+-----------------------------------+----------------+----------------+
| ![](media/image1.                 | **Advisory**   |                |
| wmf){width="0.3368055555555556in" |                |                |
| height="0.33611111111111114in"}   | #              |                |
|                                   | ##### Circular |                |
| U.S. Department                   |                |                |
|                                   |                |                |
| of Transportation                 |                |                |
|                                   |                |                |
| **Federal Aviation**              |                |                |
|                                   |                |                |
| **Administration**                |                |                |
+-----------------------------------+----------------+----------------+
| **Subject:** **AIRPORT SAFETY**   | **Date:**      | **AC No:**     |
|                                   | 04/23/04       | 150/5200-18C   |
| ####### SELF-INSPECTION           |                |                |
|                                   | **Initiated    | Change:        |
|                                   | by:** AAS-300  |                |
+-----------------------------------+----------------+----------------+

### PURPOSE. This Advisory Circular (AC) provides information to airport operators on airport self-inspection programs and identifies items that airport operators should include in such a program.

### FOCUS. Development of a self-inspection program in accordance with this AC represents an acceptable means of compliance with the 14 Code of Federal Regulations (CFR) Part 139 (Part 139) requirements.

### CANCELLATION. Advisory Circular 150/5200-18B, Airport Safety Self-Inspection, dated 5/2/88, is cancelled.

### RELATED READING MATERIAL.

a.  **14 CFR Part 139, Certification of Airports.** While Part 139
    requirements are mandatory for a holder of a Part 139 Airport
    Operating Certificate, the regulation contains many safety practices
    that the Federal Aviation Administration recommends for use at all
    airports.

b.  14 CFR Part 77, Objects Affecting Navigable Airspace.

c.  Current editions of the following advisory circulars:

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(1) AC 150/5200-33, Hazardous Wildlife Attractants on or near Airports

(2) AC 150/5210-21, Airport Certification Manual (ACM). This reference
    is pertinent for certificated airports only.

(3) AC 150/5210-20, Ground Vehicle Operations on Airports.

(4) AC 150/5200-28, Notices to Airmen (NOTAMs) for Airport Operators.

(5) AC 150/5200-30, Airport Winter Safety and Operations.

(6) AC 150/5210-5, Painting, Marking, and Lighting of Vehicles Used on
    an Airport.

(7) AC 150/5230-4, Aircraft Fuel Storage, Handling, and Dispensing on
    Airports.

(8) AC 150/5300-13, Airport Design.

(9) AC 150/5340-1, Standards for Airport Markings.

(10) AC 150/5340-18, Standards for Airport Sign Systems.

(11) AC 150/5340-21, Airport Miscellaneous Lighting Visual Aids.

(12) AC 150/5340-24, Runway and Taxiway Edge Lighting System.

(13) AC 150/5340-26*,* Maintenance of Airport Visual Aid Facilities.

(14) AC 150/5370-2, Operational Safety on Airports During Construction.

(15) AC 150/5370-10, Standards for Specifying Construction of Airports.

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d.  Obtain the latest version of the free Advisory Circular publications
    from the FAA on its Web site at
    [**www.faa.gov/arp/**](http://www.faa.gov/ARP/). In addition, these
    ACs are available by contacting the U.S. Department of
    Transportation, Subsequent Distribution Office, SVC-121.23, Ardmore
    East Business Center, 3341 Q 75th Avenue, Landover, MD 20785. All
    FAA ACs are listed in the Advisory Circular Checklist, AC 00-2.1,
    which is available on the internet. The Checklist also ex­plains how
    to obtain the circulars.

### BACKGROUND.

a.  While some hazardous airport conditions develop virtually
    instantaneously, others are gradual. It is important that the
    airport operator have an airport safety self-inspection program that
    monitors specific airport conditions in order to identify
    unsatisfactory conditions for prompt corrective actions. A number of
    airport operators have some form of a safety self-inspection
    program. The programs vary in scope and effectiveness from verbal
    instructions and unscheduled and unrecorded inspections to very
    comprehensive inspection programs with multiple daily schedules and
    widely distributed responsibilities.

b.  At airports certificated under 14 CFR Part 139, the self-inspection
    program is a key component of an airport operator's airport
    certification program and required under §139.327. An effective
    self-inspection program enables an airport operator to operate in
    compliance to Part 139 standards on a day-to-day basis. In
    accordance with Part 139, all airports must have an Airport
    Operating Certificate if serving---

    1.  Scheduled or unscheduled passenger operations of an air carrier
        with aircraft having a seating capacity of more than 30
        passengers, or

    2.  Scheduled passenger operations with aircraft having a seating
        capacity of more than 9 and less than 31 passengers.[^1]

One of the requirements of Part 139 is that the operator of each
certificated airport regularly conduct a daily safety self-inspection to
ensure that prompt corrective action is taken to eliminate unsafe
conditions on the airport. The specific requirements of the
self-inspection program at each certificated airport are addressed in
the airport certification manual.

c.  This AC suggests components, responsibilities, and items for
    regularly scheduled, continuous surveillance, periodic condition and
    special inspections, and checklists for use during any of these
    airport safety self-inspections. This guidance can be modified as
    necessary to meet local situations. The information and guidance in
    this publication serve as a basis by which airports operators may
    develop their own safety self-inspection programs.

### RESPONSIBILITIES.

a.  **Safety Self-Inspection.** Self-inspection is a primary
    responsibility of the airport owner, operator, or a duly authorized
    representative. It is customary to assign the job of assuring
    overall airport ground safety to the airport manager or operations
    supervisor. Primary attention should be given to such operational
    items as pavement areas, safety areas, markings, signs, lighting,
    aircraft rescue and fire fighting, fueling operations, navigational
    aids, ground vehicles, obstructions, public protection, wildlife
    hazard management, construction, and snow and ice control.
    Inspection of areas that have been assigned to individual air
    carriers, fixed base operators, or other tenants can be made the
    responsibility of the user. However, at Part 139 airports, the FAA
    will hold the certificate holder ultimately responsible for
    operating the airport safely.

b.  **Recommended Inspection Frequency.**

    1.  **Regularly scheduled inspection.** The airport should be
        inspected at least daily during times when aircraft activity is
        minimal in order to create the least impact on airport
        operations. Part of this inspection should be done during the
        hours of darkness at those airports that serve air carriers
        after dark.

    2.  **Continuous surveillance inspection.** Those activities and
        facilities that have been identified to require continuous
        surveillance should be inspected any time personnel are in the
        air operations area. Hazardous conditions can occur at any time
        and in a short period of time.

    3.  **Periodic condition inspection.** Periodic condition inspection
        of activities and facilities can be conducted on a regularly
        scheduled basis but less frequently than daily. The time
        interval could be weekly, monthly, or quarterly, depending on
        the activity or facility.

    4.  **Special inspection.** Special inspections of activities and
        facilities should be conducted after receipt of a complaint or
        when an unusual condition or unusual event occurs on the
        airport, such as a significant meteorological event or an
        accident or incident. Special inspections should also be
        conducted at the end of construction activity to ensure that
        there are no unsafe conditions present related to the
        construction activity. A special inspection should be conducted
        prior to construction personnel leaving the airport in the event
        that corrective actions are necessary. Special inspections
        should be documented on the appropriate portions of the
        regularly scheduled inspection checklist.

c.  **Inspection Records.** An effective safety self-inspection program
    includes procedures for reporting and correcting deficiencies. This
    means that the airport operator should have a work order system in
    place so that deficiencies can be corrected in an expeditious
    manner.

    1.  The operator should issue a Notice to Airmen (NOTAM), as
        appropriate, through the appropriate Flight Service Station
        (FSS) reporting deficient conditions that could have an
        immediate and critical impact on the safety of aircraft
        operations. When corrective actions have been taken, the NOTAM
        should be cancelled. At Part 139 airports, other similar systems
        and procedures may be used if approved by the FAA.

