Airworthiness Review & Extension Checklist Template

Use the information in this template to construct your ARC review control document

When completed, this form forms part of the aircraft records

Details of Organisation conducting the Full ARC or Review

Reference Number

Airworthiness Review & Extension

Operator or owner:

Registration:

Serial number:

Aircraft type:

Total time:

Total cycle:

Engine type:

Engine Serial Numbers:

#1
#2
#3
#4

Propeller type

Propeller Serial Numbers:

#1
#2
#3
#4

Flight Manual reference

AMP reference

Last weigh or CG calculation

Current ARC expires

Type of Airworthiness Review / Full Airworthiness Review / Extension / Extension since last
Airworthiness Review / Recommendation to Competent Authority / Transfer within EU
Import into an EU Member State

1st

2nd

Current ARC expires:

CAMO: Approval reference: Location:

Is the Physical Survey co-incident with a scheduled maintenance inspection?

If co-incident with a scheduled maintenance inspection, state type:

Is this AMO providing maintenance support during the Physical Survey?

Is this AMO assisting the ARC signatory in accordance with M.A. 710 (b)?

Is a Part 66 AME assisting with the Physical Survey

Provide Details of Name

Licence No

Records Review - Review conducted at: Between dates:

From Date

To Date

Completion of the Technical Log (including Hours and Cycles)

Technical log page or other document reference range

From TLP No

To TLP No

Findings Related to the Records Review

Review Applicable Airworthiness or other Mandatory Publications

EASA Bi-Weekly

EASA
Emergency

Conformity

Information

State of Design

(Bi-Weekly or other reference)

State of Registry

(Bi-Weekly or other reference)

Sample of the following:

Work pack reference Date AD No.

Accomplished as Required?

(Terminating Action/Repeat/NA)

Identify and Findings Related to Airworthiness or other Mandatory Directives

Details

Flight Manual (correlate during Physical Survey where applicable)

Does current Flight Manual reflect correct status (check also appendix)

Check Flight Manual respect to STCs and AD Compliance ?

Identify Findings Related to the Flight Manual

Details

Maintenance Check Review

Reference Dates accomplished Work pack or TLP

Details

From Date

To Date

Deferred maintenance details check control and transfer (technical log or next SMI)
Identify Next scheduled Maintenance Inspection

Date

Hours Due

Review CRS for correct completion and identification

Review any mandatory tasks ALS or CMR

Review EASA Form 1s (or equivalent – 8130-3 ) sampled and found satisfactory for
eligibility, correct wording and, where applicable, dual release?

Sampled component information correctly entered onto the component record system?

Work correctly certified and by approved staff in accordance with maintenance organisation
procedures?

Identify Findings Related to Maintenance Inspection and Work Packs

Changes and Repairs (including Service Bulletins) possible need to verify during Physical
Survey where applicable

Identify items sampled

Description of change or repairs Origin (SB, STC or repair approval)

Nature of approval (Agency or DOA)

Sample of the following related to change or repair:

Work pack reference

Date

Accomplished by

(Part 145 or Subpart F AMO)

Allowable damage is recorded as required?

Repeat inspections are programmed and accomplished?

FAA Form 8110 or 8100-9; Airbus RAS or other approval available for permanent
repairs?
Any effect on operational considerations such as RVSM, ETOPS or AWOPS?

Identify Findings Related to Changes and Repairs

Life-Limited Parts - possible need to verify during Physical Survey where applicable

Description Part number Serial number Location

Verify Sampled LLPs are listed in the Approved Maintenance Programme?

Verify component due forecast - Sampled LLPs are identified, recorded and have not
exceeded approved service life?

Is the most limiting factor identified? (HRS /CYC / LNDG)

Identify Findings Related to Changes and Repairs

Certificates of Release to Service

Type (Form 1 or equivalent; SMI or technical log CRS)

Document reference (SMI work order or technical log)

Identify Findings Related to Certificate of Release to Service

Type Certificate Data Sheets

Aircraft (Issue & revision)

Engine (Issue & revision)

Propeller (Issue & revision)

Identify Findings Related to Type Certificate Data Sheet

Mandatory Occurrence Reports

Were any mandatory occurrence reports relating to continuing airworthiness submitted in

the Airworthiness Review or Extension period?

If yes identify details

Details:

Identify Findings Related to Occurrence Reports

Additional Requirements if importing the aircraft into the EU - (For recommendations to
Competent Authority)

Exporting state:

Current registration:

Importing state:

Allocated registration:

When completing the checklist below, please add corresponding details and attach
supporting documents.

Has the operator applied to the EU Member State Competent Authority for
the necessary Certificate of Airworthiness and paid the required fee?

Do the aircraft, its engine, and propeller(s) have an EASA TC?

Has the exporting state’s regulator issued the aircraft with an Export C of A?

Comments:

Are back-to-birth records available? If not, by what method will the records
be reconciled?

Comments:

Are all changes (modifications) appropriately covered with an EASA STC?

Comments:

Are any additional changes required to comply with the EASA TC?

Details:

Is any maintenance required to comply with the maintenance programme?

