CASA Use only
Defect Report SDR No. /
Receipt No.
Aircraft Registration Date of Occurrence Operator Name
VH – / /
Enter engine and propeller details only if relevant ( tick box)
Manufacturer Model Serial No. TSN TSLMC
HRS
AIRCRAFT CYCS
TSO/ HRS
ENGINE TSLSV CYCS
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 MTHS TSO HRS MTHS Available for Inspection? ATA Code
CYCS LNDS CYCS LNDS YES NO
When was the defect found?
Take off Climb Cruise Descent Landing Accident Other
è
Sched. Maint. AD/SB Compliance Status
è PRE POST
Opinion as to the cause of the defect
Design Manufacture Fatigue Corrosion Inadequate Maint. Human Factors Susp. Unapp/part Operational
Other
è
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.)
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Investigation results
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…/2 (investigation Results (Contd.) and Submitter Details
Form 404 03/2006 Major Defect Reporting - Defect Report Page 1 of 3
Investigation results (Contd.)
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SUBMITTER’S DETAILS
Name Organisation Telephone Date
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Address ........................................................................................................................................... Email Address
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....................................................................................................... Postcode .............................. ...............................................................................
Defect Report Type 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 • Fatigue – does the defect display classic fatigue symptoms and what
actions may have caused the problem to develop?
Enter the date the defect occurred or was discovered.
• Corrosion – corrosion, environment and age are closely related,
Major equipment particularly in older aircraft. These aircraft are often thought of as only
Enter the applicable manufacturer’s name, model and serial number. Time the heavy transport aircraft. This is not the case and due consideration
requirements are TSN (Time Since New), TSO (Time Since Overhaul), needs to be given with respect to an aircraft.
TSLMC (Time Since Last Maintenance Check) and TSLSV (Time Since Last • Inadequate maintenance – is directed at poor maintenance practices
Shop Visit). Tick the appropriate box for time units. arising from lack of data, incorrect procedures, inadequate quality
Component control, lack of appropriate training etc.
Enter the name, manufacturer, model or part number and serial number of • Human factors – those defects that occur as the result of personnel
the assembly containing the defective part. For example, for a defective error and also relate to maintenance – for example, failure to follow the
bearing, enter the name of the component using the bearing, such as correct instructions, use of inappropriate equipment/tools, use of the
magneto. For a defective exhaust valve, enter the cylinder identity etc. incorrect fuel or lubricants.
Part • Suspected unapproved parts – this can also be related to personnel
and maintenance defects, particularly with counterfeit parts. With older
Enter the name (e.g. bearing, spar), part number (e.g. 233453-4), condition aircraft and the lack of approved spares, counterfeit parts are an
(e.g. seized, cracked) and location on aircraft/component or the Illustrated increasing problem. The identification of counterfeit parts is of
Parts Catalogue (IPC) reference (e.g. rear gearbox, LH wing or IPC page paramount importance.
97, ref 6-36).
• Operational – are related to those defects which occur as the result of
Time requirements are TSN and TSO. Tick the appropriate box for time
incorrect, inadvertent or uncommanded operation.
units – HRS (Hours), CYCS (Cycles), LNDS (Landings) and MTHS
(Months). Defect description and investigation result
Tick the appropriate box if the defective part is available for inspection Describe the defect, the circumstances under which it occurred, any
and/or destructive testing by the Authority. indications or warnings and non-obvious effects on aircraft or other systems.
State probable cause, action taken to rectify defect and recommendations to
When was the defect found?
prevent recurrence.
Tick the box for the stage of operation the aircraft was engaged in when the
State the results of any investigation undertaken.
defect occurred or was found. This includes defects found after an accident,
during maintenance or during compliance with an Airworthiness Directive. Indicate if other relevant information – for example, photographs, reports or
Tick the Other box if the stage of operation is unlisted and enter the sketches – is available.
operation – for example, preflight check. Include other relevant information such as photographs, reports or sketches,
If there exists any Airworthiness instructions or control procedures related to if available.
the defect – for example, Airworthiness Directive, Service Bulletin,
modification etc – enter the document reference and tick the appropriate Submitter’s details
Compliance Status box. Enter submitter details and tick a Defect Report Type box.
Opinion as to the cause of the defect • Notification of defect with complete investigation results – no
further submissions are anticipated.
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 • Initial defect notification only – report that does not contain all of the
leading to the malfunction or failure. Seek to be as objective as possible in required information or investigation results. A follow-up report is
determining the cause: required to be submitted.
• Design – is the design of the product meeting its intended function or is • Follow-up report from earlier defect notification – a report of
it being asked to do something outside the design scope? investigation results or additional information following from an initial
defect notification only.
• Manufacture – has the product been appropriately manufactured and
properly finished — for example, no stress raisers? Acknowledgement of your Defect Report will be forwarded to the email
address you have provided.
How to Submit this Form
Mail, fax or delivery Urgent reports
Mail the completed form to: Urgent reports may initially be submitted to CASA Service Difficulty
Civil Aviation Safety Authority Reporting Unit by telephone on 131 757 from anywhere in Australia for the
Defect Report cost of a local call. Ask for the SDR unit.
Reply Paid 2005 Alternatively, you may submit the urgent report by e-mail to:
Canberra ACT 2601 sdr@casa.gov.au
Alternatively fax the completed form to 02 6217 1920. If you use either of these methods, a completed Defect Report Form must
You may also deliver the completed form to any CASA Field Office. 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