    2.  For even the smallest airport, it is desirable to use a safety
        self-inspection checklist that constitutes a written record of
        conditions noted, and acts as a check on follow-up actions
        taken. The scheduled use of a dated checklist will assure the
        regularity and thoroughness of safety inspections and follow-up.
        The checklist can be an important administrative tool for
        airport management. It can provide a snapshot of the condition
        of the airport, indicating trends, defining problem areas,
        indicating systems that are beginning to deteriorate and helping
        to define budgetary requirements. It is most desirable to use a
        format (see examples, Appendices 1--5) in which each inspected
        area of the airport complex is positively noted. Retain the
        checklist until indicated actions are completed. Airports
        certificated under Part 139 must retain the regularly scheduled
        inspection checklist for 12 months. Airports may use additional,
        specialized materials and forms, such as maintenance work
        orders, NOTAMs, fire station and first aid reports, etc. Some
        airport operators use computerized versions specifically
        designed to meet their self-inspection requirements. There are
        several vendors that have developed these computer programs that
        can use laptops and Personal Data Assistants (PDAs). However,
        the regularly scheduled inspection checklist should be the basic
        log documenting that safety inspection responsibilities are
        being met.

d.  **Follow-up.** The airport operator should follow up on complaints
    or requests for corrective action and on all deficient items or
    problem areas noted during the daily inspection. Determine which
    problems require immediate attention and treat those with highest
    priority, including developing appropriate NOTAM notification.

### INSPECTION TECHNIQUES. 

Inspectors should vary the pattern of the inspection. Fixed inspection
patterns, while easy to learn, do not provide for an adequate
inspection. The use of such fixed inspection patterns can lead to
complacency and to the possibility of missing items that are in need of
correction. When conducting an inspection on a runway and when there is
time to do only one pass on that runway, inspection personnel, whenever
practical, should drive towards the direction of landing aircraft with
high intensity flashing beacon and headlights on day and night. This
practice will enable self-inspection personnel to see approaching
aircraft and improve visibility of the vehicle to pilots. However, it is
recommended that a runway inspection be done in both directions.
Inspection personnel should also drive the stub taxiways between the
runway and parallel taxiway as these areas are commonly overlooked.

### KNOWLEDGE AND EQUIPMENT FOR SELF-INSPECTlON. 

e.  Airport personnel who conduct safety self-inspections (referred to
    as inspectors in this AC) should receive training in at least the
    following areas:

f.  Inspectors should know the location and types of airport facilities,
    airport rules and regulations and, at Part 139 airports, be familiar
    with the FAA-approved Airport Certification Manual.

    1.  Airport familiarization, including airport signs, marking, and
        lighting;

    2.  Airport Emergency Plan (if the airport has one);

    3.  Notice to Airmen (NOTAM) notification procedures;

    4.  Procedures for pedestrians and ground vehicles in movement areas
        and safety areas;

    5.  Airport inspection procedures and techniques; and

    6.  Discrepancy reporting procedures.

g.  Inspectors should know the FAA Advisory Circular standards
    applicable to the airport and have access to copies for reference.
    Some applicable standards can be found in the FAA Advisory Circulars
    listed in paragraph 3c. (This is not an all-inclusive list.). They
    can also be found on the Internet at **www.faa.gov.**

h.  Inspectors should have a vehicle equipped with:

    1.  a two-way ground control radio capable of communicating with the
        Airport Traffic Control Tower on controlled airports and on the
        Common Traffic Advisory Frequency (CTAF) or UNICOM at
        uncontrolled airports (or at controlled airports when the tower
        is closed);

    2.  a beacon for nighttime (or inclement weather conditions)
        inspections; and

    3.  either a beacon or checkered flag for daytime inspections.

i.  Inspectors should know and use correct radio communication
    phraseology, procedures and techniques, as specified in the
    Aeronautical Information Manual. If the airport operator uses
    airport police to do all or part of the self-inspection, the police
    should use aviation terminology and not 10-4 codes.

j.  Inspectors should be supplied with checklists covering the various
    inspection areas (sample airport safety self-inspection checklists
    are contained in Appendices 1--5). While format of checklists vary,
    it is important to develop a checklist that is useful for the
    airport and its operation. If certain inspectors will be responsible
    for only certain items, separate checklists pertinent to those areas
    may be developed. A sketch of the airport should accompany the
    checklist so that the location of problems can be marked for easy
    identification.

k.  Inspectors should review the most recently completed checklist from
    the previous inspection cycle prior to beginning the inspection.

l.  If construction is in progress, inspectors should be familiar with
    the safety plan for the project.

m.  If the airport is certificated under Part 139, inspectors should be
    familiar with the airport certification manual requirements
    concerning training and self-inspection.

### COMPONENTS OF A SAFETY SELF-INSPECTION PROGRAM. A successful safety self-inspection program has four components:

n.  A regularly scheduled inspection of physical facilities (which must
    be conducted daily at airports certificated under Part 139 or in
    accordance with the FAA-approved airport certification manual). If
    the airport serves air carriers after dark, there should also be a
    nighttime inspection of lighting;

o.  Continuous surveillance inspection of certain airport activities,
    such as fueling operations, construction, airfield maintenance;

p.  A periodic condition inspection program for such things as surveying
    approach slopes, obstructions, etc.; and

q.  Special condition inspections during unusual conditions or
    situations, such as changing weather or days of unusually high
    number of aircraft operations.

### REGULARLY SCHEDULED INSPECTION.

### The regularly scheduled inspection consists of specific observations of airport physical facilities on at least a daily basis. This inspection should concen­trate on the areas described in this section, which are also included in Appendix 1. If deficiencies exist, the inspector should indicate the deficient item and identify its location on a airport sketch, providing dimensions and depths, as necessary. If appropriate, the inspector should take photographs to document the condition. {#the-regularly-scheduled-inspection-consists-of-specific-observations-of-airport-physical-facilities-on-at-least-a-daily-basis.-this-inspection-should-concentrate-on-the-areas-described-in-this-section-which-are-also-included-in-appendix-1.-if-deficiencies-exist-the-inspector-should-indicate-the-deficient-item-and-identify-its-location-on-a-airport-sketch-providing-dimensions-and-depths-as-necessary.-if-appropriate-the-inspector-should-take-photographs-to-document-the-condition. .Paragraph}

**a.** **Pavement Areas.** The condition of pavement surfaces is an
important part of airport safety. Pavement inspection should be
conducted daily before flight operations commence to ensure pavement
surfaces are clear. As a minimum, a daily inspection should be performed
of all paved areas that are the responsibility of the airport operator
or as specified in the FAA-approved Airport Certification Manual. During
the pavement inspection, the inspector should:

(1) Check the pavement lips---the area between full-strength pavement
    and shoulders or paved shoulders and safety areas---to assure that
    they are no greater than necessary to allow water to drain off the
    pavement. A lip height no greater than 1 1/2 inches is usually
    sufficient to allow proper drainage. (At airports certificated under
    Part 139, pavement lips shall not exceed 3 inches as stated in §
    139.305.)

(2) Determine if there are any cracks wide enough to cause directional
    control problems for an aircraft. Report and monitor these cracks.

(3) Determine if there are any holes that could cause directional
    control problems for an aircraft. (At airports subject to Part 139.
    any hole that cannot be covered by a 5-inch circle, and the side
    slope at any point in the hole that exceeds 3 inches in depth and is
    45 degrees or greater, is a discrepancy. If the hole cannot be
    covered by a 5-inch circle but the side slope at any point in the
    hole that exceeds 3 inches in depth or is less than 45 degrees, it
    may be a discrepancy if it is determined to be a surface variation
    that could impair directional control of an air carrier aircraft.)

(4) Check the condition of pavement areas for cracks, scaling, spalling,
    bumps, low spots, and for debris that could cause foreign object
    damage to aircraft.

(5) Check for vegetation growth along runway and taxiway edges that may
    impede drainage from the pavement surface.

(6) Check for vegetation growth in cracks.

(7) Report and monitor any cracks, holes, variations and vegetation that
    can cause loss of aircraft directional control or may cause pavement
    damage, including damaged caused by damming or ponding water.

