[CALENDAR YEAR][ACTIVITY NAME]

CONTRACT FIELD TEAM AIRCRAFT OPERATIONS SURVEY

FINAL REPORT

Version 04062010

[LETTERHEAD]

DATESURVEY EXECUTIVE SUMMARYMEMORANDUM FOR [ACTIVITY NAME] – SITE MANAGER

DCMA Dayton – [ADMINISTRATIVE CONTRACTING OFFICER]

FROM: CFT Aircraft Operations Survey Team Leader, [TEAM LEAD RANK/NAME]

SUBJECT: [ACTIVITY NAME] Survey Executive Summary

1. Overview:

From [SURVEY DATES], the CFT Aviation Program Team conducted a Survey at [ACTIVITY NAME]. The Survey Team consisted of:

SURVEY Team Lead [RANK/NAME]SURVEY Deputy Lead/Flight Operations Lead [RANK/NAME]SURVEY Flight Operations [RANK/NAME]SURVEY Ground Operations Lead [RANK/NAME]SURVEY Ground Operations [RANK/NAME]SURVEY Safety Lead [RANK/NAME]SURVEY Safety [RANK/NAME]

The purpose of the SURVEY is to assess the level of risk the Government incurs through its aircraft contract with [CONTRACTOR]. This SURVEY fulfills the requirement of the joint regulation DCMA INST 8210.2 to conduct a risk-based review of contractor operations covered by the Ground & Flight Risk Clause (DFARS 252.228-7001) and/or Flight Risk Clause (DFARS 252.228-7002). The SURVEY process provides an open forum for the Aviation Program Team (APT) to determine where the Government’s risks lie and what steps can be taken to properly manage those risks. The SURVEY is a process using aviation professionals and risk assessment tools to generate a subjective risk rating based on a frame of reference developed through inspecting similar aviation facilities. The SURVEY Team evaluated the contractor’s mitigation of risk in each of three functional elements of aircraft operations at [ACTIVITY NAME]. The analysis contained in this report provides a tool to manage and lower risk. The goal is to improve the safety and security for all personnel involved, and to better protect and conserve government resources.

2. Scope - A one paragraph statement explaining the scope of operations at the facility which will be inspected. The paragraph should include but is not limited to the following information: Prime/sub-tier flow down, type aircraft, type work, size of facility, number of hangars, number of contractor employees, approximate number of tools boxes, type of hangar fire suppression, type ARFF coverage and who is providing the coverage, number of hazmat lockers, number of paint lockers, number and type of ammunition storage and who and how fuel is provided at the facility.

FOR OFFICIAL USE ONLY 2

3. Flight Operations:[COLOR] - The overall Flight Operations Element is rated [RISK] risk. [COMMENTS]

4. Ground Operations:[COLOR] - The overall Ground Operations Element is rated [RISK] risk. [COMMENTS]

5. Safety:[COLOR] - The overall Safety Element is rated [RISK] risk. [COMMENTS]

6. Repeat Discrepancies: [LIST ALL REPEATS IN THE FOLLOWING FORMAT. e.g.][Flight Operations (0)][Ground Operations (2): Tools were not etched. Tool boxes did not have inventories developed, etc.][Safety (1): Explosive site plan was not developed, etc.]

7. Outstanding Performer(s): (OPTIONAL PARAGRAPH AS REQUIRED)[COMMENTS]

8. Conclusion/Summary:[COLOR] - The overall risk rating for [ACTIVITY NAME] is [RISK] risk. [COMMENTS]

[Electronically sign/wet sign][TEAM LEAD NAME, RANK, SERVICE]Team Lead, Survey Inspection

2 Attachments:1. [ACTIVITY NAME] Out-Brief Presentation (Out-Brief DATE)2. Detailed Report of Write-Ups (Detailed Report DATE)

FOR OFFICIAL USE ONLY 3

V16.0

CFT AIRCRAFT OPERATIONS INSPECTION PROCESS

Each element lead (and their team) conducts a facility walk-through based on their own time table. Teams focus their attention on the areas they are reviewing while keeping an eye out for observations that may interest other element teams.

While inspecting, each element team asks the following questions about each observed process and records the response:

Did the survey team ask this

question? Process QuestionsWhat was the

response?

