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?
5b-2. Does your airport have a Wildlife Hazard Assessment?
5b-3. Does your airport have a Wildlife Hazard Management Plan?
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?
1. Length (changes will require completing category XII)
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
2. Surface Condition
1. Dimensions Maintained
2. Ruts/Surface Variations
4. Objects in Safety Area/Frangible Mounting
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
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
10. No vegetation or trash
11. No evidence of smoking
12. Fuel filters
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
1. Wind cones provided/condition
2. Segmented Circle
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
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