**b**. **Safety Areas.** The inspector should know the dimensions of the
runway and taxiway safety areas at the airport. At airports certificated
under Part 139, the dimensions of the safety areas should be documented
in the airport certification manual. During the safety area inspection,
the inspector should:

1.  Determine if there are any hazardous ruts, depressions, humps or
    variations from the normal smooth surface.

2.  Check to ensure no object is located in a safety area, except
    objects that must be in the safety areas because of their functions
    (such as runway lights, signs, or navigational aids). These objects
    must be constructed on frangibly mounted structures of the lowest
    practical height. At Part 139 airports, the frangible point must be
    no higher than 3 inches above grade.

3.  Determine if the base for any equipment in safety areas is at grade
    level (especially during the winter thaw) and equipment and NAVAIDs
    mounted on frangible couplings.

4.  Check to ensure that manhole and handhole covers are at grade level
    and can support vehicles and aircraft. Check to ensure that mounts
    for light fixtures are at grade level.

5.  Check for surface variation and other damage caused by rodents or
    other animals.

6.  Report any objects that are not frangible or not at grade level.
    Also report extraneous equipment and objects, such construction
    equipment, and surface variations that would cause damage to an
    aircraft or impede emergency response vehicles. At airports
    certificated under Part 139, issue a NOTAM regarding objects in the
    safety area contrary to § 139.309 (see § 139.339)

**c. Markings.** Airport markings provide important information to
pilots during takeoff, landing, and taxiing. To avoid confusion and
disorientation, airport markings should be in compliance with FAA
marking standards specified in AC 150/5340-1, Standards for Airport
Markings. (Compliance with these standards is mandatory for operators of
airports certificated under Part 139 and for airport operators that have
accepted Federal funds for runway and taxiway
construction/rehabilitation.) The inspector should know the appropriate
markings required at the airport. During the marking inspection, the
inspector should:

(1) Check markings for correct color-coding, peeling, blistering,
    chipping, fading, and obscurity due to rubber buildup.

(2) Check to see if all runway hold position markings are clearly
    visible.

(3) During and after construction projects, check new markings for
    compliance with FAA marking standards.

(4) If the markings have glass beads, check markings during periods of
    darkness to determine if the reflectivity of glass beads is adequate
    at night.

(5) Report and monitor any nonstandard marking or markings that are
    obscured, faded or deteriorating.

**d. Signs.** Signs provide important information to pilots while
taxiing. To avoid pilot confusion and disorientation, airport signs
should be in accordance with FAA sign standards specified in AC
150/5340-18, Standards for Airport Sign Systems. (Compliance with these
standards is mandatory for operators of airports certificated under Part
139 and for airport operators that have accepted Federal funds for
runway and taxiway construction/rehabilitation.) The inspector should
know the appropriate sign standards and specifications at the airport
and at a Part 139 certificated airport, ensure signs comply with the
FAA-approved Sign Plan.

(1) Check signs to ensure they are easy to read, in accordance with
    color standards, retro-reflective, and that all lighted signs are
    working and not obscured by vegetation, dirt, snow, etc.

(2) Check signs to ensure they are frangibly mounted and concrete bases
    are properly maintained at grade level.

(3) Check to see that sign panels are not missing or damaged, that they
    have the correct legend and arrow orientation, and that they are not
    cracked or broken.

(4) During and after construction projects, check new signs for
    compliance to FAA sign standards and, at Part 139 airports, in
    accordance with the FAA-approved Sign Plan.

(5) During periods of darkness, check signs to ensure they are properly
    illuminated. Ensure mandatory instruction signs are illuminated with
    the associated runway lighting system. Check signs for correct
    operations; that they are on the correct circuits, they do not
    flicker and that they follow the intensity setting of the runway or
    taxiway lights.

(6) Report and monitor any nonstandard sign or any sign that is not
    functioning, is faded or damaged. At airports certificated under
    Part 139, issue a NOTAM regarding any malfunctioning holding
    position sign or ILS critical are sign, as specified under § 139.339

**e. Lighting.** At night and during periods of low visibility, lighting
is important for safe airport operations. Lights come in different
shapes, sizes, colors, and configurations and can be located either in
the pavement or along its edges. Inspection of lighting is best
accomplished during periods of darkness in order to evaluate lighting
systems when they provide the primary visual aid for pilots. The
inspection should concentrate on the lighting owned by the airport
operator. However, the inspector should observe any lighting owned or
operated by others and report any observed problems immediately to the
appropriate responsible owner. During the lighting inspection, the
inspector should:

**(1)** Check to ensure that the following are operable, if installed,
and that vegetation or deposits of foreign material do not obscure the
light fixture.

i.  Runway and taxiway edge lights;

ii. Apron edge lights;

iii. Runway centerline and touchdown zone lights;

iv. Taxiway centerline lights or centerline reflectors;

v.  Runway threshold/end lights; and

vi. Runway guard lights (both elevated and in-pavement, if installed).

**(2)** Check that the following are operable, if installed:

(i) Ramp lights and floodlights used in construction to ensure they are
    properly shielded);

(ii) Obstruction lights; and

(iii) Lighting in fuel storage areas.

      3.  Report all fixtures missing and lights that are not working or
          appear dim.

      4.  Report any missing or broken light fixture lenses.

      5.  Ensure that runway and taxiway lights and runway threshold
          lights are the proper color and are oriented correctly.

      6.  Check that lights function properly through the manual or
          radio control features, and that photocell controls function
          properly.

      7.  Check the lights for proper alignment, aiming and correct
          changes in intensity, for correct height, erosion around the
          bases and the height of frangibility.

**f. Navigational Aids (NAVAIDs).** The inspection of NAVAIDs should
concentrate on the visual navigational aids owned by the airport
operator. However, the inspector should observe any navigational aids
owned or operated by others, such as the FAA, and report any observed
problems immediately to the NAVAID owner. During the inspection of
NAVAIDs, the inspector should:

(1) Determine if the segmented circle is clear of vegetation and that it
    can be seen easily from the air.

(2) Determine if the airport rotating beacon is visible and working
    properly.

(3) Check the wind cone(s) to ensure that it swings freely, the cone
    fabric is not faded or frayed, and, if lighted, that all lights are
    operating.

(4) Determine if the Runway End Lights (RENLs, formerly known as Runway
    End Identifier Lights) are flashing in proper sequence and mounted
    on frangible couplings.

(5) Check Visual Glide Slope Indicators (VASIs, PLASIs, or PAPIs) to
    ensure that their lights are working and mounted on frangible
    couplings.

(6) Determine if the Approach Lighting systems are functioning properly.

(7) Report and monitor any NAVAID that is malfunctioning, inoperable or
    misaligned, damaged or missing.

**g. Obstructions.** The inspection of obstructions should con­centrate
on a visual check of construction underway on or near the airport that
could affect aircraft operations. This also includes checking for any
vegetation, especially, trees, that may penetrate the Part 77 surfaces.
During the inspection of obstructions, the inspector should:

(1) Check to ensure that construction equipment, especially tall cranes
    being used at construction sites, are not an obstruction. If
    construction is found and thought to create an obstruction, the
    airport operator should determine if proper notification to FAA,
    such as is required through Part 77 or Airport Layout Plan review,
    has been provided.

(2) Determine if obstructions are properly marked and lighted.

(3) Direct any person proposing construction near a public-use airport
    meeting the notice requirements contained in Part 77, Objects
    Affecting Navigable Airspace, to the Air Traffic Division or
    Airports District Office immediately if their construction has not
    been reported to the FAA.

(4) Report and monitor any obstruction light that is missing,
    inoperative or damaged, and any object that appears to be an
    obstruction and is not properly marked or lit.

**h. Fueling Operations.** The daily inspection on aircraft fueling
operations should concentrate on a quick inspection for the most common
problems concerning compliance with local fire safety codes at fuel
storage areas and with mobile fuelers. The inspection should also
include security, fire protection, general housekeeping, and fuel
dispensing facilities and procedures. A more detailed fueling operation
inspection should be scheduled quarterly (see Quarterly Fueling
Operations under Periodic Condition Inspection). During the daily
inspection of aircraft fueling operations, the inspector should:

(1) Determine if the fueling operator is permitting any unsafe fueling
    practices or is in violation of local fire code, such as failure to
    bond aircraft with the mobile fuelers during fueling operations or
    fueling personnel smoking while fueling aircraft.

