Hello All, On November 30, 2018, an Airbus A320-214 operated by Frontier Airlines lost the fan cowl doors of engine no.2 upon takeoff from Las Vegas-McCarran International Airport, Nevada, USA. This incident was at least the 45th fan cowl door loss event involving an Airbus A320-family aircraft. A common safety issue among these incidents is the fact that the cowl doors were not closed and latched following maintenance. This was not detected by the engineers, or by flight crewmembers during the walk-around check. The design of the fan cowl door latching system, in which the latches are positioned at the bottom of the engine nacelle in close proximity to the ground, increased the probability that unfastened latches would not be seen during the pre-departure inspections. Investigation reports into these incidents have found a multitude of human factor disturbances to be the main contributing factors. Fatigue, Pressure, Distractions, Compliancy and Back Check inspections not accomplished. In 2010 Gary Burch of Crucial - Knowledge, developed a CBT program entitled “Remember to Close the Latches” in response to this human error failure which is still pertinent today. http://www.crucial-knowledge.info/index.htm Click here for issue 23Be Safe in the Region of Risk Roger Hughes Decoding Human Factors, LLC |
Remember to Close the Latches.
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