Dillingham Airfield Aircraft Refueling Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Aircraft Refueling Company

  Premier Jet

  Air Service

  North Shore Aviation

  Barber Point Flight School

• Location of Refueling Vehicle

  Hanger 110

  JRF T-Hanger

  North Shore Aviation Hanger (DH)

  Kalaeloa Airport

  Dillingham Airfield

• Tenant has a current Revocable Permit with AIR-PM for space.

  Yes

  No

  Pending Approval By AIR-PM

• Date & Time of Inspection

  Date

• Inspection Quarter

  First

  Second

  Third

  Fourth

Aircraft Refueling Inspection

• Identifiable markings of the operator or responsible organization - approved legible signs on both sides of the exterior of the vehicle. NFPA 407 07' 5.1.3<br>

  Safe

  At Risk

  N/A

• Aircraft Fuel Service Vehicle – Parking (10'apart / 50' from buildings for Tank Vehicles OnIy). NFPA 407 07' 5.18 & 5.19<br>

  Safe

  At Risk

  N/A

• Aircraft Fuel Service Vehicle –Positioning (fueling operation).<br>

  Safe

  At Risk

  N/A

• Wheels Chocked - forward and rear of front wheels & parking brake locked. HAR 19-37-8<br>

  Safe

  At Risk

  N/A

• Vehicle Exhaust System - shielded & leak free. NFPA 407 07' 4.3.6<br>

  Safe

  At Risk

  N/A

• Marking of Aircraft Servicing Vehicle – flammable product ID, Haz Mat placarding, each side of the vehicle. HAR 19-37-10<br>

  Safe

  At Risk

  N/A

• No Smoking Sign displayed in cab & No evidence of Smoking, No ashtray in cab, Matches or Lighters. NFPA 407 07' 4.3.11, HAR 19-37-5-6<br>

  Safe

  At Risk

  N/A

• No Ignition Sources - smoking material, matches, open flames or sparks, operating equipment. NFPA 407 07' 5.5<br>

  Safe

  At Risk

  N/A

• Vehicle / Cart Lighting & Electrical Equipment. NFPA 407 07' 4.3.7<br>

  Safe

  At Risk

  N/A

• Fire Extinguishers (20 BC Dry Chemical only), 2 per Tanker, 1 per Hydrant Truck / Cart & Inspected. NFPA 407 07' 4.3.9 1-4, 5.13 1.6, NFPA 10 10' & HAR 19-37-9<br>

  Safe

  At Risk

  N/A

• Emergency Shutoffs - operable and marked properly. NFPA 407 07' 4.3.15

  Safe

  At Risk

  N/A

• Bonding & Static Electricity Protection Procedures used - Cables and Clips functional. NFPA 407 07' 4.3.3<br>

  Safe

  At Risk

  N/A

• Dead-man Control for all Nozzles, Valves & Vehicle Systems. NFPA 407 07' 4.3.16<br>

  Safe

  At Risk

  N/A

• Aircraft Fueling Hose - cuts, blistering, chafing, etc. NFPA 407 07' 5.16<br>

  Safe

  At Risk

  N/A

• No Fuel Leaks - Valves, Piping, Hoses, & Dome Covers. NFPA 407 07' 5.2<br>

  Safe

  At Risk

  N/A

• Lighting Precautions. NFPA 407 07' 5.9<br>

  Safe

  At Risk

  N/A

• Proper Fueling Procedures Observed (3,4,12,13).

  Safe

  At Risk

  N/A

Inspector's Recommendations & Photo(s)

• Recommendations

• Photo(s)

  Media

Signature(s), Date & Time of Inspection and Re - Inspection

• Name & Signature of Inspector

  Sign

• Name & Signature Operator

  Sign

• Date & Time

  Date

• Date & Time of Re - Inspection

  Date

• Inspector's Notes