(2) Check to ensure that the appropriate signs for the fuel farm are
    installed and that all gates are locked except when the facility is
    occupied by an authorized user.

(3) Report and monitor any unsafe fueling practices and violation of
    local fire codes. At Part 139 airports, report any noncompliance
    with fuel fire safety procedures specified in the FAA-approved
    Airport Certification Manual.

**i. Snow and Ice.** The inspector should be familiar with the airport's
snow and ice removal procedures and guidance provided in AC 150/5200-30,
Airport Winter Safety and Operations. At Part 139 certificated airports,
the inspector should be familiar with the airport's FAA-approved Snow
and Ice Control Plan. During the snow and ice control inspection, the
inspector should:

(1) Determine if any lights and signs are obscured by snow or damaged by
    snow removal operations.

(2) Check to ensure that snow banks and drifts next to the runway and
    taxiways provide clearance for aircraft wing tips, engines, and
    propellers.

(3) Check to ensure that snow is not piled across the runway threshold
    or across runway/runway intersections.

(4) Check to be sure that no foreign objects are left on the pavement
    from snow removal operations.

(5) Check to ensure that snow removal operations have not blocked any
    taxiways or access routes dedicated for aircraft rescue and fire
    fighting equipment.

(6) Check to ensure that snow is not accumulated or piled in the
    critical areas for electronic NAVAIDs.

(7) Check for and report slippery pavement conditions in terms of either
    braking action or MU values. If a friction measurement device is
    available, issue the appropriate numbers obtained from the
    equipment. (Do not attempt to correlate friction measurement numbers
    with braking action reports.)

(8) Report and monitor any snow and ice accumulation that has been
    missed by the snow and ice removal operation, and any dangerous
    condition created by such operations, such as obscured signs or
    lights. At airports certificated under Part 139, issue a NOTAM
    regarding snow, ice, slush or water on the movement area or loading
    ramps, and parking areas, as specified under § 139.339.

**j. Construction.** The inspector should be familiar with the airport's
construction safety procedures and guidance provided in AC 150/5370-2,
Operational Safety on Airports During Construction. At Part 139
certificated airports, the inspector should be familiar with the
airport's FAA-approved Construction Safety Plan. During the construction
inspection, the inspector should:

(1) Determine if stockpiled material and construction materials are
    properly stored to keep them from being moved by wind, jet blast, or
    prop wash, and is not left in safety areas or movement area.

(2) Check all construction adjacent to movement areas to ensure areas
    are identified with conspicuous marking and lighting.

(3) Determine if construction equipment (such as bulldozers, cranes,
    etc.) are marked and lighted and parked clear of the safety areas.

(4) Ensure construction barricades are properly positioned to define the
    limits of construction and hazardous areas and, if barricades are
    lighted, check to ensure lights are working properly and are
    positioned correctly.

(5) Check to ensure that debris and foreign objects are continuously
    being picked up around construction areas.

(6) Check for open trenches in the safety areas or adjacent to movement
    areas.

(7) Check operation of lighting in areas adjacent to construction daily
    before the construction crews depart for the day. In particular,
    ensure that mandatory instruction signs remain lit with the
    associated runway lights, even on taxiways that have been closed for
    construction.

(8) Check NOTAMs daily during construction projects to ensure they
    accurately reflect the conditions on the airport.

(9) Verify that closed taxiways or runways are properly marked and
    lighted.

(10) Report and monitor any dangerous condition created by construction
     activity, including damage to signs, lights, markings and NAVAIDS
     or equipment and supplies left in movement areas and safety areas.

**k. Aircraft Rescue and Fire Fighting.** During the inspection of
aircraft rescue and fire fighting (ARFF) capabilities, the inspector
should:

(1) Check the status of ARFF response, including the availability of
    equipment, fire fighters and extinguishing agent. At Part 139
    airports, ensure that such ARFF capabilities comply with the
    FAA-approved Airport Certification Manual and that the airport's
    ARFF Index is still appropriate for air carrier aircraft served.

(2) Ensure alarm and emergency notification communication systems are
    operable.

(3) Determine the adequacy of available fire extinguishing agents.

(4) Check for construction or maintenance activity on the movement area
    that could affect ARFF response routes. Ensure that the ARFF
    Department has been notified if construction or maintenance activity
    could affect emergency response routes.

(5) Report and monitor any ARFF vehicle, equipment or extinguishing
    agent that is not available or inoperative; any ARFF personnel that
    are not available; and any changes to aircraft that may require a
    change to ARFF capabilities. At Part 139 airports, notify the FAA if
    ARFF vehicles is inoperative and cannot be replaced immediately, as
    specified under § 139.319(g) and issue a NOTAM regarding
    non-availability of any rescue and firefighting capability, as
    specified under § 139.339.

**l.** **Public Protection.** During the public protection inspection,
check gates, fencing, locks, and other safeguards are in place and
functioning properly to prevent inadvertent entry to movement areas by
unauthorized persons and vehicles and offer protection from jet blast.
Report and monitor any safeguards that are damaged or missing. In
accordance with the airport's security plan, report unauthorized persons
or vehicles in the movement area (airports regulated by the
Transportation Security Administration may have additional requirements
for reporting and responding to unauthorized persons and vehicles).

**m. Wildlife Hazard Management.** During the wildlife hazard
inspection, the inspector should check for evidence of birds or animals
on the runways, taxiways, aprons, and ramps or other signs that wildlife
problems may have developed - such as large flocks of birds on or
adjacent to the airport. Wildlife hazards found during the daily
self-inspection should be properly documented. All dead wildlife found
and all wildlife aircraft strikes should be reported to the FAA on the
FAA Form 5200-7, Bird/Other Wildlife Strike Report. This form may be
obtained from the FAA Internet site, at
**[www.faa.gov](http://www.faa.gov/).** Additionally, the inspector
should check fencing and gates for wildlife accessibility and should
ensure that wildlife control equipment is available and operational.

### CONTINUOUS SURVEILLANCE INSPECTION. Continuous surveillance inspection consists of general observation of activities for compliance with regulations, procedures, etc., as well as abnormalities with physical facilities that are readily apparent. This is performed any time inspection personnel are on the air operations area. Continuous surveillance of airport physical facilities and activities should cover at least the areas described in this section, which are also included in Appendix 2.

**a. Ground Vehicles.** During the continuous surveillance inspection of
ground vehicles, the inspector should:

1.  Determine if vehicle drivers are following the airport's procedures
    and arrangements for the orderly operations of ground vehicles
    (including mowing machines or other maintenance vehicles in the
    safety areas). Extra attention should be paid to ground vehicle
    activity during construction, winter operations, and other special
    events.

2.  Report and monitor any vehicle operator that is not complying with
    the airport's vehicle procedures and arrangements.

3.  Report any ground vehicle accident observed and any ground vehicle
    signs and markings that are damaged, missing or obscured.

**b. Fueling Operations.** The inspector should:

(1) Emphasize fire and explosion hazards inherent in aircraft refueling.

(2) Ensure proper bonding is being used, deadman controls are not
    blocked, and no smoking prohibitions are being observed, and
    aircraft are not being fueled inside hangars.

(3) Check for proper parking of mobile fuelers to ensure these vehicles
    are at least 10' apart and 50' from buildings.

(4) Check for fuel leaks or spills in the fuel storage area and around
    mobile fuelers.

(5) Determine if the fuel farm is free of flammable materials, including
    litter and vegetation.

(6) Report and monitor any of unsafe fueling conditions discussed above
    and other obvious violations of local fire code and airport fuel
    fire safety procedures.

