Flying Control FOD: Screwdriver Found in C208 Controls
An Australian Cessna 208B Caravan pilot detected a control restriction during a flight control rigging check according to a Service Difficult Report (SDR) submitted to the Civil Aviation Safety Authority (CASA). The report described how the pilot:
…checked full and free movement of all flight controls. Very slight friction or binding of the elevator control was identified.
The issue was discussed with the LAME [Licenced Aircraft Maintenance Engineer] who investigated further and discovered an object wedged between the control column shroud and the control column attaching cables.
The shroud was removed and a screw driver was found.
CASA do not report any investigation results that explain the lost tool. Even when such information is available, it is very easy to fall for the fundamental attribution error that the personnel in a particular incident were ‘stupid’ or ‘unprofessional’ without considering the organisational environment and the circumstances they found themselves in.
We have previously discussed these FOD events:
- Tool Control and a Rotor Blade FOD Incident
- Micro FOD: Cessna 208B Grand Caravan Engine Failure & Forced Landing
- Misrigged Flying Controls: Fatal Maintenance Check Flight Accident
- FOD Damages 737 Flying Controls
- Crew Bag FOD Shatters Hawk Canopy
- C-130J Control Restriction Accident, Jalalabad
UPDATE 26 March 2017: Cessna 208 Forced Landing: Engine Failure Due To Re-Assembly Error
Plus we have discussed maintenance human factors and error management more generally here:
- Professor James Reason’s 12 Principles of Error Management
- Back to the Future: Error Management
- Maintenance Human Factors: The Next Generation
- Aircraft Maintenance: Going for Gold?
Aerossurance is pleased to sponsor the 2017 European Society of Air Safety Investigators (ESASI) 8th Regional Seminar in Ljubljana, Slovenia on 19 and 20 April 2017. Registration is just €100 per delegate. To register for the seminar please follow this link. ESASI is the European chapter of the International Society of Air Safety Investigators (ISASI).