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by taking action that best ensures, maintains, and enhances the safety of the L-1011 fuel system.
As indicated from the evaluation of results, effort toward implementing actions is to focus on
preventative measures concerning possible improvements of maintenance practices.
8.0 Lockheed Martin Working Group Report (continued)
August 4, 2000 Industry AFFSP Report Page 79
The approach taken to identify the need and type of action is to first define the potential problem,
next identify how the potential problem could occur (possible causes), and then determine how
best to prevent the occurrence of the potential problem.
For each issue identified as warranting continued investigation, conceivable ways in which
potential deficiencies could occur are to be identified by considering the following possible
opportunities of occurrence:
! Maintenance procedures not provided.
! Maintenance procedures require clarification and/or increased attention or emphasis.
! Maintenance personnel unaware of and/or not applying procedures.
The applicable airplane maintenance manual (AMM) section is then to be evaluated to determine
whether adequate instructions are provided. Where appropriate, required changes to maintenance
instructions are to be developed to ensure that the intent of the instruction and all applicable safety
measures have been adequately incorporated. Where deemed necessary, increased awareness of
instructions is to be fostered by means of enhanced training programs, SILs, or other means of
knowledge transfer.
8.10 Action Status and Continuing Efforts
Missing Ground Straps
Top priority was assigned to the issue of missing ground straps. A preventative action plan was
accomplished as described in the previous section. A thorough review of the applicable
maintenance manual procedures revealed that adequate instructions are provided for the repair and
replacement of static ground straps as specified in Chapter 20: Standard Practices.
Review of Chapter 28: Fuel Systems of the maintenance manual yielded an opportunity for
improvement. Evaluation of fuel system component installation procedures indicated an
opportunity to better clarify the requirement of installing replacement ground straps. Currently, all
applicable fuel system component installation procedures are being reviewed to ensure that
adequate ground strap installation requirements are provided. Reference to the applicable Chapter
20: Standard Practices section will also be included in the installation procedures. As an additional
safety assurance measure, the Lockheed Martin L-1011 operator training program will be
enhanced to emphasize the function and importance of ground strap assemblies, instruct proper
maintenance practices, and provide safety awareness issues for personnel who work on the fuel
tank system.
By implementing the above actions, all identified opportunities of occurrence for missing ground
straps will be addressed, and appropriate preventative action will be taken that best ensures,
maintains, and enhances the safety of the L-1011 fuel system. These actions will ensure that
appropriate AMM instructions are provided, that the instructions are comprehensive, and that
actions are taken to promote awareness of procedures and safety concerns. The chosen vehicles to
implement the maintenance practice improvements will include modification to maintenance
8.0 Lockheed Martin Working Group Report (continued)
Page 80 Industry AFFSP Report August 4, 2000
manual instructions, issuance of a SIL, and modification of the Lockheed Martin L-1011 operator
training program.
Additional Issues
As a result of the AFSSP, opportunities for improvement of maintenance practices are currently
being investigated concerning the following issues:
! Fault current bonding procedures for boost pumps and valves.
! Coupling installation procedures.
These remaining issues warranting further investigation are based on findings, which were
determined not to be significant with respect to compromising the integrity or safety condition of
the aircraft. These issues are currently in the initial stages of the investigative process as discussed
in the previous section. Based on the inspection program findings, potential safety concerns are
being identified and MM procedures are being reviewed to ensure complete and comprehensive
instructions are provided in the manual that best ensures the safety of the fuel tank system.
August 4, 2000 Industry AFFSP Report Page 81
9.0 CONCLUSIONS
In the wake of the TWA 800 disaster, questions were raised as to whether airplane fuel systems
were deteriorating as airplanes aged in commercial service. As described above, the large-scale
design review and in-service airplane fleet inspection effort performed by the industry via the
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