**c. Snow and** **Ice.** During the continuous surveillance inspection
of snow and ice removal operations, the inspector should check snow or
ice covered pavements and report and monitor any surfaces where snow and
ice may affect the safety of aircraft operations. In addition, the
inspector should monitor snow and ice removal NOTAMS to ensure they
remain current and issue timely corrections, as necessary. If the
airport uses other means to notify tenants of snow and ice removal
operations, e.g., faxed or electronic messages, the inspector should
also monitor this information for accuracy. Check to ensure that snow or
ice on pavement surfaces does not affect the safety of aircraft
operations and that NOTAMS are current.

**d. Construction.** The Inspector should check construction projects to
ensure that the contractor is following the construction safety plan.
During the continuous surveillance inspection of construction activity,
the inspector should check for, and report, any of the following
conditions:

(1) Unauthorized use of runways, taxiways, and aprons by construction
    personnel and equipment.

(2) Conditions that may result in runway incursions and other
    irregularities. This includes ensuring that construction areas are
    delineated appropriately with barricades, cones, markings, etc.

(3) Construction equipment is not operated in ILS/MLS critical areas
    unless coordination with FAA has been accomplished.

(4) Perimeter gates are left open and unattended, unlocked or
    construction vehicles and personnel are not following access and
    escort procedures.

(5) Construction vehicles not properly marked or missing appropriate
    flags and/or beacons.

(6) Foreign object debris on haul roads adjacent to movement areas that
    can be tracked onto taxiways, aprons, and ramp areas.

(7) Confusing or missing signs, markings or lighting that could
    potentially confuse or mislead pilots.

(8) Barricades and lighting are in place and operational.

**e.** **Public Protection.** Pay special attention to public protection
during construction and special events. During the continuous
surveillance inspection of safeguards used to protect the public, the
inspector should check for, and report, any of the following conditions:

(1) Unauthorized personnel, vehicles, and animals, particularly in areas
    aircraft passengers and the general public are present on the air
    carrier ramp and other portions of the movement area, i.e, remote
    aircraft parking locations.

(2) Inoperable or blocked gates, particularly those that would impede
    access by aircraft rescue and fire fighting equipment.

(3) **O**pen or unlocked gates and missing or damaged signs posted to
    prevent unauthorized access to the airfield.

(4) Damaged or missing jet blast fences.

**f. Wildlife Hazard Management.** During the continuous surveillance
inspection of wildlife hazards, the inspector should check for, and
report, any of the following conditions:

(1) Birds or animals, such as dogs, deer, etc., on or adjacent to the
    runways, taxiways, aprons, and ramps to determine if there is a
    potential wildlife hazard problem.

(2) Potential hazard created by birds on or adjacent to the airport.

(3) Wildlife strikes and carcasses found on the runways. Report these on
    FAA Form 5200-7, Bird/Other Wildlife Strike Report. This form may be
    obtained from the FAA Internet site at **www.faa.gov.**

**g. Foreign Object Debris (FOD).** The inspector should continuously
check for, and remove any FOD in movement areas, aircraft parking areas
and loading ramps.

### PERIODIC CONDITION INSPECTION. Periodic condition inspections consist of specific checks of physical facilities on a regularly scheduled basis (but less frequently than daily). Checks may require use of equipment (e.g., Walker Bar to measure VASI glide slope angles or transit to survey approach slopes, or continuous friction measurement equipment) or checking specific features of physical facilities. Periodic inspection of airport physical facilities and activities should cover at least the areas described in this section, which are also included in Appendix 3.

**a. Pavement Areas.** The inspector should check pavement surfaces for
rubber buildup, polishing, or other items affecting friction.

**b. Markings.** The inspector should:

(1) Check pavement markings to ensure they are correct and clearly
    visible. Markings on concrete and faded asphalt should be outlined
    with a black border.

(2) Determine if markings are visible at night, especially examine for
    rubber buildup in the touchdown zone areas.

    c.  **Signs.** The inspector should check signs faces for peeling
        and for fading or faded colors.

**d. Quarterly Fueling Inspections.** Airports certificated under Part
139 are required to establish fire safety standards for safe fueling
operations and conduct quarterly inspections of the fueling facilities.
The inspection procedures in this section are based on the NFPA 407 fire
code for airport fueling operations, which is one of the more common
fire codes in effect at certificated airports. The fire safety standards
for fueling operations should be listed in the Airport Certification
Manual (ACM) and the quarterly inspections should be conducted for
compliance to the fueling fire safety standards listed in the ACM.
Sample quarterly inspection checklists for fuel storage areas and mobile
fuelers are included in Appendix 5. Typical fire safety standards to
inspect quarterly are listed below. Airports certificated under Part 139
are required to maintain a record of this inspection for at least 12
months.

**(1) Fuel storage areas and loading/unloading stations.** The inspector
should:

(i) Check fuel storage areas for adequate fencing and security to
    prevent unauthorized access or tampering.

(ii) Check for "No Smoking" signs that are clearly visible.

(iii) Check fuel storage areas for materials such as trash or vegetation
      that could contribute to the spread of fire. Also check for
      equipment, functions or activities that could be ignition sources.

(iv) Note if fueling equipment appears to be in good operating condition
     and free of fuel leaks.

(v) Check piping for reasonable protection from damage by vehicles if
    piping is above ground.

(vi) Check fuel storage areas for at least two accessible and
     serviceable fire extinguishers. Where the open hose discharge
     capacity of the equipment if more than 200 gallons per minute, at
     least one wheeled extinguisher with at least 125 lbs of agent is
     also required.

(vii) Check for explosion proof equipment, switches and wiring that is
      reasonably protected from heat, abrasion or impact, which could
      cause an ignition source.

(viii) Check for piping, filters, tanks and pumps being electrically
       bonded together and interconnected to an adequate grounding rod.

(ix) Check for a serviceable bond/ground wire with clip at each
     loading/unloading facility for grounding tankers and mobile
     fuelers.

(x) Check loading stations for deadman control features.

(xi) Look for a boldly marked emergency cutoff capable of stopping all
     fuel flow with one physical movement. The emergency cutoff should
     be located outside the probable fuel spill area near the route that
     normally is used to leave the spill area or to reach the fire
     extinguishers.

**(2) Mobile fuelers.** At least once every 3 months, inspect all fuel
trucks to ensure they meet fire safety standards. The inspector should:

(i) Note if mobile fuelers appear to be in good operating condition and
    free of fuel leaks.

(ii) Check mobile fuelers for parking at least 50 feet from a building
     and at least 10 feet from each other. Note: Some airports have a
     mobile fueler maintenance building that is approved by the local
     fire marshal.

(iii) Check for flammability decals on all sides. Lettering should be at
      least 3 inches high. Also check for hazardous materials placards
      on all sides. The Hazmat number for Jet A trucks should be
      \#**1863** and \#**1203** for 100LL trucks.

(iv) Check the cab for a "No Smoking" sign and the presence of smoking
     equipment. Ashtrays and cigarette lighters are not to be provided.

(v) Check for two fire extinguishers, accessible from each side of the
    mobile fueler. Fire extinguishers should be charged, sealed and
    tagged from the last fire extinguisher inspection. Check dry
    chemical extinguishers to ensure they are only B-C rated. ABC rated
    multi-purpose dry chemical extinguishers are not to be used on
    mobile fuelers as they are highly corrosive to aircraft and can
    cause significant damage to aircraft engines.

(vi) Check emergency fuel cutoffs to ensure they are boldly marked and
     operable. There should be an emergency fuel cutoff accessible from
     each side.

(vii) Check electrical equipment, switches, wiring and tail light lens
      covers for explosion proof construction and reasonable protection
      form heat, abrasion or impact which could be an ignition source.

(viii) Check for serviceable bonding wires and clamps.

(ix) Check nozzles for deadman control feature.

(x) Check the vehicle exhaust system for exhaust leaks and for adequate
    shielding if it extends under the fuel tank portion of the vehicle.

**e. Navigational Aids.** Periodically check the aiming of REILs and
Visual Glide Slope Indicators owned by the airport.

**f. Lighting.** The inspector should:

1.  Determine that power generator and circuit resistance tests are
    being conducted.

2.  Ensure lights with adjustable optical systems are checked for proper
    aiming.

**g. Obstructions**. The inspector should:

(1) Check to ensure there are no overhead power lines in the aircraft
    parking areas.

