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# DLA Official Forms

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| Form Number:  DLA5021                                                                                                                                                                                                                                                                    |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  High Hazard Facility Risk Management Survey                                                                                                                                                                                                                                 |
| Form Version:  Jan 2021                                                                                                                                                                                                                                                                  |
| Status:  Active                                                                                                                                                                                                                                                                          |
| Functional Area:  Aviation                                                                                                                                                                                                                                                               |
| Opr:  Aviation                                                                                                                                                                                                                                                                           |
| Safeguards:  None                                                                                                                                                                                                                                                                        |
| Electronic:  Yes                                                                                                                                                                                                                                                                         |
| Form Link:  Documents/FormsSite/forms/DL5021.pdf                                                                                                                                                                                                                                         |
| Type:  Primary                                                                                                                                                                                                                                                                           |
| Prescribed:  DLAM 6055.06 Vol. 1                                                                                                                                                                                                                                                         |
| Description:  This form updates and redesignates DSCR Form 4250-A to a DLA-level form as a result of the 2019 forms survey on MSC-level forms.  The DLA Form 5021 is utilized to conduct inspections on high hazard facilities IAW DLAM 6055.06, Fire Prevention Program, March 12, 2018 |
| Records Retention:  6055.64 Firemen Logs and Inspections.  Temporary. Cutoff at end of CY. Destroy after 7 years.  Pending Approval.                                                                                                                                                     |
| Form Audience:  MSC Fire & Emergency Services                                                                                                                                                                                                                                            |

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