• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

ACSI Review

  • FAA Form 5010-1 Update/Review<br>

  • Obstruction Chart Review

  • ACM / ACS Review (201)<br>

  • Review Self Inspection Records and Procedures for Corrective Action (327)

  • Review of NOTAM Records and Procedures (339)

  • Movement Area Inspection (Daylight) (311)<br>

  • Movement Are Inspection (Night) (311)<br>

  • Perimeter Fence Inspection (335)<br>

  • Solicit Comments From Local Coordinator

  • ARFF Response Drill (Day-light) (319)<br>

  • ARFF Response Drill (Night) (319)<br>

  • Fuel Farm and Fueling Vehicle Inspection (321)<br>

  • Airport Layout Plan Review<br>

  • Lease/Use Agreement Review

ARFF Station

  • Personnel Training Records (319)<br>

  • Vehicle Maintenance Records (319)

  • Refractometer Test / Records (319)<br>

  • Emergency Plan (325)<br>

Exit Interview

  • Discussion of Federal Agreement Compliance Issues

  • Discussion of Deficiencies / Violations Observed<br>

  • Establish Corrective Action Suspense Dates<br>

  • Discussion of Safety Related Issues or Recommendations

  • Discussion of ATCT and Other FAA Issues or Recommendations<br>

Other Items

  • Items

  • Photo(s)

Name & Rank of Inspector

  • Name & Rank of inspector

  • Date & Time of Inspection

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