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AIRPORT CERTIFICATION SAFETY INSPECTION CHECKLIST (Order 5280.5C)

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AIRPORT CERTIFICATION SAFETY INSPECTION CHECKLIST (Order 5280.5C)

CERTIFICATE HOLDER

AIRPORT NAME

AIRPORT CLASSIFICATION

AIRPORT ARFF INDEX

FAA ACSI (INSPECTORS)

DATE & TIME OF START OF FAR 139 INSPECTION

FAR 139 PRE-INSPECTION MEETING

Reviewed Airport Master Record (5010 Form)?

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

Reviewed previous inspection?

List issues from previous inspections that have not been addressed (explain mitigation and timeframe to correct this issue).

Obstruction Chart Review

Comments:

METHODS AND PROCEDURES FOR COMPLIANCE

Compliance with Advisory Circulars (139.7)

EXEMPTIONS - NUMBER ON RECORD ( )

Justification Still Valid (139.111)

AIRPORT CERTIFICATION MANUAL

Compliance with ACM (201a)

Preparation (201a)

Content (203)

Maintenance (201b)

Comments:

RECORDS

Furnished upon request (301a)

Maintained for Specified Duration (301b)

Comments

PERSONNEL

Sufficient Qualified Personnel (303a)

Properly Equipped (303b)

Trained (303c)

Records for Training for 24 CCM (303d)

Use of Independent Organization or Designee (303f)

Comments

PAVED AREA

Lips (305a1)

Holes (305a2)

Cracks / Surface Variations (305a3)

Debris / Contaminants (305a3)

Chemical Solvents Removed (305a5)

Drainage / Ponding (305a6)

Comments

SAFETY AREAS

Dimensions Maintained (309a)

Rut / Surface Variations (309a)

Drainage (309b2)

Support Aircraft / Equipment (309b3)

Objects in Safety Area / Frangible Mounting (309b4)

Comments

MARKING, SIGNS, AND LIGHTING

Runway Marking Meets Specs (311A1)

Taxiway Centerline (311a2)

Taxiway Edge Marking (311a3)

Holding Position Marking (311a4)

ILS Critical Area Marking (311a5)

Sign Identifying Taxing Routes (311b1)

Holding Position Sign (311b1ii)

ILS Critical Area Sign (311b1iii)

Signs Internally Illuminated (311b2)

Runway Lighting Meets Specifications (311c1)

Taxiway Lighting / Reflectors (311c2)

Airport Beacons (311c3)

Airport-owned Approach Lighting (311c4)

Obstruction Marking / Lighting (311c5)

Marking / Signs / Lighting Properly Maintained (311d)

Other Lighting Shielded / Adjusted (311e)

Comments

ARFF OPERATIONS

ARFF Capability Meets Index Provided During ACR OPNS (319a)

ARFF Requirements Meets for Increase in Index (319b)

Reduction in ARFF Index Meets Conditions (319d)

Vehicle Communication in Required Vehicles (319e)

Vehicle Marking & Lighting (319f)

Vehicle Readiness (319g)

Response Drill (No. Vehicles) (319h)

Personnel Properly Equipped (319f1)

Personnel Properly Trained (319i2)

Live-Fire Drill Every 12 Consecutive Calendar Months for all Personnel (319i3)

Personnel Trained and Current in Basic Emergency Medical Care Provided for ACR OPNS (319i4)

Records of Training for 24 CCM (319l5)

Sufficient Personnel to Meet Requirement (319i6)

Alert Procedures / Equipment Established (317i7)

Hazardous Materials Guidance Available, ERG 2012 (319j)

Comments

HAZARDOUS MATERIAL

Procedures for Hazardous Substances and Materials (321a)

Acceptables Fire Safety Standards Established (321b)

Compliance to Fire Safety Standards (321c)

Inspection of Fuel Facilities every 3 CCM (321d)

Record of Inspection for 12 CCM (321d)

Fueling Agent Supervisor Training Every 24 CCM (321e1)

Fuel Agent On-the-Job Training Every 24 CCM (321e2)

Written Confirmation Every 12 CCM that Training has been accomplished (321f)

Required immediate Corrective Action / Notify FAA of Non-Compliance (321g)

Comments

TRAFFIC / WIND INDICTORS

Wind Cones Provided / Lighted (323a)

Segments Circle, Landing Strip, and Traffic Pattern Indicators Provided When No ATCT (323b)

Comments

AIRPORT EMERGENCY PLAN

Develop / Maintain Plan / Procedures for Prompt Response / Sufficient Detail (325b)

