Space Mission Packing Assessment Form
Evaluate and verify the completeness and adequacy of packed equipment and supplies for the upcoming space mission.
Crew Member Full Name
*
First Name
Last Name
Crew Member Role
*
Please Select
Commander
Pilot
Mission Specialist
Flight Engineer
Payload Specialist
Other
Mission Name or Code
*
Mission Launch Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Packing Checklist: Indicate the status of each item group below.
*
Rows
Packed
Not Packed
Not Applicable
Life Support Systems
1
2
3
Communication Devices
4
5
6
Navigation Equipment
7
8
9
Medical Supplies
10
11
12
Food & Water Rations
13
14
15
Personal Items
16
17
18
Scientific Instruments
19
20
21
Emergency Tools
22
23
24
How would you rate the adequacy of packing for each category?
*
Rows
Insufficient
Adequate
Excellent
Life Support Systems
25
26
27
Communication Devices
28
29
30
Navigation Equipment
31
32
33
Medical Supplies
34
35
36
Food & Water Rations
37
38
39
Personal Items
40
41
42
Scientific Instruments
43
44
45
Emergency Tools
46
47
48
Rate the criticality of the following items for mission success.
*
Rows
Low
Moderate
High
Oxygen Supply
49
50
51
Water Filtration Unit
52
53
54
Primary Communication Device
55
56
57
Medical Kit
58
59
60
Navigation Computer
61
62
63
Is any critical item missing or incomplete?
*
No, all critical items are present and complete.
Yes, one or more critical items are missing/incomplete (please specify below).
If any critical item is missing or incomplete, specify the item(s) and provide details.
Overall packing assessment
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Additional comments or recommendations
Submit Assessment
Should be Empty: