Information
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Document No.
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Sponsor
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Airport
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Conducted on
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Inspected by
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Airport Personnel
I. Pre-Inspection
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1. Reviewed previous inspection?
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1a. Any outstanding issues from previous inspection?
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2. Reviewed Airport Master Record (5010 Form)?
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Note changes in Section XII.
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3. Reviewed Airport Sketch?
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3a. Airport Sketch changes?
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4. Reviewed Airport Facility Directory?
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4a. Airport Facility Directory changes?
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5. Interviewed Airport Representitive?<br>
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5a. Interview items?
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5b. Wildlife Management Survey?
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5b-1. Has your airport had a Wildlife Site Visit?
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If yes, when was it completed?
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5b-2. Does your airport have a Wildlife Hazard Assessment?
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If yes, when was it completed?
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5b-3. Does your airport have a Wildlife Hazard Management Plan?
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If yes, when was it completed?
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5b-4. Do you have a state wildlife depredation permit?
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5b-5. Does your airport have fencing around the airport?
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If yes, how high is the fence?
II. Runways
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1. Length (changes will require completing section XI)
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2. Width
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3. Surface Condition
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4. Pavement Edge
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5. Runway Object Free Area / Primary Surface
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6. Approach Surface (separate form is required)
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7. Transitional Surface
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8. Runway Protection Zone
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9. Surface Gradient
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10. Line of Sight
III. Taxiways
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1. Width
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2. Surface Condition
IV. Safety Areas
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1. Dimensions Maintained
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2. Ruts/Surface Variations
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3. Drainage
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4. Objects in Safety Area/Frangible Mounting
V. Markings, Signs, and Lighting
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1. Runway Markings
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2. Runway Signs
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3. Runway Lighting/Reflectors
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4. Hold Position Markings
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5. Hold Position Signs
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6. Taxiway Markings
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7. Taxiway Signs
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8. Taxiway Lighting/Reflectors
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9. Obstruction Markings/Lighting
VI. Navigation/Weather
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1. Airport Beacon
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2. PAPI/VASI
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3. AWOS
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4. Wind Indicators
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5. Segmented Circle
VII. Fuel Storage Areas
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1. Fencing/Locks
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2. Piping Protected
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3. No Smoking/Flammable/Identification Signs
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4. Deadman Controls
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5. Fire Extinguishers
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6. Emergency Shutoff
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7. Fuel Leaks
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8. Bonding Wire/Clips
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9. Grounding
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10. Vegetation/Trash
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11. Evidence of Smoking
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12. Fuel Filters
VIII. Mobile Fuelers
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1. No Smoking Signs (in cab)
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2. No Smoking/Flammability/Identification Signs (on tank)
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3. Bonding Wire/Clips
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4. Deadman Control
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5. Fire Extinguishers
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6. Emergency Shutoff Operable and Signed
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7. Vehicle Exhaust Shielded
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8. Fuel Leaks
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9. Evidence of Smoking (no ashtray)
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10. Vehicle Parking (10' apart, 50' from structure, on pavement)
IX. Observations
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1. Wildlife
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2. Construction
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3. Hazards
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4. Miscellaneous
X. Sketches
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Sketches
Sketch
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Add drawing
XI. Runway Length Change (if applicable)
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Was there a change in the length/direction of a runway or displaced threshold?
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Note: Horizontal DATUM should be NAD83 / Vertical DATUM should be NAVD88
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1. Runway ID
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2. Type of change
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3. Date of change
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4. Old runway length
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5. New runway length
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6. Distance runway extended or shortened / direction
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7. Runway width
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8. Runway end change
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9. New Latitude and Longitude
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10. New runway end elevation
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11. New runway touch down zone elevation (highest elevation in the first 3,000 feet)
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12. New runway azimuthal (true)
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13. Displaced threshold length
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14. Displaced threshold width
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15. Displaced threshold Latitude and Longitude
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16. Displaced threshold elevation
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17. Change to ARP Latitude and Longitude (if appropriate)
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18. Additional information
XII. Airport Master Record Changes
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Airport Master Record Changes
Change
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Number of item
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Old Information
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New Information
XIII. Signatures
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Airport Representative
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State Inspector
