DIRECCIÓN TÉCNICA

STRUCTURAL DAMAGE-REPAIR REPORT

1.- GENERAL DATA

DATE: REPAIR STATION: CUSTOMER: NON ROUTINE WORK No.:

AIRCRAFT TYPE: REGISTER NUMBER: MSN: TFC: TFH:

2.- DAMAGE LOCATION

STA./FRAME STRINGER OTHER REFERENCE

RIGHT SIDE LEFT SIDE

FUSELAGE ( ) ( ) FLAP WING ( ) ( ) SLAT HOR. STAB. ( ) ( ) SPOILER VERT. STAB. ( ) ( ) AILERON

RADOME ( ) ( ) DOOR ( ) ( ) PYLON ( ) ( ) RUDDER ( ) ( ) ELEVATOR ( )

SERIAL NUMBER: _____________

PART NUMBER: _____________

No. 1 No. 2 AIR INTAKE ( ) ( ) ENGINE COMPONENTS ( ) ( ) FAN COWL ( ) ( ) THRUST REVERSER ( ) ( ) CNA/PRIMARY EXHAUST ( ) ( )

RIGHT SIDE LEFT SIDE

( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

LOCATION: _________________

SERIAL NUMBER: ________________

PART NUMBER: _________________

OTHER (SPECIFY):

3.- DAMAGED ELEMENTS

METALLIC STRUCTURE ( ) COMPOSITE MATERIAL ( )

SKIN BEAM / SPAR STRINGER

( ) ( ) ( )

FRAME BULKHEAD STIFFENER

( ) ( ) ( )

RIB FITTING

( ) ( )

OTHER (SPECIFY):

4.- DAMAGE CLASIFICATION AND DIMENSIONS (Dent, Scratch, Crack, Gouge, Nick, Lightning Strike, Corrosion, Delamination, etc.)

DAMAGE DESCRIPTION LENGTH WIDTH DEPTH A B INSPECTOR SIGNATURE OR STAMP

A=Distance from the location of the maximum dent depth to the adjacent stiffener member edge (only Airbus family). B=Distance between the Dent Edge and any cutout in the skin or any fastener row (only Airbus family).

5.- DAMAGE ANALYSIS

ALLOWABLE DAMAGE

YES ( ) NO ( )

MANUAL REFERENCE REVISION SUPERVISOR

NAME, A & P No., SIGNATURE OR STAMP

ADDITIONAL WORK REQUIRED

YES ( ) NO ( ) DESCRIPTION:

NOTE IF THE DAMAGE IS OUT OF LIMITS A REPAIR SHOULD BE ACCOMPLISHED AND REPORTED IN THIS DOCUMENT. IF THE REPAIR IS NOT COVERED BY SRM, AMM, OHM, SOPM OR CMM, CONTACT THE ENGENIEERING DEPARTMENT.

6.- INSPECTION NON DESTRUCTIVE TEST

DYE PENETRANT EDDY CURRENT ULTRASONIC TEST DVI OTHER INSPECTOR

( ) INTERNAL ( ) EXTERNAL ( ) ( ) ( ) ( )

NAME, A & P No., SIGNATURE OR STAMP NDT MANUAL REFERENCE REMARKS OR FINDINGS

TAP TEST

( )

INSPECTOR OR SUPERVISOR

NAME, A & P No., SIGNATURE OR STAMP NOTE: IN CASE OF A NON DESTRUCTIVE TEST, INSPECTOR MUST BE CERTIFIED. SUPERVISOR ONLY CAN PERFORM TAP TEST INSPECTION.

MAINTENANCE FORM MNT-672-98R11 March 18, 2019

DIRECCIÓN TÉCNICA

STRUCTURAL DAMAGE-REPAIR REPORT

7.- FINAL DIMENSIONS

REWORKED DAMAGE LENGTH WIDTH DEPTH

INSPECTOR NAME A & P No.

SIGNATURE OR STAMP

8.- REPAIR DESCRIPTION

USED SHEET MATERIAL: THICKNESS:

FASTENER TYPE PART NUMBER FASTENER TYPE PART NUMBER

ENGINEERING DOCUMENT USED FOR REPAIR:

MANUAL REFERENCE PAGE FIGURE REVISION

REWORKED DAMAGE

TEMPORARY ( ) PERMANENT ( ) REPAIR

CATEGORY INITIAL INSPECTION REPETITIVE INSPECTION INSPECTOR

NAME A & P No. SIGNATURE OR STAMP

TRHESHOLD METHOD INTERVAL METHOD

WEIGHT OF STRUCTURAL ELEMENTS REMOVED: ARM:

WEIGHT OF STRUCTURAL ELEMENTS INSTALLED:

NOTE: THE ARM IS THE CENTER OF STRUCTURAL ELEMENTS INSTALLED TO DATUM LINE OF THE AIRPLANE

REPAIR DIMENSIONS LENGTH OR DIAMETER WIDTH

CUTOUT DIMENSIONS LENGTH OR DIAMETER WIDTH

COMMENTS:

9.- SIGNATURE NOTE: PUT THE LEGEND N/A OR A CROSSED LINE IN THE FIELDS WHICH ARE NOT REQUIRED/USED FOR DAMAGE EVALUATION. PLEASE REFER TO

PROCEDURE NUMBER PIT-GIN/22 FOR FILLING PROCEDURE OF STRUCTURAL DAMAGE REPAIR REPORT MNT-672-98.

MECHANIC

NAME, A & P No. SIGNATURE

SUPERVISOR

NAME A & P No. SIGNATURE OR STAMP

WHOSOEVER SIGN THIS FORM CERTIFIES THAT THE JOBS HERE MENTIONED WERE ACCOMPLISHED COMPLETELY IN ACCORDANCE WITH PROCEDURES THEREIN INDICATED. FOLLOWING

THE POLICIES ESTABLISHED BY MEXICANA MRO SERVICES BASED UPON STANDARDS AND REGULATIONS ISSUED BY AUTHORITIES AND MAINTENANCE MANUALS RECOMMENDATIONS.

MAINTENANCE FORM MNT-672-98R11 March 18, 2019