Safety Survey

Unit Surveyed: __________________________________

Date: ________________________________

Persons Contacted: ____________________________________________________________________

OVERALL RATING: ____________________________________________________________________

Instructions: The survey officials should place their initials in the column which shows the rating for each item. Normally if an item is rated NO (unsatisfactory), an explanation or comment should be made at the end of the report using the same identification of paragraphs and titles as the original item rated. The survey official should sign one copy and leave it with the unit commander after having discussed it with unit commander, if appropriate. If the survey was conducted by a wing staff representative, the unit commander should acknowledge the receipt of the survey and indicate in writing any necessary corrective action taken. A reference copy may be retained by the surveying activity. The rater should add any comments which will provide a clear and concise picture of the situation at the time of the survey.

Identification of Columns: Yes (satisfactory), No (unsatisfactory)

COMMAND SECTION	Yes	No
1. Is the commander advised by key staff officers and the unit safety officer of deficiencies which are creating accident potentials in areas of personnel, logistics, and operations?	____	____
2. Is the commander's follow-up action to correct accident potentials effective?	____	____
3. Does the commander actively support the unit safety program?	____	____
4. Does the commander personally establish policies to emphasize safety?	____	____
5. Is an effective training program established to indoctrinate all personnel on the importance of safety?	____	____
6. Do commanders assure themselves that there is expeditious and effective coordination between key staff and operating agencies in matters pertaining to safety?	____	____
7. Do commanders require periodic safety surveys in their command?	____	____
8. Has the commander published a supplement to CAPR 62-1 or other document on safety?	____	____

OPERATIONS AND TRAINING		Yes	No
1. Check the following items by reviewing records and directives:
	a. Are procedures in effect to insure that pilots are aware of latest safety-of-flight information?	____	____
	b. Do checkout questionnaires require pilots to demonstrate a thorough knowledge of aircraft systems and operating procedures?	____	____
	c. Does the unit maintain a current Pilot Information File in accordance with CAPR 60-1?	____	____
	d. Are checkout requirements for each airplane specified in Writing with regard to hours, missions, and maneuvers required? (Day? Night?)	____	____
	e. Are pilots encouraged to report hazards to flight and near accidents?	____	____
	f. Are Go/No Go, Wind/Cross-wind values established for takeoffs and landings?	____	____
	g. Are crosswind landing restrictions posted in the aircraft?	____	____
	h. Are CAP-conducted checkouts, rechecks, proficiency, standardization, instrument, instructor pilot checks, etc., adequate in accordance with CAPR 60-1?	____	____
	i. Are completed checks reviewed by a responsible supervisor before finally approved and filed?	____	____
	j. Is a system established to ensure that pilots do not fly unless they have met the minimum CAPR 60-1 requirements?	____	____
	k. Is a system established to ensure that the aircraft is not released for flight unless it is airworthy?	____	____
	l. Do all pilots review the PIF before each flight?	____	____
	m. Do all taildragger aircraft have shoulder harness installed?	____	____
	n. Is security of aircraft adequate enough to prevent unauthorized flights?	____	____
	o. Are unprepared taxiways clear of any holes or depressions?	____	____
2. Check these items by actually examining the aircraft and observing operations of aircraft if possible:
	a. Do crews properly plan their flights?	____	____
	b. Are passengers properly briefed?	____	____
	c. Are flight plans filed for all flights outside of local area?	____	____
	d. Are aircraft thoroughly inspected prior to each flight?	____	____
	e. Are current checklists used?	____	____
	f. Are periodic no-notice spot checks administered to the pilots?	____	____
	g. Are standard hand signals used in directing aircraft?	____	____
	h. When aircraft are parked, are main gear wheels chocked for and aft?	____	____
	i. Are aircraft tied down after each day's flight?	____	____
	j. Are aircraft properly grounded before refueling?	____	____
	k. Are fuel tank sumps drained before flight?	____	____
	l. Are pilots wearing their shoulder harness if installed in the aircraft?	____	____

ACCIDENT PREVENTION		Yes	No
1. Are aircraft and vehicles thoroughly inspected prior to operation?		____	____
2. Does the safety officer:
	a. Supervise the accident investigating and reporting system. to assure complete, accurate, and prompt reporting?	____	____
	b. Monitor training programs, briefings, and critiques for safety considerations?	____	____
	c. Receive command support?	____	____
	d. Perform duties not related to safety?	____	____
	e. Assure compliance with all accident prevention policies?	____	____
	f. Cooperate with and exchange ideas with other safety officers and agencies?	____	____
	g. Maintain a reference file on safety and associated publications?	____	____
3. Are safety publications receiving proper distribution?		____	____
4. Are bulletin boards conspicuous, neat, and up-to-date?		____	____
5. Are records maintained on all accidents? Are safety hazards reports on file?		____	____
6. Is corrective action accomplished on all recommendations submitted by the activity as a result of accidents and safety hazard reports?		____	____
7. Are adequate fire fighting facilities available? (If not, have personnel been trained in first aid and crash fire procedures?)		____	____
8. Are sufficient fire extinguishers readily available for emergency use?		____	____
9. Are monthly safety briefings held and documented? Documentation should include all personnel who attended.		____	____

MAINTENANCE	Yes	No
1. Are all aircraft equipped with a maintenance form for writeups after each flight?	____	____
2. Are aircraft being flown with excessive number of delayed discrepancies to the extent that safety may be compromised?	____	____
3. Are cockpits and/or flight decks regularly cleaned and kept free of foreign objects?	____	____
4. Is the maintenance officer taking an active part in the accident prevention program for pilots?	____	____
5. Does aircraft cannibalization have an adverse effect on safety of flight?	____	____
6. Is overall maintenance adequate and thorough enough to be an effective agent for vehicle/aircraft accident prevention?	____	____
7. Are 100-hour, annual, transponder, ELT, Altimeter / Static System inspections being accomplished as appropriate and logged in aircraft logs?	____	____
8. Are CAP vehicles equipped with seat belts?	____	____
9. Is there an adequate system for insuring pilots do not fly the aircraft if it is grounded for maintenance?	____	____

FACILITIES	Yes	No
1 . Are proper lifting rules observed when handling large/bulky materials to avoid muscle strain?	____	____
2. Is electrical equipment properly guarded to prevent possibilities of shock and fire?	____	____
3. Are cords or wires strung across floors?	____	____
4. Are steps equipped with non-slip treads or painted with non-slip material?	____	____
5. Are stairways well lighted?	____	____
6. Are fire extinguishers available and do they have a current inspection?	____	____
7. Are flammables stored in office areas, that is, paint, thinner, cleaning solvent?	____	____
8. Are aisles or passageways kept clear?	____	____
9. Are sidewalks /pathways free from hazards such as snow, ice, rocks, tripping hazards, etc.?	____	____
10. Are electrical outlets overloaded by multiple plugs?	____	____

EXPLANATIONS AND/OR COMMENTS:

_____________________________________________

SIGNATURE AND TITLE OF SURVEY OFFICIAL

_____________________________________________

SIGNATURE OF UNIT COMMANDER

(Reprinted from CAPR 62-1(E), Attachment 4, dated 1 March 1991)

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