121 ARW FY22 Annual Safety Inspection Report

  • Organization Inspected:

  • Area:

  • Unit:

  • Unit:

  • Conducted on:

  • Inspection & Assessment Conducted by:


  • Building(s):

  • Describe:

  • Unit Activity/Work Area (Room):

  • Date of Inspection:

  • Deficiency, Hazard, or Observation:

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  • Probability:

  • Severity:

  • Risk Assessment Code:

  • Description of Hazard:

  • Reference:

  • Description of Deficiency:

  • Reference:

  • Cause of Deficiency or Hazard:

  • Describe:

  • Recommendations for Improvement/Compliance:

  • Follow-Up Date:

  • Supervisor or POC: (Rank and Name)

  • Phone Number: (x0000)



  • Was the commander available for a formal out brief within 3 days after completion of inspection? (AFI 91-202_ANGSUP)

  • Date of Out-brief:

  • Commander's Rank, Name, and Title

  • Signature:

  • Reason for Commander not out-briefed?

  • Appointee's Rank, Name, Title:

  • Date of Out-brief:

  • Signature:


  • Date of Formal Report Submission:

  • Safety office representative rank and name:

  • Signature:


  • TR- TRAINING: Inadequate training in: guidance/policy/procedure, training oversight, initial qualification training, hands-on training , controls/metrics of training process/progress, training evaluation, training documentation, individual(s) not qualified, not experienced enough to perform task.

    EQ- EQUIPMENT: Correct tools/equipment not available, unserviceable or not used, incorrect tool selection. Equipment defect or design flaw, inadequate equipment maintenance.

    TD- TECHNICAL DATA: Tech data, operating instruction, or checklist incorrect, conflicting, misleading, unavailable, overly complex , outdated. (If tech data is incorrect/conflicting, misleading or too complex, individual must generate AFTO 22 and submit copy to MXS supervision)

    HE- HUMAN ERROR: Used as last resort. When all equipment, technical data, training, and other factors are adequate. When another qualified technician would not have made the same error.

    MC- MISCONDUCT: When all equipment, technical data, training, and other factors are adequate. The technician is fully aware of all requirements, demonstrates task competency, and the process is correct as written. Another qualified technician would not have made the same error and there is clear evidence the technician consciously disregarded technical data and/or regulations.

    PI- PROCESS INADEQUATE OR FAULTY: Used when root cause analysis indicates all other root cause codes are not applicable. Established shop process for accomplishing the task is faulty and will be changed as a result of the root cause analysis.

    LS- LEADERSHIP/SUPERVISION: Ineffective communication, decision making process ineffective, involvement insufficient, physical work environment issue, failure to adequately program resources.

    OT- OTHER: Enter specific issues that cannot be linked to ROOT CAUSES above.

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