C of A Renewal Status Report - Jamaica Civil Aviation Authority

Jamaica Civil Aviation AuthorityFlight Safety Division4 Winchester Road - Kingston 10 – JamaicaAircraft Status Report(C of A Renewals only)Note: Use back of form if additional space required.Aircraft Type: MSN: Registration:ManualsManual Reference No. Rev No. Date (d-m-y)Maintenance ScheduleFlight ManualMELScheduled Inspections accomplished in past 12 monthsInspection TypeA/CHours1) 5)2) 6)3) 7)4) 8)Date (d-m-y) Inspection A/CHoursDate (d-m-y)Significant Repairs, Replacements and Modifications accomplished in past 12 monthsDescriptionA/CHoursDate (d-m-y)Airframe/Engine/Prop - AD’s (or equivalent mandatory notices) accomplished in past 12 monthsNumber Description A/CHoursDate (d-m-y)FSAW 0011 (Jun/02)1

Engine(s)ManufacturerModel/Part #Serial #Rec. TBOTSNTSO1 2 3 4Propeller(s)ManufacturerModel/Part #Serial #Rec. TBOTSNTSO1 2 3 4Documents (on board)YesOriginal C of R................................................................................Original C of A................................................................................Flight Manual ..................................................................................Operations Manual (AOC holders)......................................................Technical Log .................................................................................Minimum Equipment list..................................................................Current Weight and Balance Schedule .............................................Radio Licence .................................................................................Compass Correction Card................................................................Certificate of Insurance....................................................................Certificate of Maintenance Review ..................................................Safety Equipment and Placards (installed)YesFirst Aid Kit(s) / locations ...............................................................Life Jackets / locations ....................................................................Fire Extinguisher(s) / locations ........................................................Required placards............................................................................Passenger Briefing cards..................................................................NoNoFSAW 0011 (Jun/02)2

Maintenance Certification(complete one only)If AMO used (Commercial & Private Aircraft)I hereby certify that such inspections and other work necessary to ensure the continuedairworthiness of this aircraft have been carried out, recorded, certified, the aircraftconforms to its Type Certificate Data Sheet No. ________________ and the aircraft isserviceable and considered satisfactory for the renewal of the Certificate of Airworthiness._______________________________AMO Name / No. (print)_______________________________Signature__________________________AMO Authorized Inspector / No. (print)______________Date (d-m-y)If AME used (Private Aircraft only)I hereby certify that such inspections and other work necessary to ensure the continuedairworthiness of this aircraft have been carried out, recorded, certified, the aircraftconforms to its Type Certificate Data Sheet No. _____________ and that the aircraft isserviceable and considered satisfactory for the renewal of the Certificate of Airworthiness.__________________________ ________________________ _________AME Name & Licence No. (print) Signature Date (d-m-y)Notes: All required aircraft documents and manuals must be made available forassessment at the time of the JCAA aircraft survey.The aircraft should be under cover and should have sufficient cowlings andpanels removed / open to facilitate the survey.Comments (JCAA use only):____________________________________Inspector’s Signature / No._______________Date (d-m-y)FSAW 0011 (Jun/02)3