MINISTRY OF TRANSPORTATION

DIRECTORATE GENERAL OF CIVIL AVIATION

Office Complex Soekarno-Hatta International Airport, C3 St., Tangerang, Banten- Indonesia
Telp.: (+6221) 225 66288, (+6221) 256 08887 Fax. : (+6221) 225 66399
Website : hubud.dephub.go.id; e-mail: daao_dgca@dephub.go.id

PART 91/141 INSPECTION CHECKLIST

Company Name Date of Inspection:
Certificate Number

AIRWORTHINESS SURVEILLANCE
Reference : - CASR 91; CASR 141.417

NO SUBJECT SAT UNSAT N/A

A. Maintenance Facilities
1 All technical manuals are current and available.
2 Facilities and equipment are adequate.
3 Personnel are trained and licensed.
4 Test equipment and special tools are controlled and calibrated.
5 Adequate support equipment for aircraft operated.
Spare parts and material are adequate, properly stored,
6
segregated and tagged.
B. Personnel-Qualification / Supervision
Is each person performing aircraft maintenance authorized to
1
perform that function?
2 Is each person authorizing return to service qualified to do so?
C. Maintenance Program/ Inspection Items
Is the Maintenance /Inspect ion Aircraft Program evaluated and
1
approved by the DGCA?
Is Each aircraft necessary for that training inspected and
2
maintained by appropriate personnel and facility?
Are the aircraft used by the pilot school has received an
3
inspection for the issuance of an airworthiness certificate?
Are the aircraft manufacturer recommendation being
accomplished as related the following:
4
• Lubrication requirements 100 hours;
• Retractable landing gear rigging;
Are the following system and equipment as applicable properly
5
maintained?
VOR; Altimeter; Altitude Reporting; ATC Transponder;
6
Emergency Locater Transmitter
D. Record Systems
1 Records of the total time in service of the airframe.
Records of life-limited parts of each airframe, engine, propellers,
2
rotor, and appliance.
A record of last overhaul of all equipment and current inspection
3
status.
Identification of current inspection status of the aircraft and next
4
inspection included its appliance
5 A record of current alteration/ASB compliance.

DGCA Form No. 91-11 (Jun 2019) Page 1 of 3

 NO SUBJECT SAT UNSAT N/A
E. Airworthiness Directive Compliance
The operator operates al l aircraft, engines, propellers, or
1
appliances in accordance with all applicable AD's.
The operator keeps AD records to include current status of
2
applicable AD's and method of compliance.
3 AD compliance is verified by aircraft inspection.
F. Inspection Program
The operator inspection program is based on current
1
manufacturer's manuals.
The operator inspection program includes all mandatory
2
requirements.
The operator has competent personnel and adequate facilities and
3
equipment to perform maintenance.
The operator ensures that each aircraft released to service is
4
airworthy.
G. Aircraft Weight and Balance
Aircraft empty weight and e.g. position are calculated in
1 accordance with manufacturer's manuals or maintenance
inspection program manual.
2 Calibrated scales are used for aircraft weighing.
Weight intervals are based on manufacturer's manuals or
3
inspection program and within limitation.
H. Fueling and Servicing
Fueling operations are conducted in accordance with
1
manufacturer manuals or inspection program manual.
Competent personnel, facilities and equipment are available
2 along the operator's routes for the proper maintenance and
servicing of aircraft
3 Does the operator have STC to use automotive fuel?
4 Is the storage of automotive fuel adequate?
5 Are the aircraft fuel tanks marked with type and grade of fuel?
6 Is the required emergency equipment in each aircraft?
Records of receiving inspection are adequate included water
7
contamination check
8 Safety precautions during refueling are adequate.
I. Spot Inspection of Aircraft During Maintenance
Operator is following inspection program manual Procedures
1
during all maintenance work.
Does the quality of inspection or discrepancy reports meet
2
acceptable standards?
The quality of inspections or discrepancy reports are
3
acceptable
4 Inspection program are adequately followed.
Operator is using the proper tools and equipment and it is
5
calibrated.
Deferred maintenance and repetitive defects are properly
6
recorded and followed up.
7 Shift-hand-over procedures are properly followed.

DGCA Form No. 91-11 (Jun 2019) Page 2 of 3

 REMARK

Note : Inspector must write necessary information to describe their inspection either with or without finding, contain at least references, area visited,
method of inspection and inspection subject.

DGCA INSPECTOR

DGCA Form No. 91-11 (Jun 2019) Page 3 of 3