DRAFT - CDRL A006 - Safety Mishap Report-RPA
84 KB Posted
- Attached to
- Remotely Piloted Aircraft (RPA) Federal contract opportunity
- Solicitation number
- FA4890-10-R-0009
About this file
Draft CDRL A006 Safety Mishap Report
Text of this file
Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA. 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for Contract/PR No. listed in Block E.
| A. CONTRACT LINE ITEM NO. |
| B. EXHIBIT |
| C. CATEGORY: |
TDP TM OTHER X
| D. SYSTEM/ITEM |
| E. CONTRACT/PR NO. |
| F. CONTRACTOR |
RPV
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
| A006 |
| Accident/Incident Report |
| Safety Mishap Report |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
| DI-SAFT-81563 |
| PWS Para 4.3.5 |
| HQ ACC AMIC/PCE |
| 7. DD 250 REQ |
| 9.DIST STATEMENT REQUIRED |
| 10. FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
LT
| BLOCK 16 |
| BLOCK 16 |
b. COPIES
| 8. APP CODE |
| B |
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT |
SUBMISSION
a. ADDRESSEE
Draft Final
A
| BLOCK 16 |
| BLOCK 16 |
Reg
Repro
| 16. REMARKS: |
| HQ ACC AMIC/CO |
(4) Electronic format shall be compatible with Microsoft Office and will be delivered via the ACC AMIC LAN electronic mail system.
(5) Submit mishap/event information IAW AFI 91-204, Chapter 5 with follow-up information IAW Chapter 6 of this publication. Report shall be submitted using the attached “CDRL A006 ACC Form 164 Ground Mishap Report”
(9) Distribution authorized to U.S. Government agencies only (administrative or operational data, 23 May 07). Other requests for this document shall be referred to HQ ACC AMIC/PKC.
(10), (11), (12), (13) Report shall be submitted NLT COB next business day and updates shall be provided as an addendum to the CDRL.
(15) Repro is electronic mail.
(16) Report should be sent via NIPRNET.
HQ ACC AMIC/PCE
HQ ACC AMIC/PMA
Host Base Safety Office
15. TOTAL
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
image1.emf
ACC Form 164 Ground Mishap Report.xfdl image2.wmf
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