Yes No Yes NoDoes the process/program exist?Does it meet guidance/requirements?Is the process/program adhered to?Is the process/program documented?Are there risks/issues associated with how program is executed?Are there overarching issues with this process?Are there any outstanding performers in this process/program?

Each element team looks at ALL operations that affect (directly or indirectly) their area of responsibility, including back shops and aircraft assembly areas. For example, in new production contracts the Ground and Flight Risk Clause usually does not apply because the aircraft are normally not considered “in the open”, yet tools lost during assembly directly affect safety when the aircraft are “in the open.” This risk must be quantified regardless of the GFRC’s applicability.

When an area of concern is identified, the element team will assign a Risk Assessment Code (RAC) using the relative Probability and Severity of each question as explained on the next page.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

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V16.0

DEFINITIONS AND RISK ASSESSMENT CODE

RISK ASSESSMENTCODE MATRIX

SEVERITY

Minimal Minor Moderate Significant Severe

I II III IV V

PRO

BA

BIL

ITY

Near Certainty 5 GREEN YELLOW RED RED RED

Highly Likely 4 GREEN YELLOW YELLOW RED RED

Likely 3 GREEN GREEN YELLOW YELLOW RED

Low Likelihood 2 GREEN GREEN GREEN YELLOW YELLOW

Not Likely 1 GREEN GREEN GREEN GREEN YELLOW

PROBABILITY – A subjective estimate based on available data and an evaluator’s experience of the likelihood that a risk event will occur during the planned length of the contract.

1. NOT LIKELY – Not impossible, but it can be assumed occurrence will almost never occur in the life of a contract.

2. LOW LIKELIHOOD – Occurrence unlikely/remote, but possible in the life of a contract.

3. LIKELY – May occur sometime in the life of a contract.

4. HIGHLY LIKELY – Occurs several times in the life of a contract.

5. NEAR CERTAINTY – Occurs often in the life of a contract.

SEVERITY – A qualitative measure of the most reasonable credible mishap resulting from personnel error, environmental conditions, design inadequacies, procedural deficiencies, or system, subsystem, or component failure or malfunction.

I. MINIMAL – Could result in injury or illness not resulting in a lost work day, loss less than $20K, or minimal environmental damage not violating law or regulation.

II. MINOR – The resulting total cost of property damage is $20,000 or more, but less than $50,000; or a recordable injury or illness not otherwise classified as a Class A, B, or C mishap.

III. MODERATE – The resulting total cost of property damages to Government and other property is $50,000 or more, but less than $500,000; or a nonfatal injury or illness that results in 1 or more days away from work, not including the day of the injury.

IV. SIGNIFICANT – The resulting total cost of damages to Government and other property is $500,000 or more, but less than $2 million. An injury or occupational illness results in permanent partial disability, or when three or more personnel are hospitalized for inpatient care (which, for mishap reporting purposes only, does not include just observation or diagnostic care) as a result of a single mishap.

V. SEVERE - The resulting total cost of damages to Government and other property is $2 million or more, a DoD aircraft is destroyed (excluding UAS Groups 1, 2, or 3), or an injury or occupational illness results in a fatality or permanent total disability.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

5

V16.0COLOR / RISK RATINGS

1. GREEN / LOW RISK – The likelihood of damage to equipment and/or injury to personnel is low.

2. YELLOW / MODERATE RISK – Risk mitigation is inadequate. The likelihood of damage to equipment and/or injury to personnel is moderate.

3. RED / HIGH RISK – Risk mitigation is ineffective or nonexistent. The likelihood of damage to equipment and/or injury to personnel is high.

4. NOT EVALUATED (NE) – The element/sub-element exists at location but inspectors did not have an opportunity to inspect (e.g. no ground handling or servicing conducted during inspection week).

5. NOT APPLICABLE (NA) – The element/sub-element does not exist at location (e.g. no welding requirements, no battery shop requirements, etc.).

NOTE: If the element receives a “Green/Low Risk”, do not leave the comment section blank. Discuss why it received this rating. What was inspected and led you to this rating?