(2) Annually survey trees and other structures near the airport that
    could affect glide path angles, approach light lanes, or be an
    obstruction to Part 77 surfaces.

**h. Aircraft Rescue and Fire Fighting.** The inspector should:

(1) Periodically determine if the aircraft rescue and fire fighting
    equipment is capable of meeting response times, if it is required
    under Part 139.

(2) Ensure that recurrent training and hot-fire drills are being
    conducted as required by Part 139.

(3) Check to ensure the availability of adequate entry tools.

### SPECIAL CONDITION INSPECTIONS. Special condition inspections occur after receipt of a complaint or as triggered by an unusual condition or event. A special inspection should be conducted after an accident or incident. Depending upon circumstances, special condition inspections may include the inspection of any of the specific facilities or activities under the other three components. A special condition inspection of airport physical facilities and activities should cover at least the areas described in this section, which are also included in Appendix 4.

**a. Pavement Areas.** After a rain or thunderstorm, the inspector
should check the pavement areas for ponding and edge damming.

**b. Markings and Signs.** The inspector should:

(1) Determine if markings are visible at night especially when the
    pavement is wet following a rain.

(2) After construction or maintenance operations, ensure that pavement
    markings are correct.

**c. Safety Areas.** The inspector should:

(1) Ensure that the storm sewer system is checked to verify that inlets
    are not clogged and drainage channels are free of debris. Note any
    standing water.

(2) Ensure all inlet covers are in place and sewer covers are at grade
    level.

(3) Conduct a special inspection before reopening a runway or taxiway
    following any construction or maintenance that has been performed in
    or around that safety area.

(4) Any time an aircraft has left the pavement and entered a safety
    area, check to ensure that no ruts or holes have been made by the
    aircraft tires or by personnel and equipment during the recovery
    operation.

(5) Check for construction and maintenance activities to ensure that no
    hazardous conditions have been created (equipment left in safety
    areas, unacceptable pavement lips created by ground alteration work,
    ruts from mowing equipment, etc.).

(6) Inspect engineered materials arresting system (EMAS), if installed,
    for damage and for deterioration.

(7) Physically drive or walk the safety areas to check for any
    discrepancies.

**d. Snow and Ice.** Several special inspections may be needed during a
winter storm until the airport is back to a normal operation. The
inspector should:

(1) Check to ensure that all foreign objects have been picked up after
    snow and ice removal operations.

(2) If a friction measurement device is available, issue the appropriate
    numbers obtained from the equipment. Do not attempt to correlate
    friction measurement numbers with braking action reports. If a
    friction measurement device is not available, issue to Air Traffic
    braking action reports.

(3) Conduct a special sign inspection after snowstorms for signs that
    may have been damaged by plows or by snow thrown by blowers.

**e. Construction.** The inspector should:

(1) Ensure that construction areas are barricaded and lighted properly.

(2) Check construction equipment to ensure that they are parked within
    the pre-arranged areas.

(3) Conduct night inspections to ensure that barricades, warning
    lighting, and reflectors are adequate to keep aircraft away from the
    construction area.

(4) Check the location of construction material and stockpiles to ensure
    that they are outside of safety areas and do not block any signs.

(5) Check any movement areas adjacent to construction areas or movement
    areas traversed by construction vehicles to ensure there is no FOD
    present.

(6) Check movement areas around construction sites for potentially
    confusing marking, lighting, and signs that could cause pilot
    confusion or result in a runway incursion.

**f. Surface Movement Guidance and Control Systems (SMGCS).**

(1) For operations below 1,200 feet runway visual range, the inspector
    should conduct an initial inspection of stop bar lights, runway
    guard lights, clearance bar lights, taxiway centerline lights, and
    taxiway edge lights installed on the low visibility routes in
    accordance with the airport's SMGCS plan.

(2) SMGCS lighting systems that are not electronically monitored should
    be periodically inspected every 2 to 4 hours for during operations
    below 1,200 feet to 600 feet. For operations below 600 feet, these
    inspections should take place every 2 hours. Such inspections should
    be detailed in the airport's SMGCS plan.

### CONDITION REPORTING. Alert users of the airport to any unsafe conditions that exists and that could affect their operations. Ensure appropriate NOTAMS are issued for unsafe conditions that are identified during an inspection but cannot be corrected immediately. After reporting NOTAMs to the Flight Service Station, follow-up to ensure that the NOTAMS were processed and transmitted.

![](media/image2.png){width="2.5375in" height="0.5888888888888889in"}

### David L. Bennett {#david-l.-bennett .Paragraph}

### Director, Office of Airport Safety and Standards {#director-office-of-airport-safety-and-standards .Paragraph}

## APPENDICES 1--4

## SUGGESTED AIRPORT SAFETY SELF-INSPECTION CHECKLISTS

### An airport safety self-inspection checklist should cover the condition of the facilities and equipment on the airport for it to be a part of a good safety inspection program. The checklist should be developed so that it is useful for the airport and its operation. A sketch of the airport is highly recommended to readily identify the location of problems found during the daily inspection. {#an-airport-safety-self-inspection-checklist-should-cover-the-condition-of-the-facilities-and-equipment-on-the-airport-for-it-to-be-a-part-of-a-good-safety-inspection-program.-the-checklist-should-be-developed-so-that-it-is-useful-for-the-airport-and-its-operation.-a-sketch-of-the-airport-is-highly-recommended-to-readily-identify-the-location-of-problems-found-during-the-daily-inspection. .Paragraph}

### The suggested checklists consist of a listing of facilities and equipment and a series of conditions that are inspected.  {#the-suggested-checklists-consist-of-a-listing-of-facilities-and-equipment-and-a-series-of-conditions-that-are-inspected. .Paragraph}

### The blank squares indicate the conditions to be evaluated for each facility. A check (√) in one of these squares would indicate that the condition of the facility and equipment was found to be satisfactory. On the other hand, an "x" in one of these squares would indicate that the condition of the facility and equipment was found to be unsatisfactory. {#the-blank-squares-indicate-the-conditions-to-be-evaluated-for-each-facility.-a-check-in-one-of-these-squares-would-indicate-that-the-condition-of-the-facility-and-equipment-was-found-to-be-satisfactory.-on-the-other-hand-an-x-in-one-of-these-squares-would-indicate-that-the-condition-of-the-facility-and-equipment-was-found-to-be-unsatisfactory. .Paragraph}

### When an unsatisfactory condition is found: {#when-an-unsatisfactory-condition-is-found .Paragraph}

### An "x" for each applicable square should be entered; {#an-x-for-each-applicable-square-should-be-entered .Paragraph}

### A note provided in the Remark/Action Taken section;  {#a-note-provided-in-the-remarkaction-taken-section .Paragraph}

### The location of the condition should be identified in the airport sketch; and {#the-location-of-the-condition-should-be-identified-in-the-airport-sketch-and .Paragraph}

### Appropriate follow-up action including NOTAMs should be initiated. Corrective action should be documented on either the self-inspection checklists or on a separate work order system. {#appropriate-follow-up-action-including-notams-should-be-initiated.-corrective-action-should-be-documented-on-either-the-self-inspection-checklists-or-on-a-separate-work-order-system. .Paragraph}

### These checklists are ideal for electronic conversion to PDAs and laptop computers. {#these-checklists-are-ideal-for-electronic-conversion-to-pdas-and-laptop-computers. .Paragraph}

