Atch_13_-_166A.pdf

1. NAME OF CARRIER/CONTRACT NUMBER 2B. DATE 3. TYPE AIRCRAFT AND TAIL NUMBER

4A. GACL (PAX & LBS) (IAW CONTRACT) 5. ROUTING

SAT UNSAT N/A SAT UNSAT N/A

b. Contractor Rep. available within required times (PWS 1.3.11)

(2) MAJOR:

a. Provide seats/service/meals for Govt. sponsored pax (PWS 1.3.16)

b. Cargo compartment usable/no obstructions (PWS 1.3.2)

e. Baggage containers (PWS 1.1.3.1) c. Provide aircraft lighting (PWS 1.3.15)

f. Baggage compartment restraints (PWS 1.1.3.2 & 1.4.2) (3) MINOR:

g. Meals to ALL pax from PHC approved source (PWS 1.1.4.5, 1.3.16) a. Provide tie‐down fittings and devices (PWS 1.3.9.1)

h. Baggage off‐load times (PWS 1.2.6)

i. Seat maps (PWS 1.1.2.1) 11. GENERAL OPERATIONS

(1) CRITICAL:

a. Failure to obtain approval for extended parking (PWS 5.10)

(2) MAJOR:

a. All aircraft systems fully operational (PWS 1.0)

b. Safety (PWS 1.0; reference applicable AFI/Base Reg, etc.)

c. Safety barriers (PWS 4.7)

(3) NON‐SDS

d. Hot Towels (PWS 1.1.3.4)

e. Food service: other than catering for all pax (PWS 1.1.3 & 1.1.4)

f. Inoperative lavatories; passenger‐lavatory ratio (PWS 1.0)

a. Contractor Rep. available within required times (PWS 1.1.1.)

b. Passenger care during delays and diversions (PWS 1.1.5 & 1.1.6)

c. Pets (PWS 1.2.2)

(2) MAJOR:

a. Passenger services (PWS 1.1)

g. ACFT passenger systems functional (e.g. lights, seats) (PWS 1.1.3)

(3) MINOR, Continued:

h. Overhead Compartments (PWS 1.1.2.2)

i. Approved seat covers (PWS 1.1.2.2)

10. CARGO DISCREPANCIES

(1) CRITICAL:

a. Provide signature service (PWS 1.3.13)

(3) MINOR:

a. Pillows and blankets for all passengers (PWS 1.1.3.3)

b. In‐flight entertainment (PWS 1.1.3.5)

c. In‐flight passenger service (PWS 1.1.3)

b. Sanitation (1.1 &1.1.3)

c. Clean pillows & blankets at origin/turnaround stops (PWS 1.1.3.3)

d. Seat blocking (PWS 1.1.2.2)

12. WERE ANY CONTRACT VIOLATIONS ISSUED? NO YES (IF YES ATTACH COPY OF QASP‐FORM 166B)

13. ADDITIONAL COMMENTS OR OBSERVATIONS

14. EVALUATED BY (Name/Organization) 15. SIGNATURE

PRE‐FLIGHT SURVEILLANCE ACTIVITY CHECKLIST (FOR USE BY QUALITY ASSURANCE PERSONNEL)

QASP‐Form 166A 11 FEB 2015

I. IDENTIFICATION DATA

II. CHECKLIST ITEMS

9. PASSENGER DISCREPANCIES

2A. MISSION NUMBER

(1) CRITICAL:

6. INSPECTED AT

7A. TIME POSITIONED (ZULU) Scheduled/Actual 7B. DEPARTURE TIME (ZULU) Scheduled/Actual

8A. NAME OF CARRIER REPRESENTATIVE 8B. NAMES AND TITLES OF GOVERNMENT PERSONNEL

4B. ACFT CAPE (PAX & LBS)