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Defect Report

CASA Use only

SDR No.

Receipt No.

Aircraft Registration

VH –

Date of Occurrence

/ /

Operator Name

Enter engine and propeller details only if relevant						( tick box)
	Manufacturer	Model	Serial No.	TSN	TSLMC
AIRCRAFT						HRS
AIRCRAFT						CYCS
						CYCS


ENGINE					TSO/	HRS
ENGINE					TSLSV	CYCS
					TSLSV	CYCS


PROPELLER					TSO	HRS
PROPELLER						CYCS

AERONAUTICAL PRODUCT (COMPONENT) (Assembly that contains defective part)

Name

Manufacturer

Model

Serial No.

PART (Specific item that was defective)

Part Name

Part Number

Part Condition

Location on Aircraft

TSN

HRS

CYCS

MTHS

LNDS

TSO

HRS

CYCS

MTHS

LNDS

Available for Inspection?

YES

ATA Code

When was the defect found?

Take off

Climb

Cruise

Descent

Landing

Accident

Other

Sched. Maint. AD/SB

Compliance Status

	PRE		POST

Opinion as to the cause of the defect

Design

Manufacture

Fatigue

Corrosion

Inadequate Maint. Human Factors Susp. Unapp/part Operational

Other

Opinion of criticality ( tick appropriate box)

High

Medium

Low

Description (If relevant, include circumstances under which it occurred, indications or warnings, hidden consequences, probable cause, action taken to rectify the defect and recommendations to prevent recurrence.)

.................................................................................................................................................................................................................................................

Investigation results

…/2 (investigation Results (Contd.) and Submitter Details

Form 404 03/2006

Major Defect Reporting - Defect Report

Page 1 of 3

Investigation results (Contd.)

SUBMITTER’S DETAILS

Name	Organisation

Address ...........................................................................................................................................

...........................................................................................................................................................

....................................................................................................... Postcode ..............................

Defect Report Type

Telephone	Date
	/	/
Email Address

...............................................................................

Submitter ARN

Notification of defect with complete	Initial defect notification only	Follow-up report from earlier
investigation results	(follow-up report required)	defect notification

Submitter Reference Number

CASA is collecting the information on this form to facilitate corrective actions to the reported defects. This is authorised by regulations made under the Civil Aviation Act 1988. CASA usually gives some or all of this information to the relevant manufacturers and airworthiness agencies.

Please send material relating to this application by email:

Yes No

I am aware of, and accept, the risk that information sent via email may be intercepted and read during transmission, not delivered or modified. (If you do not accept the risk, material will be sent by post.)

For information on CASA's Privacy Policy, please visit http://www.casa.gov.au/tools/privacy/index.htm

The Federal Government TimeSaver initiative aims to assess the time taken to complete Government forms.	Hrs	Mins

Please indicate the approximate time taken to complete this form.

Page 2 of 3

Major Defect Reporting - Defect Report

Form 404 03/2006

General Information

This form is to be used by persons reporting aircraft defects, as required by the Civil Aviation Regulations. Helpful Instructions below contains instructions for completing the form. Enquiries regarding the form may be directed to any CASA Field Office.

Helpful Instructions

Date of occurrence

Enter the date the defect occurred or was discovered.

Major equipment

Enter the applicable manufacturer’s name, model and serial number. Time requirements are TSN (Time Since New), TSO (Time Since Overhaul), TSLMC (Time Since Last Maintenance Check) and TSLSV (Time Since Last Shop Visit). Tick the appropriate box for time units.

Component

Enter the name, manufacturer, model or part number and serial number of the assembly containing the defective part. For example, for a defective bearing, enter the name of the component using the bearing, such as magneto. For a defective exhaust valve, enter the cylinder identity etc.

Part

Enter the name (e.g. bearing, spar), part number (e.g. 233453-4), condition (e.g. seized, cracked) and location on aircraft/component or the Illustrated Parts Catalogue (IPC) reference (e.g. rear gearbox, LH wing or IPC page 97, ref 6-36).

