Appendix 2 APPENDIX 2. SAMPLE WRITTEN REPORT FORMAT TO BE FOLLOWED BY
REGULATED ENTITIES NOT AUTHORIZED USE OF THE WEB-BASED VDRP The following sample is only a suggested format to be followed when preparing the written report that will be submitted to the Federal Aviation Administration (FAA). While a certificate holder, qualified fractional ownership program (as defined in paragraph 5e of this AC), or Production Approval Holder (PAH) should include at least all the elements specified below, the structure of the written report can be modified by the regulated entity to fit its particular needs.
1. GENERAL.
a. Date.
b. Certificate type or equivalent.
c. Pertinent regulated entity number or equivalent.
d. Company name.
e. Company address.
f. Company official filing report.
(1) Name.
(2) Position.
(3) Telephone number.
(4) E-mail address.
2. DESCRIPTION OF APPARENT VIOLATION.
a. Applicable part of Title 14 of the Code of Federal Regulations.
b. Date apparent violation was discovered.
c. Location of discovery.
d. Company official who discovered the apparent violation.
(1) Name.
(2) Position.
(3) Telephone number.
(4) E-mail address.
e. Date and time of initial notification to the FAA.
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f. Name of FAA official notified (principal inspector (PI)).
g. Company official responsible for immediate action.
(1) Name.
(2) Position.
(3) Telephone number.
(4) E-mail address.
h. Duration of time apparent violation remained undetected—hours, cycles, or days.
3. SUMMARY OF APP ARENT VI OLATION. The summ ary should be a brief statem ent that describes the nature of the apparent violation and identifies the specific aircraft, engines, appliances, facilities, checkpoint, gate, cargo, and/or individuals associated with the apparent violation.
4. IMMEDIATE ACTION.
a. When immediate action was taken.
b. Description of immediate action. This description should outline the immediate steps that were taken to cease the violative action.
c. Company official responsible for immediate action.
(1) Name.
(2) Position.
(3) Telephone number.
(4) E-mail address.
5. ANALYSIS.
a. Summary of evidence. This summary should describe the scope of the apparent violation and explain how it was detected. In addition, conclusions reached regarding possible or probable systemic deficiencies (i.e., who, what, when, why, and how the noncompliance occurred) should be described.
b. Reasons why the apparent violation was inadvertent.
c. Supporting documentation. The evidence associated with the apparent violation should be attached. This evidence should include a statement regarding how the certificate holder, qualified fractional ownership program, or PAH determined the extent of the apparent violation.
6. COMPREHENSIVE FIX PROPOSAL. The proposed long-term corrective steps to be taken by the certificate holder, qualified fractional ownership program, or PAH to preclude Page 2
Appendix 2 recurrence of the apparent violation should be listed in this section. Each corrective step should identify the individual or department responsible for implementing and completing the corrective step as well as the time allotted for completion of each corrective step. Examples of types of questions or issues that a comprehensive fix proposal should address are as follows:
a. Whether the apparent violation involves equipment, facilities, or individuals beyond those addressed in the initial notification and for which immediate action was taken.
b. Whether procedural or organizational changes are necessary.
c. How it will be determined whether any procedural or organizational changes are effective.
d. What procedures will be developed to ensure that the affected area is periodically reviewed in the future so that concerns can be identified before a violation occurs.
e. Who will be responsible for performing periodic reviews.
f. To whom in the certificate holder’s, qualified fractional ownership program’s, or PAH’s organization the results of those periodic reviews will be reported, and how they will be documented?
7. RESPONSIBILITY FOR MONITORING THE IMPLEMENTATION OF THE COMPREHENSIVE FIX.
a. Name.
b. Position.
c. Telephone number.
d. E-mail address.
8. FAA ACCEPTANCE (TO BE COMPLETED BY THE FAA).
a. Name.
b. Position (PI).
c. Date.
d. Office.
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