AIRCRAFT DAMAGE REPORTING FORM

   
To:abxmc@abxair.com,abxsafety@abxair.com, ABX.GTScheduler@abxair.com, Rob.Davis@abxair.com, Gregg.Wehrung@abxair.com, Janice.Sheets@abxair.com, Chris.Theofilos@abxair.com, James.Moeller@abxair.com ?
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Subject:
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THIS FORM IS TO BE COMPLETED BY MAINTENANCE REP ON DUTY AND SENT TO MAINTENANCE CONTROL AND IMMEDIATE SUPERVISOR
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STATION TAIL NUMBER FLT# OPS DATE
N
GMT TIME OF INCIDENT LOG PAGE AND ITEM #
DELAY/CANX(Y/N) MINUTES DAMAGE CODE
DETAILED DESCIPTION OF DAMAGE:
 
LEFT SEAT  :  EE# 
RIGHT SEAT:  EE# 
OBS 1 SEAT:  EE# 
OBS 2 SEAT:  EE# 
PAX SEAT 1:  EE# 
PAX SEAT 2:  EE# 
PAX SEAT 3:  EE# 
 
    PERSONS ON GROUND DIRECTLY INVOLVED:  
NAME EE# EMPLOYER DESCRIPTION OF INVOLVEMENT
 
DESCRIBE DAMAGE TO ANY GROUND EQUIPMENT OR OTHER AIRCRAFT INVOLVED. INCLUDE MAKE, MODEL, A/C REGISTRATION NUNBER. IF EQUIPMENT IS NOT ABX PROPERTY, PROVIDE COMPANY NAME, CONTACT PERSON AND PHONE NUMBER.
 
WEATHER INFORMATION
VISIBILITY: GOOD FAIR POOR  TEMPATURE DEGREES
WEATHER: CLEAR RAIN FOG SNOW SLEET HAIL
 
WIND VELOCITY: KNOTS: DIRECTION:
 
 
MAINTENANCE CONTROL SECTION:
DOES REPORTED DAMAGE QUALIFY AS A REPORTABLE DAMAGE EVENT? YES____ NO____
IF YES, RECORD WORK PACKAGE NO: THAT EVENT WAS DOCUMENTED IN: ___________________________
IS NTSB NOTIFICATION REQUIRED (GMM CH1, 04.08.01 SECTION 830.5)? YES____ NO_____