Time requirements are TSN and TSO. Tick the appropriate box for time units – HRS (Hours), CYCS (Cycles), LNDS (Landings) and MTHS (Months).

Tick the appropriate box if the defective part is available for inspection and/or destructive testing by the Authority.

When was the defect found?

Tick the box for the stage of operation the aircraft was engaged in when the defect occurred or was found. This includes defects found after an accident, during maintenance or during compliance with an Airworthiness Directive. Tick the Other box if the stage of operation is unlisted and enter the operation – for example, preflight check.

If there exists any Airworthiness instructions or control procedures related to the defect – for example, Airworthiness Directive, Service Bulletin, modification etc – enter the document reference and tick the appropriate

Compliance Status box.

Opinion as to the cause of the defect

Tick the box or boxes that best describe the reason for the failure. It is appreciated that it is likely the defect will have multiple reasons ultimately leading to the malfunction or failure. Seek to be as objective as possible in determining the cause:

∙Design – is the design of the product meeting its intended function or is it being asked to do something outside the design scope?

∙Manufacture – has the product been appropriately manufactured and properly finished — for example, no stress raisers?

∙Fatigue – does the defect display classic fatigue symptoms and what actions may have caused the problem to develop?

∙Corrosion – corrosion, environment and age are closely related, particularly in older aircraft. These aircraft are often thought of as only the heavy transport aircraft. This is not the case and due consideration needs to be given with respect to an aircraft.

∙Inadequate maintenance – is directed at poor maintenance practices arising from lack of data, incorrect procedures, inadequate quality control, lack of appropriate training etc.

∙Human factors – those defects that occur as the result of personnel error and also relate to maintenance – for example, failure to follow the correct instructions, use of inappropriate equipment/tools, use of the incorrect fuel or lubricants.

∙Suspected unapproved parts – this can also be related to personnel and maintenance defects, particularly with counterfeit parts. With older aircraft and the lack of approved spares, counterfeit parts are an increasing problem. The identification of counterfeit parts is of paramount importance.

∙Operational – are related to those defects which occur as the result of incorrect, inadvertent or uncommanded operation.

Defect description and investigation result

Describe the defect, the circumstances under which it occurred, any indications or warnings and non-obvious effects on aircraft or other systems. State probable cause, action taken to rectify defect and recommendations to prevent recurrence.

State the results of any investigation undertaken.

Indicate if other relevant information – for example, photographs, reports or sketches – is available.

Include other relevant information such as photographs, reports or sketches, if available.

Submitter’s details

Enter submitter details and tick a Defect Report Type box.

∙Notification of defect with complete investigation results – no further submissions are anticipated.

∙Initial defect notification only – report that does not contain all of the required information or investigation results. A follow-up report is required to be submitted.

∙Follow-up report from earlier defect notification – a report of investigation results or additional information following from an initial defect notification only.

Acknowledgement of your Defect Report will be forwarded to the email address you have provided.

How to Submit this Form

Mail, fax or delivery

Mail the completed form to:

Civil Aviation Safety Authority Defect Report

Reply Paid 2005 Canberra ACT 2601

Alternatively fax the completed form to 02 6217 1920.

You may also deliver the completed form to any CASA Field Office.

Urgent reports

Urgent reports may initially be submitted to CASA Service Difficulty Reporting Unit by telephone on 131 757 from anywhere in Australia for the cost of a local call. Ask for the SDR unit.

Alternatively, you may submit the urgent report by e-mail to:

sdr@casa.gov.au

If you use either of these methods, a completed Defect Report Form must follow by mail or fax.

Using the Internet form

The Internet form is available on CASA’s home page at:

http://www.casa.gov.au

Form 404 03/2006

Major Defect Reporting - Defect Report

Page 3 of 3

Question	Answer
Form Name	Form 404 Australia
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	CYCS, TSLMC, IPC, LNDS

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