The investigation found the galley leak was from an overflowing drain after a drain line had been blocked with ice that formed due to an inoperable drain line heater. The water flowed forward and through a decompression panel into the aircraft's main equipment centre before leaking onto three of the aircraft's four generator control units, causing them to malfunction and shut down.
The investigation identified a number of safety issues in regard to the protection of aircraft systems from liquids, and other factors including the provision of information to flight crews. In response, the aircraft manufacturer and operator implemented a number of safety actions intended to prevent a recurrence. In addition, the United States Federal Aviation Administration issued a notice of proposed rulemaking to adopt a new airworthiness directive for certain 747-400 and 747-400D series aircraft to install improved water protection. The Australian Transport Safety Bureau has issued two safety recommendations and one safety advisory notice as a result of the investigation.
Occurrence summary
| Investigation number | AO-2008-003 |
|---|---|
| Occurrence date | 07/01/2008 |
| Location | 25 km NNW of Bangkok International Airport |
| State | International |
| Report release date | 13/12/2010 |
| Report status | Final |
| Investigation level | Systemic |
| Investigation type | Occurrence Investigation |
| Investigation status | Completed |
| Mode of transport | Aviation |
| Aviation occurrence category | Electrical system |
| Occurrence class | Serious Incident |
| Highest injury level | None |
Aircraft details
| Manufacturer | The Boeing Company |
|---|---|
| Model | 747 |
| Registration | VH-OJM |
| Serial number | 25245 |
| Sector | Jet |
| Operation type | Air Transport High Capacity |
| Departure point | London Heathrow, UK |
| Destination | Bangkok, Thailand |
| Damage | Nil |