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

GREEN / LOW RISK

YELLOW / MODERATE RISK

RISK MITIGATION IS INADEQUATE

RED / HIGH RISK

RISK MITIGATION IS INEFFECTIVE OR NONEXISTENT

NOT EVALUATED

THE ELEMENT/SUB-ELEMENT EXISTS AT LOCATION BUT INSPECTORS DID NOT HAVE AN OPPORTUNITY TO INSPECT

NOT APPLICABLE

THE ELEMENT/SUB-ELEMENT DOES NOT EXIST AT LOCATION

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V16.0

STATUS CODES / DEFINITIONS / INSTRUCTIONS

1. STRENGTH (S) – A superior program, procedure, or technique that significantly contributes to mitigating risk. Strengths are always assessed as Green.

2. OBSERVATION (O) – Discovery by the Survey team of an area or item, attributed to the contractor that is not contractually required or explicitly regulated by applicable Instructions. However, the area or item exhibits elevated risk (Yellow or Red Risk Rating) or presents an opportunity for improvement (Green Risk Rating). Observations can be assigned a risk rating of Green, Yellow, or Red.

Instructions for Observation: All Observations must be evaluated for appropriate adjudication by the GFR/GGFR following the Survey. Adjudication may require coordination with DCMA-Dayton Air Operations. GFR/GGFRs shall not communicate to the contractor, either verbally or in writing, a requirement to correct a Survey Observation unless a link to contractual requirements is established. If a link is established, then the GFR/GGFR would upgrade the Observation to a Discrepancy. Additionally, the GFR/GGFR will document the actions taken for elevated risk and be prepared to discuss their analysis and actions.

3. DISCREPANCY (D) – Discovery by the Survey team of an area or item, attributed to the contractor, that is contractually required or explicitly regulated by applicable Instructions but is not in compliance. Discrepancies can be assigned a risk rating of Green, Yellow, or Red.

Instructions for Discrepancy: Corrective action for discrepancies is required regardless of risk. The GFR/GGFR will also document the actions taken for all Discrepancies and be prepared to discuss their analysis and actions.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

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F – FLIGHT OPERATIONS [COLOR]

Element comments:

The overall Flight Operations Element is rated [INSERT RISK LEVEL IN CAPS – LOW, MODERATE, or HIGH] risk. Enter comments about the overall element here.

FA – FLIGHT PROCEDURES [COLOR] Process comments:

Enter general comments about the process here.

Write-up # FA- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

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V16.0

FB – FLIGHT CREW INFORMATION FILE (FCIF) PROGRAM [COLOR]Process comments:

Enter general comments about the process here.

Write-up # FB- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

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V16.0

FC – CREW/NON-CREW FLIGHT RECORDS [COLOR]Process comments:

Enter general comments about the process here.

Write-up # FC- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

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V16.0

FD – FLIGHT PLANS AND APPROVAL [COLOR]Process comments:

Enter general comments about the process here.

Write-up # FD- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

11

V16.0

FE – FLIGHT BY SUPERVISORY PERSONNEL [COLOR]Process comments:

Enter general comments about the process here.

Write-up # FE- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

12

V16.0SA – FLIGHT SAFETY [COLOR]

Process comments:

Enter general comments about the process here.

Write-up # SA- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: DCMA 8210.1B, Para X.X.XACME GO-6358, Ch 3, D-2

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

13

V16.0SD – MISHAP PLAN [COLOR]

Process comments:

Enter general comments about the process here.

Write-up # SD- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

14

V16.0CD – TEAMING [COLOR]

Process comments:

Enter general comments about the process here.

Write-up # CD- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

15

V16.0G – GROUND OPERATIONS [COLOR]

Element comments:

The overall Ground Operations Element is rated [INSERT RISK LEVEL IN CAPS – LOW, MODERATE, or HIGH] risk. Enter comments about the overall element here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

16

V16.0

GA – GROUND PROCEDURES [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GA- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

17

V16.0

GB – TOOL CONTROL [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GB- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

18

V16.0

GC – FOREIGN OBJECT DAMAGE/DEBRIS (FOD) PROGRAM [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GC- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

19

V16.0

GD – AIRCRAFT GROUND HANDLING [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GD- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

