MX Event Notification Form

Mx Event Notification Form
This Jot Form is being discontinued and will be removed Wednesday afternoon on 3/3/21. Please use link below to access the Smartsheet maintenance notification form. If you have any questions contact your RMM.

https://app.smartsheet.com/b/form/91bf067d0fec470ba087ed54628cc534
Type a question
Name of Notifier *
Name of Notifier or Point of Contact, Reference REACH GOM, Chapter 5, para 5.1.3.2
Name of Point of Contact (POC) if different that Notifier
Name of Point of Contact, Reference REACH GOM, Chapter 5, para 5.1.3.2
Point of Contact Telephone Number if different than Notifier
Telephone Number of Point of Contact, Reference REACH GOM, Chapter 5, para 5.1.3.2
Tail #
Model
Program
Discrepancy
Current Status
B/U Aircraft
OOS Date
ERTS Date
Type*
Choose type of MX or Update
Region*

Region 1 - SinclairRegion 2 - DriscollRegion 3 - MirajkarRegion 4 - MorganRegion 5 - CastleRegion MCC - Mowery
Program / Region 1 Base location*

REACH 01REACH 03REACH 06REACH 07REACH 17REACH 18REACH 35Other
Program / Region 2 Base location

REACH 02REACH 31REACH 32REACH 33REACH 36REACH 38REACH 39REACH 41REACH 42REACH 44REACH 100Other
Program / Region 3 Base location*

REACH 12REACH 26REACH 29REACH 30REACH 45REACH 47REACH 71REACH 101Other
Program / Region 4 Base location*

REACH 09REACH 11REACH 13REACH 16REACH 21REACH 22REACH 27REACH 43REACH 46REACH 48Other
Program / Region 5 Base location*

REACH 05REACH 08REACH 19REACH 23REACH 34REACH 37REACH 49REACH 50REACH 61Other
Program / Region MCC Base location*

MCCOther
Model of Aircraft*

AS350B3B200BK117 C2EC130EC135P2+EC135P3Other
Aircraft Type*
Tail #*
Tail # - EC130*

N127CHN412RXN413RXOther
Tail # - BK117 C2*

N392TCN390FDN836WCOther
Tail # - AS350B3*

N612RXN61RXN62RXN63RXN64RXN65RXN68RXN854MBN859MBN934EMN941EMN942EMOther
Tail # - B200*

N370CSN911RXN913RXOther
Tail # - EC135P3*

N319RXN322RXN323RXN324RXN890CSN891CSN892CSOther
Tail # - EC135P2+*

N112MTN30RXN31RXN312RXN313RXN314RXN315RXN316RXN317RXN318RXN321RXN36RXN37RXN38RXN39RXN444YEN555YEN832CSN833CSN834CSN837CSN838CSN839CSN893CSOther
Spare Covering Mx Event*

YesNo
Tail # of Spare Aircraft Covering Mx
Spare Aircraft in Service
Is This An Update To The ERTS?*

NoYes
Mx Event Performed On A DelaySpare Aircraft / Training Aircraft
Estimated Start Of Mx Event*

MonthDayYear
DateHourMinutesAM/PM Option
Estimated Completion Of Mx Event *

MonthDayYear
DateHourMinutesAM/PM Option
Weather Status*

GreenYellowRed
Opportunity MX?*

NoYes - No PilotYes - No Med crewYes - Red WeatherOther
Is this A Tech Records Or Quality Assurance Reviewed Item? No Is Typical.*

NoYes - FAA 337 Form Created or ModifiedYes - Services Life Limited (SLL) Component changeYes - Chip Event / Any ExceedanceYes - Out Side Vendor (OSV)Yes - Follow Inspection Or Task after Mx. (I.E. Mast ReTq After Install)
Scheduled Maintenance

Please provide a brief description of the Job Scope
Unscheduled Maintenance

Please provide a brief description of the discrepancy
Update

Please provide current status of the MX- is Estimated Return to Service going to be met or extended? If ERTS is extended, please provide a reason, i.e. tooling, added discrepancy, duty day, etc.
Audit Error Corrected

Please provide a brief description of correction(s) made
Reason *
Mx Event notification must be accompanied with a phone call to MxC: 707-336-2060
Email Address To Send An Additional copy of JotForm
I.E. FIRST.LAST@reachair.com
Should be Empty:

Mx Event Notification Form

Scheduled Maintenance

Unscheduled Maintenance

Update

Audit Error Corrected

Mx Event notification must be accompanied with a phone call to MxC: 707-336-2060