Aircraft Mechanic Safety Assessment
Complete this assessment to review aircraft maintenance safety practices, identify hazards, and record corrective actions.
Mechanic and Assessment Details
Mechanic Name
*
First Name
Middle Name
Last Name
Employee / Crew ID
Department / Base
*
Job Title / Specialization
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift / Time
Hour Minutes
AM
PM
AM/PM Option
Aircraft Type / Model
*
Evaluator Name
*
First Name
Middle Name
Last Name
Evaluator Role
*
Location / Hangar / Bay
Safety Practices and Compliance Evaluation
PPE Use
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Tool Control
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Lockout/Tagout or Energy Isolation
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Hazard Recognition
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Use of Checklists
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Housekeeping
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Communication
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Adherence to Maintenance Procedures
*
Compliant
Partially Compliant
Non-Compliant
Not Observed
Hazards, Incidents, and Corrective Actions
Brief incident or hazard description
*
Severity / risk rating
*
Low
Moderate
High
Critical
Immediate mitigation taken
*
Corrective action required
*
Is retraining or supervision needed?
*
No
Retraining
Supervision
Both
Due date or follow-up date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
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