Survey for Collecting RV Nose Gear Failures
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Section 1
Reporting
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Source
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Name
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Email Address
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Aircraft registration #
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Model
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Engine type
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Propeller type
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Year placed in service
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Nose wheel bearing type
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Nose skid plate device installed?
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Nose gear leg reinforcement installed?
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Vans Service Bulletin 07-11-09 Fork Modification Done
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Aircraft Empty Weight in lbs
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Nose empty weight in lbs
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Rough tire pressures kept on the nose wheel in lbs
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Pilot name
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Pilot total time
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Pilot total time in type
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Landings on paved
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Landings on un-paved high quality
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Landings on un-paved average quality
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Landings on un-paved low quality
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Section 2
Date
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Location
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Gear fail type
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Surface type
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Surface condition
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Surface quality
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Speed (mph)
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Flap position
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Braking action
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Stick position
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Pilot Weight
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Passenger Weight
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Baggage Rear Weight
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Baggage Front Weight
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Time on plane
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Nose wheel pant
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NTSB ID
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Pertinent info
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Number of daily responses
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