B-767 Delay/Irregularity Report

To: ABXMC@abxair.com,ABXSC@abxair.com,Steve.Neely@abxair.com	?
From:	?
Subject:

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SEND THIS FORM TO YOUR FEILD SUPERVISOR AND REGIONAL MANAGER.

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Station	Date(mm/dd/yyyy)	ACFT Number	Flight Number
		N

Scheduled Departure	Actual Departure	Delay Minutes	Completed By EMP#

Time original problem was discovered:

Enter times as MILITARY local

Who discovered the problem?:

Maintenance Flight

Enter log items or brief description of the problem:*List Details Below*

1-What time was maintenance control notified?

2-Please explain if squawk was found by flight crew.

3- Was inspection of this required by the PRE-D ccheck?

Yes No

4- What time was the pre-departure started and completed ?

5- Who are the maintenance personnel on duty?

6- What reference was used to clear the problem?

7- What is the 30 day history as researched through MXI??

8- Give a detailed chronological account in the space below.

LIST THE TIMES IN MILITARY LOCAL. LIST ALL STEPS TAKEN IN DETAIL.