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Mandatory data
Airplane type *
Registration mark *
Airplane S/N *
1. Flight hours *
Number of landings *
2. Failure detection date: (format: dd mm yy)
3. Failure has been detected at:
--- select ---
1. Flight
2. Taxiing
3. Take-off run
4. Take-off
5. Touch down
6. Landing run
7. Daily inspection
8. Periodical inspection
9. Other
4. Consequences for operation:
--- select ---
1. No consequences
2. Airplane put out of operation
3. Airplane returned from take-off
4. Flight with damaged aggregates
5. Emergency landing
6. Occurence on the ground
7. Other
5. Failure description
6.Identification of the damaged part
Failed part name
Catalogue number of failed part
Worked out operation units
Serial No.*
7. Notes, additional data (kind of failure, defect, incorrect activity):
Additional data
8. Claimed (select what applicable)
-
Yes
No
No. of claim
9.Order of spare parts (encircle what applicable)
Item
Name of part
Catalogue part No.
No. of pieces
Owner *
Home airport *
Operator *
Date *
Elaborated by *
Email *