Response Instructions Aircraft, Bomb, Structure, Fuel, Natural, Hazardous Materials, Sabotage / Hijack, Power, Water (325b)

Must Address Medical, Transportation, Hospital, Ambulance, Inventory, Injured, Crowds, Disable Aircraft. (325c)

Provides for Marshaling, Emergency Alarm, Coordination of ATCT Functions. (325d)

Contains Procedures for Notifying Agencies of Accident Location and Other Information. (325e)

Contains Provisions for Water Rescue to the Extent Practical. (325f)

Coordinate and Develop Plan with Participating Agencies / Personnel. (325g1 & 2)

Airport Personnel are Properly Trained (325g3)

Review Plan every 12 CCM (325g4)

Full-Scale Exercise every 36 CCM for Class 1 Airports. (325h)

Consistent with the Approved Security Program (325i)

Comments

SELF-INSPECTION PROGRAM

Inspect Daily or As Required. (327a1)

Inspect when Required by Unusual Conditions; Accidents (327a2 & 3)

Equipment Provided (327b1)

Procedures / Equipment for Dissemination of Information to User (327b2)

Ensured Inspections Conducted by Qualified Personnel (327b3)

Personnel Properly Trained (327b3)

Reporting System to Ensure Prompt Correction of Unsafe Condition, including Wildlife Strikes (327c1)

12 CCM of Records of Inspection Showing Conditions Found and all Corrective Actions (327c1)

Record of Training for 24 CCM (327c2)

Comments

PEDESTRIANS AND GROUND VEHICLES

Limit Access Movement / Safety Area (329a)

Establish / Implement Procedures for Safe Operation on Movement / Safety Area. (329b)

Pedestrians and Vehicle Control with ATCT (329c)

Pedestrians and Vehicle Control - No ATCT (329b)

Pedestrians and Vehicle Operators Training on Airport Procedures & Consequences of Noncompliance. (329e)

Records of Training for 24 CCM (329f1)

12 CCM of Records for Accidents or Incidents Involving Pedestrians, Ground Vehicle, and or Aircraft. (329)

Comments

OBSTRUCTIONS

Objects within Airport Authority Determined to be an Obstruction Removed, Marked or Lighted. (331)

Comments

PROTECTION OF NAVAIDS

Prevent Construction that would Derogate NAVAIDs or at Facilities. (333a)

Protect NAVAIDs from Vandalism & Thief. (333b)

Prevent NAVAIDs Signal Interruptions. (333c)

Comments

PUBLIC PROTECTION

Prevent Inadvertent Entry to Movement Area by Unauthorized Person or Vehicles. (335a1)

Reasonable Protection from ACFT Blast (335a2)

Comments

WILDLIFE HAZARD MANAGEEEMENT

Immediate Measure Taken to Alleviate Wildlife Hazards When Detected. (337a)

Provide for a Wildlife Hazard Assessment when Required. (337b)

Wildlife Hazard Assessment Conducted by Qualified Personnel. (337c)

Wildlife Hazard Assessment Contents. (337e)

Wildlife Hazard Assessment Submitted to FAA. (337d)

Wildlife Hazard Management Plan Formulated and Implemented When Required by FAA. (337f6)

Plan Addressees Required Contents. (337f)

Procedures to Review and Evaluate the Plan every 12 CCM or as Required. (337f7)

Airport Personnel Training Program by a Qualified Wildlife Biologist. (337f7)

Comments

AIRPORT CONDITION REPORTING

Collection / Dissemination of Airport Condition. (339a)

Use of NOTAM / Other System. (339b)

Provide Information on Required Conditions. (339c)

12 CCM of Records of Each Dissemination. (339d)

Comments

IDENTIFYING MARKING AND LIGHTING CONSTRUCTION AND OTHER UNSERVICEABLE AREAS

Mark / Light Construction / Unserviceable Areas & Equipment. (341a1)

Pre-Construction Review of Utilities. (341e2)

Comments

NONCOMPLYING CONDITIONS

Limit ACR OPNS to Safe Area when Uncorrected Unsafe Conditions Exist. (343)

Comments

METHODS AND PROCEDURES FOR COMPLIANCE

Other

MISCELLANEOUS OBSERVATION(S)

Miscellaneous Observations

Miscellaneous Photos

FAR 139 POST-INSPECTION MEETING

List issues from inspections that needs to be addressed (explain mitigation and timeframe to correct these issue).

Comments

SIGNATURE OF OBSERVER & COMMENTS

Name of Observer

Observer's Comments

Date & Time FAR 139 Inspection Completed

Date of AIR-L, AIR-LF Review