Page Intentionally Blank

## APPENDIX 1

## AIRPORT SAFETY SELF-INSPECTION CHECKLIST

**DATE**: **DAY**: **√ Satisfactory**

**X Unsatisfactory**

[**Day Inspector/Time:** **Night Inspector/Time: **]{.underline}

+-------------+------------------+---+---+-----------------+-----------+
| #           | #####            | # | # | #####           | *         |
|             |                  | # | # |                 | *RESOLVED |
| #           | ##### CONDITIONS | # | # | ##### REMARKS   | BY**      |
|  FACILITIES |                  | # | # |                 |           |
|             |                  | # | # |                 | *         |
|             |                  |   |   |                 | *(Date/In |
|             |                  |   |   |                 | itials)** |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
|             |                  | D | N |                 |           |
+=============+==================+===+===+=================+===========+
| # Pav       | ##### Paveme     | # | # | #####           |           |
| ement Areas | nt lips over 3\" | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Hole -- 5\ | # | # | #####           |           |
|             | " diam. 3\" deep | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Cracks     | # | # | #####           |           |
|             | /spalling/heaves | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### FOD: gr    | # | # | #####           |           |
|             | avel/debris/sand | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##               | # | # | #####           |           |
|             |  Rubber deposits | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### P          | # | # | #####           |           |
|             | onding/edge dams | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # S         | ##### Ru         | # | # | #####           |           |
| afety Areas | ts/humps/erosion | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Drain      | # | # | #####           |           |
|             | age/construction | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Support eq | # | # | #####           |           |
|             | uipment/aircraft | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |  Frangible bases | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Unau       | # | # | #####           |           |
|             | thorized objects | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # Markings  | ##### Clearly    | # | # | #####           |           |
|             | visible/standard | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |  Runway markings | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             | Taxiway markings | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Holding p  | # | # | #####           |           |
|             | osition markings | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #                | # | # | #####           |           |
|             | #### Glass beads | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # Signs     | ##### Standar    | # | # | #####           |           |
|             | d/meet Sign Plan | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### O          | # | # | #####           |           |
|             | bscured/operable | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Damaged    | # | # | #####           |           |
|             | /retroreflective | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # Lighting  | ##### Obscure    | # | # | #####           |           |
|             | d/dirty/operable | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |  Damaged/missing | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Fault      | # | # | #####           |           |
|             | y aim/adjustment | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |  Runway lighting | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             | Taxiway lighting | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Pilot      | # | # | #####           |           |
|             | control lighting | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # Naviga    | ##### Rotating   | # | # | #####           |           |
| tional Aids |  beacon operable | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |  Wind indicators | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### RE         | # | # | #####           |           |
|             | NLs/VGSI systems | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # O         | #                | # | # | #####           |           |
| bstructions | #### Obstruction | # | # |                 |           |
|             |  lights operable | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##               | # | # | #####           |           |
|             | ### Cranes/trees | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # Fueling   | ##### Fen        | # | # | #####           |           |
|  Operations | cing/gates/signs | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Fuel       | # | # | #####           |           |
|             | marking/labeling | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Fi         | # | # | #####           |           |
|             | re extinguishers | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##               | # | # | #####           |           |
|             | ### Frayed wires | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Fuel       | # | # | #####           |           |
|             | leaks/vegetation | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| #           | ##### Su         | # | # | #####           | #         |
|  Snow & Ice | rface conditions | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Sno        | # | # | #####           | #         |
|             | wbank clearances | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Lights     | # | # | #####           | #         |
|             | & signs obscured | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### NAVAIDs    | # | # | #####           | #         |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #                | # | # | #####           | #         |
|             | #### Fire access | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           | #         |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # C         | ##### B          | # | # | #####           | #         |
| onstruction | arricades/lights | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### E          | # | # | #####           | #         |
|             | quipment parking | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Mat        | # | # | #####           | #         |
|             | erial stockpiles | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Confusin   | # | # | #####           | #         |
|             | g signs/markings | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           | #         |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| #           | #                | # | # | #####           | #         |
| Aircraft Re | #### Equipment/c | # | # |                 |           |
| scue and Fi | rew availability | # | # |                 |           |
| re Fighting |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Commu      | # | # | #####           | #         |
|             | nications/alarms | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Response   | # | # | #####           | #         |
|             |  routes affected | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           | #         |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # Public    | ##### Fen        | # | # | #####           | #         |
|  Protection | cing/gates/signs | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Je         | # | # | #####           | #         |
|             | t blast problems | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           | #         |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
| # Wildl     | ##### Wildlife   | # | # | #####           | #         |
| ife Hazards | present/location | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Com        | # | # | #####           | #         |
|             | plying with WHMP | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | ##### Dead birds | # | # | #####           | #         |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+
|             | #####            | # | # | #####           | #         |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  | # | # |                 |           |
|             |                  |   |   |                 |           |
+-------------+------------------+---+---+-----------------+-----------+

**Comments/Remarks**:

#### Airfield Map on Reverse Side 

![](media/image3.wmf){width="7.038888888888889in"
height="9.47638888888889in"}

## APPENDIX 2

## CONTINUOUS SURVEILLANCE CHECKLIST

+--------------+-------------------+---+------------------------------+
| **√          |                   |   |                              |
| Sa           |                   |   |                              |
| tisfactory** |                   |   |                              |
|              |                   |   |                              |
| **DATE:      |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| DAY:         |                   |   |                              |
| \_\_\_\_     |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| X            |                   |   |                              |
| Unsa         |                   |   |                              |
| tisfactory** |                   |   |                              |
|              |                   |   |                              |
| **TIME:      |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| INSPECTOR:   |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_** |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **           | **CONDITIONS**    | * | **REMARKS/ACTIONS TAKEN**    |
| FACILITIES** |                   | * |                              |
|              |                   | √ |                              |
|              |                   | * |                              |
|              |                   | * |                              |
+--------------+-------------------+---+------------------------------+
| ######## Gro | ## Rules/Pr       |   |                              |
| und Vehicles | ocedures Followed |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Fueling    | **Fire/Explosion  |   |                              |
| Operations** | Hazards**         |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Signing/No      |   |                              |
|              | smoking**         |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Snow &     | ## S              |   |                              |
| Ice**        | urface Conditions |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Co         | ## Safety Plan    |   |                              |
| nstruction** |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              | ########          |   |                              |
|              | Runway Incursions |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Runway &        |   |                              |
|              | Taxiway Use**     |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **FOD**           |   |                              |
+--------------+-------------------+---+------------------------------+
| # Publi      | **Unauthorized    |   |                              |
| c Protection | Persons**         |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Unauthorized    |   |                              |
|              | Vehicles**        |   |                              |
+--------------+-------------------+---+------------------------------+
|              | ###               |   |                              |
|              | ##### Gates clear |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| # Wild       | #####             |   |                              |
| life Hazards | ### Birds/Animals |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| # M          | **Pedestrians in  |   |                              |
| iscellaneous | Movement Areas**  |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Passenger       |   |                              |
|              | Load/Unload**     |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Debris in       |   |                              |
|              | Movement Area**   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Additional |                   |   |                              |
| Remarks**    |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+

Airfield Map on Reverse Side

![](media/image3.wmf){width="6.08125in" height="9.268055555555556in"}

## APPENDIX 3

## PERIODIC CONDITION INSPECTION CHECKLIST

+--------------+-------------------+---+------------------------------+
| **√          |                   |   |                              |
| Sa           |                   |   |                              |
| tisfactory** |                   |   |                              |
|              |                   |   |                              |
| **DATE:      |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| DAY:         |                   |   |                              |
| \_\_\_\_     |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| X            |                   |   |                              |
| Unsa         |                   |   |                              |
| tisfactory** |                   |   |                              |
|              |                   |   |                              |
| **TIME:      |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| INSPECTOR:   |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_** |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **           | **CONDITIONS**    | * | **REMARKS/ACTIONS TAKEN**    |
| FACILITIES** |                   | * |                              |
|              |                   | √ |                              |
|              |                   | * |                              |
|              |                   | * |                              |
+--------------+-------------------+---+------------------------------+
| # Pa         | #######           |   |                              |
| vement Areas | # Rubber Deposits |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Polishing**     |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| ####         | ## Visible        |   |                              |
| ##### Markin |                   |   |                              |
| gs and Signs |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Standards**     |   |                              |
+--------------+-------------------+---+------------------------------+
| **Fueling    | ######## Ph       |   |                              |
| Operations** | ysical Facilities |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Mobile          |   |                              |
|              | Fuelers**         |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Fire            |   |                              |
|              | Extinguishers**   |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Fuel            |   |                              |
|              | M                 |   |                              |
|              | arking/Labeling** |   |                              |
+--------------+-------------------+---+------------------------------+
|              | #####             |   |                              |
|              | ### Frayed Wiring |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| ##           | ##                |   |                              |
| ###### Navig | RENLs/VGSI Aiming |   |                              |
| ational Aids |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Lighting** | ######## Powe     |   |                              |
|              | r Generator Check |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Circuit         |   |                              |
|              | Resistance Test** |   |                              |
+--------------+-------------------+---+------------------------------+
|              | *                 |   |                              |
|              | *Aim/Adjustment** |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Ob         | ## Surveyed       |   |                              |
| structions** |  Trees/Structures |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Overhead Power  |   |                              |
|              | Lines**           |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| # Aircraft   | **Response        |   |                              |
| Rescue and F | Times**           |   |                              |
| ire Fighting |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Live Fire       |   |                              |
|              | Drills**          |   |                              |
+--------------+-------------------+---+------------------------------+
|              | ######## Training |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Additional |                   |   |                              |
| Remarks**    |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+

