Flight Safety Reporting Instructions - Cub Crafters CC11-100 Maintenance Manual

10. FLIGHT SAFETY REPORTING INSTRUCTIONS

This form is to be used for the owner/operator of the aircraft to provide information to Cub
Crafters, Inc. of any safety of flight or service difficulty experienced with the aircraft in
accordance with ASTM F2295. Additional forms may be obtained by writing or calling Cub
Crafter's customer service department at 509-248-9491.
It is the responsibility of the owner/operator to notify Cub Crafters of any safety of flight issue or
significant service difficulty upon discovery.
After completing the form below, e-mail or mail it to:
Cub Crafters, Inc.
1918 South 16
Yakima, WA. 98903
support@cubcrafters.com
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Print or type all entries
NAME (Last, First and Middle )
ORGANIZATION (If applicable )
ADDRESS (Number, street, city, state, and postal code )
PRIMARY TELEPHONE NUMBER ALTERNATE TELEPHONE NUMBER
DESCRIPTION OF SAFETY OF FLIGHT ISSUE OR SIGNIFICANT SERVICE DIFFICULTY (Describe in detail. Use additional
pages if necessary. )
SIGNATURE
Manual number SC10000AMM
Date: 10/01/2010
CUB CRAFTERS, INC.
CC11-100 MAINTENANCE MANUAL
Avenue
th
CONTINUED OPERATIONAL SAFETY REPORTING FORM
AIRCRAFT MODEL
AIRCRAFT SERIAL NUMBER
AIRCRAFT REGISTRATION NUMBER
E-MAIL ADDRESS (optional )
DATE
5.2
Page: 15