ࡱ> !` Hbjbj\\ ~>> 4 EEEhVFLF,FXTGJJJJ}KLMPSSSSSSS$UhvWS]kM}K}KkMkMSJJTNNNkMJJSNkMSNNNJG p>-4E{M(NN(T0XTN"XM"XN"XN(kMkMNkMkMkMkMkMSSNkMkMkMXTkMkMkMkMFFF*,FFF*,H$l" CAP MISHAP INVESTIGATION FORM (See CAPR 62-2)DATE OF MISHAP:TIME OF MISHAP:PLACE OF MISHAP: FORMTEXT       FORMTEXT       FORMTEXT      CAP INDIVIDUAL OR PROPERTY INVOLVEDNAME, A/C N-NUMBER OR VEHICLE IDENTIFICATION NUMBER:YEAR, MAKE, MODEL: FORMTEXT       FORMTEXT      DESCRIBE INJURY OR PROPERTY DAMAGE:COST OF TREATMENT OR REPAIR: FORMTEXT       FORMTEXT      INVESTIGATION. Attach copies of investigating board/officer's reports. Report should include background, training, experience, supervision, circumstances of the mishap, damage/injury, cost, cause, factors, and recommended corrective action. Photographs or sketches should be attached as applicable.CONCLUSION OF INVESTIGATIONPROBABLE CAUSE OF MISHAP: (Pilot error, inadequate supervision, material, etc., and supporting facts). FORMTEXT       RECOMMENDED CORRECTIVE ACTION: (Include pecuniary liability recommendations if negligence is involved. See CAPR 62-2). FORMTEXT       AIRCRAFT INFORMATION (Complete the following information for CAP aircraft involved in accidents or incidents).TOTAL TIME AIRFRAME:DATE OF ANNUAL INSP:TIME FLOWN LAST 12 MOS: TIME SINCE LAST 100-HOUR INSPECTION: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      TOTAL TIME ENGINE:TIME SINCE LAST MAJOR O'HAUL:TIME SINCE TOP O'HAUL:LIST ANY RECENT MAINTENANCE: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      IF MISHAP WAS DUE TO MATERIAL FAILURE, COMPLETE THE FOLLOWING INFORMATION:NOMENCLATURE OF FAILED PART: MANUFA:<Z\^       ( * , 6 8 : <    . 0 2 < > @ B V X Z d f h j  ڽڽڽڽڽjh?CJUjJh?CJUjth?CJUjh?CJUjh?CJUmHnHujh?CJUjh?CJU h?CJ h?6 h?6CJh? h?54\^~$IfYkd$$Ifl'8(04 la $$Ifa$HH : }www$Ifkd$$IflF d'h h h 0    4 la: < }t $$Ifa$kd$$IflF d'h h h 0    4 la   @ 2lkd$$Ifl0^'n 04 la$IfYkd$$Ifl'8(04 la@ h j nkd2$$Ifl0^'n 04 la$If  > $Iflkd$$Ifl0^'n 04 la       , . 0 : < > @ ^  Q R S T ^ _   $&f246@BZ\8:<h&(ҺҺҭҥҘҺҥҋjh?CJUj h?CJUh?@CJjV h?CJU h?6CJh?jLh?CJU h?CJjh?CJUmHnHujh?CJUjh?CJU6> @ -$ $$Ifa$Ykd $$Ifl'8(04 la $$Ifa$nkd$$Ifl0^'n 04 la R S EYkd $$Ifl'8(04 la$IfYkd& $$Ifl'8(04 la "$&[kd $$Ifl'8(04 la$If DFHJLNPRTVXZ$IfYkdt $$Ifl'8(04 la Z\:<h@:::$IfYkd $$Ifl'8(04 la $$Ifa$[kd $$Ifl'8(04 la8`fkd$$Ifl\b' $  04 la$If(*468:NPR\^`bvxz~ ߸ߴ߬ߟߒ߅jh?CJUjh?CJUjh?CJUh?@CJh?j"h?CJUjh?CJUjNh?CJU h?CJjh?CJUmHnHujh?CJU4B|jdddd$Ifkd$$Ifl\b' $  04 la|~lffff$Ifkd$$Ifl\b' $  04 la  >>>>>>>>>>>?? ?????.?0?2??@?B?V?X?Z?d?f?h?j???@ @<@>@@@L@@@@ҿҲҥҘΑ҄ґjh?CJU h?6CJjh?CJUj(h?CJUjh?CJUjTh?CJUUh? h?CJjh?CJUmHnHujh?CJUjh?CJU4 ja $$Ifa$kd\$$Ifl\b' $  04 la>*>^>>$IfYkdr$$Ifl'8(04 laCTURER PART NUMBER: ESTIMATED OPERATING TIME:CAUSE OF FAILURE: (Excessive wear, corrosion, etc.) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      NOTE: ATTACH PHOTOGRAPH OF DAMAGED MATERIAL(S)IS FAILED PART AVAILABLE FOR INSPECTION?  FORMCHECKBOX  Yes (If Yes, list name and telephone number of CAP contact.)  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" # $ % & ' ( ) S Y Z n 0 00000000000 0000u: ^00`'^^000000000000000000`)0000.0.0.0.0.0.0.0.0.0.0.70000=0=0=00B0B0B00G0G0G`'00L0L0L`'0000S0S0S0S0S5w700Z0Z0Z` 7000000c0c0c`00h0h00l0l`000q0q000000y0y0ympqrs000000000000000 `'v:000000``'00`0000000000000000000000000000000000000000000`0000`0  ( @ BrC Z|>h??~AAZBBCC@DDJEvEE:FF GRGGHHH %&')*,-.012345689:;=>H amsu  ,2wS_e"$06 o Q]ceqwy   ` l r    0 < B ~   Z f l n z FFFFFFFFFFFFFFFFFFFFFG$G$FFFFFFFFFFFFFFFFF8@0(  B S  ?Text33Text2Text3Text4Text5Text6Text7Text8Text34Check1Check2Text24Text36Text22Text40Text26Text39Text41Text37bv !xTp Rz  [ o  t3fd   m  ::/a ~9Lj< ?Q    0 w ~ S Z  ?>lO./?O`au   45YvwRSrs }~$89Lj;<ZuEF  ?JPQey    _ `      / 0 O P w } ~ ( ) S Y Z n @ 8  X```` PP P@PPPP>UnknownGz Times New Roman5Symbol3& z Arial"hRfRf1&  $!24d 3KX)?>l*-CAP MISHAP INVESTIGATION FORM (See CAPR 62-2) jsanderson jsandersonOh+'0 $0 P \ h t0CAP MISHAP INVESTIGATION FORM (See CAPR 62-2) jsanderson capf079.dot jsanderson2Microsoft Office Word@G@$H@,4@,4 ՜.+,0 hp|  CAP d .CAP MISHAP INVESTIGATION FORM (See CAPR 62-2) Title  !"#$%&'()*+,-./0123456789:;<=>?ABCDEFGHIJKLMNOPQRSTUVWXYZ[]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FP-4Data @71Table\"XWordDocument~SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q