Real World Example of Document Control Failure Needed

[RedneckJunky]

Hi All,

I'm preparing a presentation on Process Management and one of the subtopics is control of documents. I'm looking for any high-profile examples of document control failures - anybody have something funny or extreme you'd like to share? Thanks in advance!

 

[JQuality]

I have personally seen instances of poor print control cause hundreds of thousands of dollars in additional manufacturing cost because tools were built using obsolete prints instead of the most current revision level.

The tools were eventually reworked, but not without months of delay and tremendous expense.

That's pretty extreme in my view.

 

[Mikishots]

Hi All,

I'm preparing a presentation on Process Management and one of the subtopics is control of documents. I'm looking for any high-profile examples of document control failures - anybody have something funny or extreme you'd like to share? Thanks in advance!

The metric mix-up of the Mars Orbiter in 1999 can be considered one. The procedures in place did not match - the forces in one were defined in Newtons and the other was defined in foot-pounds. Evidently, no units were provided with the calculations themselves and the result was the orbiter burning up in the atmosphere.

 

[Corinnep]

I have a little diddy working in Autodesk Vault that might apply. I am DC Manager at my facility. I never "delete" a thing and because my access is on a higher level, I do have delete rights. Long story short I "accidentally" deleted 58 Drawings and it's asseblies (.idw and .iam). When I realized what happened, I ran to our IT guy who went to look for a back up. And..................... the last back up was 6 months ago. The lesson learned is, "ALWAYS BACK UP" I don't know if this can help you.

 

[Corinnep]

I have seen that done to my dismay.

 

[somashekar]

A documented procedure shall be established to define the controls needed a) to approve documents for adequacy prior to issue,
Above is one of the first requirement in control of documents as in ISO9001.
A drawing for a 60mm custom 'O' ring was issued to development and being an electronic industry, a little less attention was paid for rubber parts. The person to approve was not available and it was agreed to go ahead with development (tooling included) as it was a simple and a small part.
The first article was promptly inspected and accepted by the inspection based on the drawing copy had, and was communicated. When the time came for the assembly of the new product, the assembly supervisor promptly stopped the final assembly, put the 'O' ring around his neck and shouted .. for the reason that it was a 60cm 'O' ring which he was issued.
Big loss of time, money, face-off, blame game, followed.
..... Had the drawing been approved for adequacy prior to issue >>>>