Document: SLSA-MIP-5-4-0-US
Date of Issue: 05/2016
Revision: -
17-3
17.4
Airplane failure card
BRM AERO s.r.o.
Letecká 255, 686 04 Kunovice, Czech Republic
Airplane Failure Card
Dear customer,
We would like to ask you for your assistance at obtaining information for continuous increasing
reliability of airplanes produced by our company. Please fill out the card in case of any failure on your
airplane. After filling out, send it to the address mentioned above. By sending us the card, you provide
us with valuable data, which enable us to improve reliability of your airplane as well.
Mandatory data
Airplane type:
Registration mark:
Airplane S/N:
1.
Flight units: flight hours
– number of landing | | | | | : | | | - | | | |
2.
Failure detection date: day
– month – year (format: “dd mm yy”) | | | | | |
3.
Failure has been detected at:
1. Flight
6. Landing run
(encircle appropriate number)
2. Taxiing
7. Daily inspection
3. Take-off run
8. Periodical inspection
4. Take-off
9. Other
5. Touch down
4.
Consequences for operation:
1. No consequences
5. Emergency landing
(encircle appropriate number)
2. Airplane put out of operation 6. Occurrence on the ground
3. Airplane returned from
7. Other
take-off
4. Flight with damaged aggregates
5.
Failure description:
6.
Identification of the damaged part
Failed part name
Catalogue number
of failed part
Worked out
operation units
Serial No.*
Note: State maximum detectable data * fill out if required
7.
Notes, additional data (kind of failure, defect, incorrect activity):
Additional data
8.
Claimed (encircle what applicable):
YES - NO
No. of claim:
9.
Order of spare parts (encircle what applicable): YES - NO
Item
Name of part
Catalogue part No.
No. of pieces
Owner:
Home airport:
Operator:
Date:
Elaborated by:
Summary of Contents for S-LSA
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