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Maintenance Error Decision Aid (MEDA) Results Form


Section I -- General Information
Reference #: __ __ __ __ __ Interviewer's Name:_______________
Airline: ______________________ Interviewer's Telephone
#: __ __ __ __ __ __ __ __ __
Station of Error: _______________ Date of Investigation: _ _ / _ _ / _ _
Aircraft Type: _________________ Date of Event: _ _ / _ _ / _ _
Engine Type: _________________ Time of Event: _ _ : _ _ am pm
Reg. #: __ __ __ __ __ __ __ Shift of Error: ___________________
Fleet Number: __ __ __ __ __ __ Type of Maintenance (Circle):
ATA #: __ __ __ __ 1. Line -- If Line, what type?
____________________________
Aircraft Zone:__________________ 2. Base -- If Base, what type?
____________________________
Ref. # of previous
related event: __ __ __ __ __
Date Changes
Implemented: _ _ / _ _ / _ _

Section II -- Event
Please select the event (check all that apply)
1. Operations Process Event ( ) f. Diversion
( ) a. Flight Delay (write in length)
        _ _ days _ _  hrs. _ _ min.
( ) g. Other (explain below)
( ) b. Flight Cancellation ( ) 2. Aircraft Damage Event
( ) c. Gate Return ( ) 3. Personal Injury Event
( ) d. In-Flight Shut Down ( ) 4. Rework
( ) e. Air Turn-Back ( ) 5. Other Event (explain below)
Describe the incident/degradation/failure (e.g., could not pressurize) that caused the event.
 

Section III -- Maintenance Error
Please select the maintenance error(s) that caused the event:
1. Installation Error 3. Repair Error (e.g., component or structural repair) 6. Airplane/Equipment Damage Error
( ) a. Equipment/part not installed   ( ) a. Tools/equipment used improperly
( ) b. Wrong equipment/ part installed 4. Fault Isolation/ Test/Inspection Error ( ) b. Defective tools/ equipment used
( ) c. Wrong orientation ( ) a. Did not detect fault ( ) c. Struck by/against
( ) d. Improper location ( ) b. Not found by fault isolation ( ) d. Pulled/pushed/ drove into
( ) e. Incomplete installation ( ) c. Not found by operational/functional test ( ) e. Other (explain below)
( ) f. Extra parts installed ( ) d. Not found by inspection  
( ) g. Access not closed ( ) e. Access not closed 7. Personal Injury Error
( ) h. System/equipment not reactivated/ deactivated ( ) f. System/equipment not deactivated/ reactivated ( ) a. Slip/trip/fall
( ) i. Damaged on installation ( ) g. Other (explain below)  ( ) b. Caught in/on/ between
( ) j. Cross connection   ( ) c. Struck by / against
( ) k. Other (explain below) 5. Foreign Object Damage Error ( ) d. Hazard contacted (e.g., electricity, hot or cold surfaces, and sharp surfaces)
  ( ) a. Material left in aircraft / engine ( ) e. Hazardous substance exposure (e.g., toxic or noxious substances)
2. Servicing Error ( ) b. Debris on ramp ( ) f. Hazardous thermal environment exposure (heat, cold, or humidity)
( ) a. Not enough fluid ( ) c. Debris falling into open systems ( ) g. Other (explain below)
( ) b. Too much fluid ( ) d. Other (explain below)  
( ) c. Wrong fluid type   ( ) 8. Other (explain below)
( ) d. Required servicing not performed    
( ) e. Access not closed    
( ) f. System/equipment not deactivated/ reactivated    
( ) g. Other (explain below)    
Describe the specific maintenance error (e.g., auto pressure controller installed in wrong location).

Section IV -- Contributing Factors Checklist
N/A _ A. Information (e.g., work cards, maintenance manuals, service bulletins, maintenance tips, non-routines, IPC, etc.)
  _ 1. Not understandable _ 5. Update process is too long/ complicated
  _ 2. Unavailable/inaccessible _ 6. Incorrectly modified manufacturer's MM/SB
  _ 3. Incorrect _ 7. Information not used
  _ 4. Too much/conflicting information _ 8. Other (explain below)
  Describe specifically how the selected information factor(s) contributed to the error.

N/A _ B. _______ Equipment/Tools/Safety Equipment
  _ 1. Unsafe _ 6. Inappropriate for the task _ 11. Not used
  _ 2. Unreliable _ 7. Cannot use in intended environment _ 12. Incorrectly used
  _ 3. Layout of controls or displays _ 8. No instructions _ 13. Other (explain below)
  _ 4. Mis-calibrated _ 9. Too complicated  
  _ 5. Unavailable _ 10. Incorrectly labeled  
  Describe specifically how selected equipment/tools/safety equipment factor(s) contributed to the error.

