Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

I. Pre-Inspection

  • 1. Reviewed previous inspection?

  • 1a. Outstanding items?

  • List all outstanding items from previous inspections (describe mitigation a and time frames that will be used)

  • 2. Reviewed Airport Master Record (5010 Form)?

  • 2a. Airport Master Record changes?

  • List of changes to Airport Master Record (list changes by category and item numbers, give regulation or circular if applicable)

  • 3. Reviewed Airport Sketch?

  • 3a. Airport Sketch changes?

  • Describe changes to Airport Sketch (copy of marked up sketch will be sent separately)

  • 4. Reviewed Airport Facility Directory?

  • 4a. Airport Facility Directory changes?

  • List changes or additions that need to be made to the Airport Facility Directory

  • 5. Interviewed Sponsor Representitive?

  • 5a. Interview items?

  • List any items that came out of the interview

  • 5b. Wildlife Management Survey

  • 5b-1. Does your airport have a Wildlife Site Visit?

  • If yes, when was it completed?

  • 5b-2. Does your airport have a Wildlife Hazard Assessment?

  • If yes, when was it completed?

  • 5b-3. Does your airport have a Wildlife Hazard Management Plan?

  • If yes, when was it completed?

  • 5b-4. Do you have a state wildlife depredation permit?

  • 5b-5. Does your airport have fencing around the airport?

  • If yes, how high is the fence?

II. Runways

  • 1. Length (changes will require completing category XII)

  • 2. Width

  • 3. Surface Condition

  • 4. Pavement Edge

  • 5. Runway Object Free Area / Primary Surface

  • 6. Approach Surface (separate form is required)

  • 7. Transitional Surface

  • 8. Runway Protection Zone

  • 9. Surface Gradient

  • 10. Line of Sight

III. Taxiways

  • 1. Width

  • 2. Surface Condition

IV. Safety Areas

  • 1. Dimensions Maintained

  • 2. Ruts/Surface Variations

  • 3. Drainage

  • 4. Objects in Safety Area/Frangible Mounting

V. Markings, Signs and Lighting

  • 1. Runway Markings

  • 2. Taxiway Centerline

  • 3. Taxiway Edge Markings

  • 4. Holding Position Markings

  • 5. Signs Identifying Taxiing Routes

  • 6. Holding Position Signs

  • 7. Signs Internally Illuminated

  • 8. Runway Lighting/Reflectors

  • 9. Taxiway Lighting/Reflectors

  • 10. Airport Beacon

  • 11. Obstruction Marking/Lighting

  • 12. Markings/Signs/Lighting Properly Maintained

VI. Fuel Storage Areas

  • 1. Fencing/Locks/Signs

  • 2. Piping protected from vehicles

  • 3. No Smoking signs posted

  • 4. Deadman Controls for loading stations

  • 5. Fire Extinguishers - Inspected/Accessible

  • 6. Emergency Shutoff - Signed/Accessible

  • 7. Fuel Leaks

  • 8. Bonding wire/clips

  • 9. Grounding

  • 10. No vegetation or trash

  • 11. No evidence of smoking

  • 12. Fuel filters

VII. Mobile Fuelers

  • 1. No Smoking sign in cab

  • 2. Flammability signs/haz mat placards all sides

  • 3. Bonding cables and clips

  • 4. Deadman control

  • 5. Fire Extinguishers - proper type/inspected

  • 6. Emergency shutoffs operable and marked

  • 7. Fuel leaks

  • 8. Vehicle exhaust system - shielded

  • 9. No evidence of smoking - no ashtray in cab

  • 10. Vehicle parking - 10' apart/50' from buildings - on pavement

VIII. Traffic/Wind Indicators

  • 1. Wind cones provided/condition

  • 2. Segmented Circle

IX. Wildlife Observations

X. Miscellaneous Observations

XI. Sketches

  • Add drawing

XII. Runway Length Change (required if there was a change in the runway length or displaced threshold)

  • Was there a change in the length/direction of a runway or displaced threshold?

  • Note: Horizontal DATUM should be NAD83 / Vertical DATUM should be NAVD88

  • 1. Runway ID

  • 2. Type of change

  • 3. Date of change

  • 4. Old runway length

  • 5. New runway length

  • 6. Distance runway extended or shortened/Direction

  • 7. Runway width

  • 8. Runway end changed

  • 9. New Latitude and Longitude

  • 10. New runway end elevation

  • 11. New runway touch down zone elevation (highest elevation in the first 3,000 feet)

  • 12. New runway azimuths (true)

  • 13. Displaced threshold length

  • 14. Displaced threshold width

  • 15. Displaced threshold Latitude and Longitude

  • 16. Displaced threshold elevation

  • 17. Change to ARP Latitude and Longitude (if appropriate)

  • 18. Additional information

Signatures

  • Airport Representative

  • State Inspector

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