Form Number: CA 43-05
Section/division
Telephone number:
AIRWORTHINESS
011-545-1000
Physical address
Ikhaya Lokundiza, 16 Treur Close, Waterfall Park, Bekker Street, Midrand, Gauteng
Postal address:
Private Bag X73, Halfway House 1685
Email:
[email protected]
Website: www.caa.co.za
INSPECTION REPORT FOR HOT AIR BALLOON
1.
Registration Marks
2.
Make/Model
Envelope
3.
Burner Serial Number
4.
Basket Serial Number
5.
(i)
Cylinder Serial Number:
―
Z
Basket
6.
Serial Number
Burner
Tank(s)
Date of next Hydrostatic test:
(i)
(ii)
(ii)
(iii)
(iii)
(iv)
(iv)
(v)
(v)
(vi)
(vi)
(vii)
(vii)
(viii)
(viii)
Current Flight Time
8. Date of last Flight
Type of inspection
If applicable, hours by
10.
program
which MPI was overflown
11. Record work accomplished since the last renewal / issue of certificate of
airworthiness
12. Record of major component changes
13. EQUIPMENT STATUS
YES
7.
9.
(i)
(ii)
NO
Is mass and balance data and equipment list available? Amended to
date?
Last calibration date of instruments?
(iii)
Fabric grab test results?
(iv) Thermal strips/indicators are serviceable & no exceedances are noted.
14. Since the last C of A renewal / issue, the following were complied with or embodied:
(i)
Airworthiness Directives numbers
(ii)
Manufacturer’s recommendations (e.g. S.B.’s, S.I.’s, SL’s etc.) no’s
(iii) Modification no’s
15. Does radio equipment comply with the equipment list?
16. Amended to date
CA 43-05
16 SEPTEMBER 2015
Yes
No
Yes
No
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Yes
No
17. Are the relevant approved documents available as per Part 91 of the CARs
18. I, the undersigned
hereby certify that I have completed a
On
(Indicate Inspection Type)
Z
―
Balloon
At (hours) on
(date) and that
All mandatory overhauls, modifications and special inspections due in accordance with the Approved
(i)
Maintenance Program have been done and are recorded in the applicable logbooks.
(ii) This balloon is airworthy.
(iii)
The information given on this form is true in every respect to the best of my knowledge and belief.
SIGNATURE
NAME IN BLOCK LETTERS
DATE
19. AME licence no / AMO approval no.
20. Name of Owner/Operator
21. Address of Owner/Operator
Postal Code
CA 43-05
16 SEPTEMBER 2015
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