N/A _ C. _______ Aircraft Design/Configuration/Parts
  _ 1. Complex _ 4. Parts unavailable _ 6. Easy to install incorrectly
  _ 2. Inaccessible _ 5. Parts incorrectly labeled _ 7. Other (explain below)
  _ 3. Aircraft configuration variability    
  Describe specifically how the selected aircraft design/ configuration/parts factor(s) contributed to error.

N/A _ D. ______________________________Job/Task
  _ 1. Repetitive/ monotonous _ 3. New task or task change _ 5. Other (explain below)
  _ 2. Complex/ confusing _ 4. Different from other similar tasks  
  Describe specifically how the selected job/task factor(s) contributed to the error.

N/A _ E. ______________Technical Knowledge/Skills
  _ 1. Skills _ 3. Task planning _ 5. Aircraft system knowledge
  _ 2. Task knowledge _ 4. Airline process knowledge _ 6. Other (explain below)
  Describe specifically how the selected technical knowledge/skills factor(s) contributed to the error.

N/A _ F. Individual Factors
  _ 1. Physical health (including hearing and sight) _ 5. Complacency _ 9. Memory lapse (forgot)
  _ 2. Fatigue _ 6. Body size/strength _ 10. Other (explain below)
  _ 3. Time constraints _ 7. Personal event (e.g., family problem, car accident)  
  _ 4. Peer pressure during task performance _ 8. Workplace distractions/interruptions  
  Describe specifically how the selected factors affecting individual performance contributed to the error.

N/A _ G. Environment/Facilities
  _ 1. High noise levels _ 5. Rain _ 9. Vibrations _ 13. Inadequate ventilation
  _ 2. Hot _ 6. Snow _ 10. Cleanliness _ 14. Other (explain below)
  _ 3. Cold _ 7. Lighting _ 11. Hazardous/ toxic substances  
  _ 4. Humidity _ 8. Wind _ 12. Power sources  
  Describe specifically how the selected environment/facilities factor(s) contributed to the error.

N/A _ H. Organizational Factors
  _ 1. Quality of support from technical organizations (e.g., engineering, planning, technical pubs) _ 6. Work process/procedure
  _ 2. Company policies _ 7. Work process/procedure not followed
  _ 3. Not enough staff _ 8. Work process/procedure not documented
  _ 4. Corporate change/ restructuring _ 9. Work group normal practice (norm)
  _ 5. Union action _ 10. Other (explain below)
  Describe specifically how the selected organizational factor(s) contributed to the error.

N/A _ I. Leadership/Supervision
  _ 1. Planning/ organization of tasks _ 3. Delegation/ assignment of task _ 5. Amount of supervision
  _ 2. Prioritization of work _ 4. Unrealistic attitude/expectations _ 6. Other (explain below)
  Describe specifically how the selected leadership/supervision factor(s) contributed to the error.

N/A _ J. Communication
  _ 1. Between departments _ 4. Between maintenance crew and lead _ 7. Other (explain below)
  _ 2. Between mechanics _ 5. Between lead and management  
  _ 3. Between shifts _ 6. Between flight crew and maintenance  
  Describe specifically how the selected communication factor(s) contributed to the error.

N/A _ K. Other Contributing Factors (explain below)
  Describe specifically how this other factor contributed to the error.



Section V -- Error Prevention Strategies
A. What current existing procedures, processes, and/or policies in your organization are intended to prevent the incident, but didn't?
( ) Maintenance Policies or Processes (specify)
_______________________________________________________
( ) Inspection or Functional Check (specify)
_______________________________________________________
  Required Maintenance Documentation
  ( ) Maintenance manuals (specify)
_______________________________________________________
  ( ) Logbooks (specify)
_______________________________________________________
  ( ) Work cards (specify)
_______________________________________________________
  ( ) Engineering documents (specify)
_______________________________________________________
  ( ) Other (specify)
_______________________________________________________
  Supporting Documentation
  ( ) Service Bulletins (specify)
_______________________________________________________
  ( ) Training materials (specify)
_______________________________________________________
  ( ) All-operator letters (specify)
_______________________________________________________
  ( ) Inter-company bulletins (specify)
_______________________________________________________
  ( ) Other (specify)
_______________________________________________________
( ) Other (specify)
_______________________________________________________

B. List recommendations for error prevention strategies.
Recommendation # Contributing Factor #  
     





(Use additional pages, as necessary)

Section VI -- Summary of Contributing Factors, Error, and Event
Provide a brief summary of the event.



(Use additional pages, as necessary)
Date modified:
2010-05-03

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