Details:

Do the aircraft’s instruments and equipment comply with EU OPS 1.800 Subparts K & L?

Details:

Is the aircraft appropriately equipped where applicable for:

ETOPS?

LROPS?
RVSM?

MNPS?

RNAV?

AWOPS?

Details:

Identify Findings Related to Additional Requirements for Import into EU

Check Flights (Import only)

Specify schedule or check list to which aircraft was tested and attach a completed copy:

Details of any anomalies

Identify Findings Related to Check Flights

The review complements the scope of the physical survey described below. The ARC
signatory should add additional items to this checklist for the aircraft under review and
choose an appropriate number of samples to verify

Examples would be repair data with a repair or the disposition of components described in
the records to ensure no discrepancies exist. Any invasive activity such as opening panels
or operating any system must be co-ordinated with, and certified by, an appropriately
licensed and authorised aircraft maintenance engineer.

Aircraft Documents

Aircraft Document Folder contains required certificates e.g. C of A, C of R,

Noise Certificate, Radio Licence, Insurance Certificate,?

MEL is applicable and at latest revision?

Tech Log contains correct contents, SMI CRS, Notice to Crews (as applicable),
deferred defects correctly certified/deferred/cleared with MEL references
and limitations correct?

Pre-flight/Daily/other check sheets carried in technical log are at latest revision?

Dent and Damage Log correctly completed and cross-refers to data assessed
during record review?
Aircraft Physical Inspection

Flight Deck

Safety Equipment in date, correctly stowed

Required placards in place & legible

Compass Correction Cards available and in date

Flight Deck seats and harnesses in satisfactory condition

Ships tech library available and discs in date.

Cabin Inspection

Safety Equipment in date and correctly stowed iaw Config Drawing

Required placards in place and legible

Maximum weight instructions in galley and overhead stowage’s

Galley stowage retainers correctly operate and secure

Seating configuration iaw Config Drawing and complies with national

requirements (i.e. CAP 747 GR 2)

Placards at all exits provide correct instructions for opening

Pax seats at exits are correct with respect to recline/break back, table and
stowage locks serviceable, no smoking placards and sealed waste containers

External Inspection

Required markings and placards are properly installed and legible?

Review ATA Chapter 11 or equivalent and, where applicable, the AFM, STCs
or ADs to ensure compliance.

No obvious damage/lightning strikes, missing fasteners or leaks

Any repairs/dents/buckles have been correctly assessed and documented in

dent and buckle log.

Where a repair has been sampled during the records review, check that
repairs accomplished iaw the SRM or other instructions approved through
Part 21?

Cargo bay floor and linings satisfactory with regard to integrity and unrepaired
damage
LLPs sampled by part number and serial number for correlation with documents viewed
during document review

State Additional items here based on records review

Identify Findings Related to Check Flights

Extension Extensions

Has the aircraft remained in a Controlled Environment over the last 12 months?

If “No,” a full Airworthiness Review is required and a recommendation submitted to the

Competent Authority.

The last Extension was accomplished on:

1st Extension

2nd Extension

Continuing Airworthiness (12 months)

Has the aircraft and its components been maintained by a Part 145
AMO?

Have all changes incorporated complied with Part 21 as approved by a

DOA or the Agency?

Has the aircraft operated outside the limits stipulated in the Flight Manual, Certificate of
Airworthiness or other limit imposed by the Agency?

Comments:

Has the aircraft been involved in an accident or incident?

Comment:

Complete the Verification Statement to be submitted to the Competent Authority

Complete all relevant blocks of this form but do not submit to the Competent
Authority unless indicated

Attach a copy of the Certificate of Registration to be submitted to the Competent Authority

Attach a copy of the application for an ARC to be submitted to the Competent Authority
Ensure that all findings do not affect safety, have been rectified or deferred, or
reported to the Competent Authority (Findings that indicate systemic problems
having no direct effect on safety should be raised as Corrective Actions)

Include the following as required to be submitted to the Competent Authority:

A copy of the Export C of A

Documents signifying approval of the Flight Manual and supplements

An AD compliance list

A list of life-limited components

A copy of the proposed maintenance programme

The latest weight and balance schedule for the aircraft in its current configuration

Reference to Part 21 approvals for changes and repairs

A copy of work packages relating to maintenance and other work required by

the operator and Agency

A copy of the check flight report

Confirmation of Issue, Extension or Recommendation for the Issue of an ARC

Aircraft registration:

Manufacturer’s serial number:

Has been subject to:

Extension / Airworthiness Review / Airworthiness Review for Import

This Aircraft: Complies / Does Not Comply with Part M

If the Extension or Airworthiness Review (including that required for an Import into the EU)
is inconclusive, advise the Competent Authority Immediately

Recommendation for the issue of an Airworthiness Review Certificate

Record review period between: and

Physical survey period between: and

This certifies that the aircraft has been subject to a record review and physical survey on
dates indicated above and complies with the applicable aspects of Part M. On this basis, it
is recommended that this aircraft is issued with an Airworthiness Review Certificate in
accordance with M.A. 901