**Airfield Map on Reverse Side**

## ![](media/image3.wmf){width="6.622222222222222in" height="9.111805555555556in"}

##   {#section-236 .unnumbered}

## APPENDIX 4

## SPECIAL INSPECTION CHECKLIST

+--------------+-------------------+---+------------------------------+
| **√          |                   |   |                              |
| Sa           |                   |   |                              |
| tisfactory** |                   |   |                              |
|              |                   |   |                              |
| **DATE:      |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| DAY:         |                   |   |                              |
| \_\_\_\_     |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| X            |                   |   |                              |
| Unsa         |                   |   |                              |
| tisfactory** |                   |   |                              |
|              |                   |   |                              |
| **TIME:      |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| INSPECTOR:   |                   |   |                              |
| \_\_         |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_\_ |                   |   |                              |
| \_\_\_\_\_** |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **           | **CONDITIONS**    | * | **REMARKS/ACTIONS TAKEN**    |
| FACILITIES** |                   | * |                              |
|              |                   | √ |                              |
|              |                   | * |                              |
|              |                   | * |                              |
+--------------+-------------------+---+------------------------------+
| # Pa         | ########          |   |                              |
| vement Areas | Ponding/Edge Dams |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Markings** | ## V              |   |                              |
|              | isible after rain |   |                              |
| **And        |                   |   |                              |
| Signs**      |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Standards after |   |                              |
|              | Construction**    |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Safety     | **Drainage**      |   |                              |
| Areas**      |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Reopening       |   |                              |
|              | Runways**         |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Reopening       |   |                              |
|              | Taxiways**        |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Snow and   | ## S              |   |                              |
| Ice**        | urface conditions |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Snowbank        |   |                              |
|              | clearance**       |   |                              |
+--------------+-------------------+---+------------------------------+
|              | ######## Lights   |   |                              |
|              |  & Signs Obscured |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **FOD**           |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Braking         |   |                              |
|              | Action/MU         |   |                              |
|              | Reports**         |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Co         | **Barricades**    |   |                              |
| nstruction** |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Construction    |   |                              |
|              | Lights**          |   |                              |
+--------------+-------------------+---+------------------------------+
|              | **Equipment       |   |                              |
|              | Parking**         |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **SMGCS**    | ## SMGCS Lighting |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
| **Additional |                   |   |                              |
| Remarks**    |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+
|              |                   |   |                              |
+--------------+-------------------+---+------------------------------+

**Airfield Map on Reverse Side**

![](media/image3.wmf){width="6.622222222222222in"
height="9.111805555555556in"}

## APPENDIX 5A

## QUARTERLY INSPECTION -- MOBILE FUELERS

**Inspector: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fueling Agent:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

<table style="width:100%;">
<colgroup>
<col style="width: 36%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 0%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><blockquote>
<p><strong>S</strong> – <strong>Satisfactory</strong></p>
<p><strong>U</strong> – <strong>Unsatisfactory</strong></p>
<p><strong>R</strong> – <strong>Remark Below</strong></p>
</blockquote></td>
<td colspan="4"><h1 id="jet-a-fuelers">Jet A Fuelers</h1></td>
<td colspan="5"><h1 id="ll-fuelers">100LL Fuelers</h1></td>
<td colspan="3"><h1 id="other-fueler">Other Fueler</h1></td>
</tr>
<tr class="even">
<td><strong>S</strong></td>
<td><strong>U</strong></td>
<td><strong>R</strong></td>
<td colspan="2"><strong>S</strong></td>
<td colspan="3"><strong>U</strong></td>
<td><strong>R</strong></td>
<td><strong>S</strong></td>
<td><strong>U</strong></td>
<td><strong>R</strong></td>
</tr>
<tr class="odd">
<td>No Smoking sign in cab</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Flammability Signs/Haz Mat Placards all sides</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Bonding Cables and Clips functional</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Deadman Control for all nozzles</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>2 Fire Extinguishers – Proper type/Inspected</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Emergency Shutoffs operable and marked</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>No Fuel Leaks – Hoses/Gaskets/Valves</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Vehicle Exhaust System – Shielded/Leak free</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>No evidence of Smoking – No ashtray in cab</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Vehicle Parking – 10' apart/50' from buildings.</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Explosion proof electrical/Light lens intact</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Ignition Sources (Clothing, Shoes, Matches)</td>
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="10"></td>
<td colspan="3"><h2 id="no-of-mobile-fuelers">No of Mobile
Fuelers</h2></td>
</tr>
<tr class="even">
<td>Proper Fueling Procedures Observed</td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td colspan="2"></td>
<td colspan="3" rowspan="3"><p>Jet A ________________</p>
<p>100 LL _______________</p>
<p>Other ________________</p></td>
</tr>
<tr class="odd">
<td>Fueling Personnel Meet Training Requirements</td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>Fueling Personnel Training Records maintained</td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="13"></td>
</tr>
<tr class="even">
<td
colspan="13">Remarks:<u>__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</u></td>
</tr>
</tbody>
</table>

Page Intentionally Blank

## APPENDIX 5B

## QUARTERLY INSPECTION -- FUEL STORAGE AREAS

**Inspector: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fueling Agent:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date:**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

<table style="width:100%;">
<colgroup>
<col style="width: 36%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><blockquote>
<p><strong>S</strong> – <strong>Satisfactory</strong></p>
<p><strong>U</strong> – <strong>Unsatisfactory</strong></p>
<p><strong>R</strong> – <strong>Remark Below</strong></p>
</blockquote></td>
<td colspan="3"><h1 id="jet-a-section">Jet A Section</h1></td>
<td colspan="3"><h1 id="ll-section">100LL Section</h1></td>
<td colspan="3"><h1 id="other-_________">Other _________</h1></td>
</tr>
<tr class="even">
<td><strong>S</strong></td>
<td><strong>U</strong></td>
<td><strong>R</strong></td>
<td><strong>S</strong></td>
<td><strong>U</strong></td>
<td><strong>R</strong></td>
<td><strong>S</strong></td>
<td><strong>U</strong></td>
<td><strong>R</strong></td>
</tr>
<tr class="odd">
<td>Fencing/Locks/Signs</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Piping protected from vehicles</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>No Smoking signs posted</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Deadman Controls for loading stations</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>2 Fire Extinguishers – Inspected/Accessible</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Boldly Marked Emergency Cutoffs – Location</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>No Fuel Leaks</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Bonding wire/clips at loading stations/operable</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Piping/Pumps bonded and grounded</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>No vegetation or materials to spread fire</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>No evidence of Smoking</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Hoses in good condition</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Explosion Proof Electrical Equipment</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="10"></td>
</tr>
<tr class="odd">
<td
colspan="10">Remarks:<u>____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</u></td>
</tr>
</tbody>
</table>

[^1]: Part 139 is only applicable in the State of Alaska to airport
    operators serving scheduled or unscheduled passenger operations of
    an air carrier with aircraft having a seating capacity of more than
    30 passengers.