XtremeAIR XA41, Руководство по обслуживанию

Страница: 266 / 284

Occurrence Report
Consecutice No:
___/____
Issue: _.__
DOA No EASA.21J.360 Page 1 of 2
Form: FDO-0010-329 Issue: C.01
Design Holder
Contact Data: XtremeAir GmbH
Harzstrasse 2
D-39444 Hecklingen
E-Mail:
Fax:
Phone:
support@xtremeair.de
+ 49 39267 60999 22
+ 49 39267 60999 0
Electronic Report
Form refer to: www.xtremeair.com Phone Sundays
and Holidays: + 49 171 1985500
With Attention to:
Head of Design Organisation
Head of Airworthiness
1. General Information
Reporting
Organisation: Reporting
Date:
Contact
Person: Phone &
E-Mail:
Occurrence
Title: Occurrence
Finding Date:
ATA-Chapter: Occurrence
Location in A/C:
Other Parties
already informed:
[_] None [_] EASA [_] NAA [_] CAMO [_] …
Occurrence
Caused:
[_] No Damage/Injury [_] Damage to Aircraft [_] Damage to Property [_] Personal Injury
2. Aircraft Information
Aircraft
Type: Aircraft
S/N:
Operator/
Owner: Aircraft
Registration:
Aircraft
Flight Hours: Aircraft
total Cycles:
3. Engine, Propeller and Component Information
(as relevant)
Information
related to:
[_] Engine [_] Propeller [_] Component
Parts Catalogue
(IPC) Reference:
Part Number
and Name: Serial
Number:
Manufacturing
Date: TCDS or ETSO
Reference:
Time since
New (TSN): Time since
Overhaul (TSO):