20

V16.0

GE – AIRCRAFT SERVICING [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GE- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

21

V16.0

GF – TRAINING AND CERTIFICATION [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GF- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

22

V16.0

GG – GROUND SUPPORT EQUIPMENT (GSE) [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GG- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

23

V16.0

GH – ENGINES/AUXILIARY POWER UNIT (APU) [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GH- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

24

V16.0

GI – SITE-SPECIFIC HAZARDOUS OPERATIONS [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GI- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

25

V16.0

GJ – SUPPORT SHOPS [COLOR]Process comments:

Enter general comments about the process here.- Life Support: - Egress Maintenance:- Tire and wheel: - Corrosion Control/Cleaning/Aircraft Paint:- Battery: - NDI:

Write-up # GJ- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

26

V16.0

GK – HYDRAULIC FLUID CONTAMINATION [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GK- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

27

V16.0

GL – WEIGHT AND BALANCE [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GL- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

28

V16.0

GM – CALIBRATION PROCEDURES [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GM- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

29

V16.0

GN – AIRCRAFT SECURITY [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GN- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

30

V16.0

GO – OIL ANALYSIS/HANDLING [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GO- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

31

V16.0

GP – TECHNICAL PUBLICATIONS AND AIRCRAFT RECORDS [COLOR]Process comments:

Enter general comments about the process here.

Write-up # GP- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

32

V16.0CB – APT RESPONSIBILITIES (GGR) [COLOR]

Process comments:

Enter general comments about the process here.

Write-up # CB- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

33

V16.0CD – TEAMING [COLOR]

Process comments:

Enter general comments about the process here.

Write-up # CD- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

34

V16.0SE – SEVERE WEATHER PLAN [COLOR]

Process comments:

Enter general comments about the process here.

Write-up # SE- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

35

V16.0S – SAFETY [COLOR]

Element comments: The overall Safety Element is rated [INSERT RISK LEVEL IN CAPS – LOW, MODERATE, or HIGH] risk. Enter comments about the overall element here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

36

V16.0

SB – GROUND SAFETY [COLOR] Process comments:

Enter general comments about the process here.

Write-up # SB- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

Ref: ACME GO-6358, Ch 3, D-2DCMA 8210.1B, Para X.X.X

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

37

V16.0

SC – AIRCRAFT RESCUE & FIRE FIGHTING (ARFF) [COLOR]Process comments:

Enter general comments about the process here.

Write-up # SC- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

38

V16.0

SD – MISHAP PLAN [COLOR]Process comments:

Enter general comments about the process here.

Write-up # SD- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

39

V16.0

SE – SEVERE WEATHER PLAN [COLOR]Process comments:

Enter general comments about the process here.

Write-up # SE- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

40

V16.0

SF – FUELS STORAGE/DELIVERY/MAINTENANCE [COLOR]Process comments:

Enter general comments about the process here.

Write-up # SF- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

41

V16.0

SG – FACILITIES [COLOR] Process comments:

Enter general comments about the process here.

Write-up # SG- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

42

V16.0

SH – HAZMAT AND EXPLOSIVES [COLOR]Process comments:

Enter general comments about the process here.

Write-up # SH- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

43

V16.0

CD – TEAMING [COLOR]Process comments:

Enter general comments about the process here.

Write-up # CD- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

44

V16.0

GA – GROUND PROCEDURES [COLOR]Process comments:

Enter general comments about the process here. ROE – Use this section to report 8210.1 Chapter 5 GOP shortcomings (Procedures that lack clarity, detail, specificity, etc.). You will still report issues of non-compliance, etc. under the applicable sub-element of the Safety Report. You can include a note in the applicable process comment to the effect of, “See GA section of this report for Procedural deficiencies.”

Write-up # GA- STATUS RISK ACCOUNTABLEStrength Green Government only

CAR Response Due Observation Yellow Contractor onlyYes No Discrepancy Red Government & Contractor

Write-up comments:

Enter write-up comments here.

FOR OFFICIAL USE ONLY – MAY CONTAIN PROPRIETARY DATA – DO NOT RELEASE TO ANY NON-GOVERNMENT PERSON WITHOUT FIRST CONSULTING GENERAL COUNSEL

45