Atch_13_-_Form_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

a. Signature service from origin to destination (PWS 1.3.13 & 1.3.13.1)

a. Seats & service for Gov sponsor personnel(PWS 1.3.16 & 1.3.16.1)

(1) CRITICAL:

a. Failure to obtain approval for extended parking (PWS 5.10 to 5.10.2)

(2) MAJOR:

a. Provide tie‐down fittings and devices (PWS 1.3.9.1)

11. GENERAL OPERATIONS

b. Cargo compartment serviceable w/no obstruction (PWS 1.3.2 &1.3.9)

c. Provide Aircraft Lighting (PWS 1.3.15)

(3) MINOR:

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

b. Passenger care during delays and diversions (PWS 1.1.5 ‐ 1.1.6.2)

c. Pets (PWS 1.2.2, 1.2.2.1. & 1.2.2.2.)

(2) MAJOR:

a. Passenger Services (PWS 1.1)

e. Baggage compartment restraints (PWS 1.1.3.2 & 1.4.2)

f. Food service: meals to ALL passengers (PWS 1.1.4 ‐ 1.1.4.5)

g. Baggage off‐load times (PWS 1.2.6 ‐ 1.2.6.3)

h. Seat maps (PWS 1.1.2.1)

(3) MINOR:

10. CARGO DISCREPANCIES

(1) CRITICAL:

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

(2) MAJOR:

b. Sanitation (1.1 & 1.1.3)

c. Seat blocking (PWS 1.1.2.2)

d. Baggage containers (PWS 1.1.3.1)

QUALITY ASSURANCE INSPECTION FORM

QASP‐Form 166A 8 APR 2015

I. IDENTIFICATION DATA

II. CHECKLIST ITEMS

9. PASSENGER DISCREPANCIES

2A. MISSION NUMBER

(1) CRITICAL:

6. INSPECTION LOCATION

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)

(2) MAJOR:

a. All aircraft systems fully operational (PWS 1)

b. Safety (PWS 1; reference applicable AFI/Base Reg, etc.)

c.

a.

b.

(3) NON‐SDS (list as needed)

e. Pillows and Blankets (PWS 1.1.3.3)

f. Hot Towels (PWS 1.1.3.4)

g. In‐Flight entertainment system(PWS 1.1.3.5)

(3) MINOR:

h. Approved crew rest seat covers (PWS 1.1.2.2)

a. In‐flight passenger services (PWS 1.1.3)

b. Food service: other than catering all pax (PWS 1.1.4. ‐ 1.1.4.4)

c. Settlement of claims (PWS 1.2.1 ‐ 1.2.1.2)

d. Overhead Bin Blocking (PWS 1.1.2.2) d.

12. WERE ANY CONTRACT VIOLATIONS ISSUED? NO YES (IF YES ATTACH COPY OF VIOLATION FORM)

13. ADDITIONAL COMMENTS OR OBSERVATIONS

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

HT711-16-R-C001

Attachment 13

DRAFT