Unscheduled Engine Replacement Authorization - Bird Strike Damage

1. Section 1: Aircraft & Powerplant Identification

Critical identification data for aircraft and both damaged and replacement powerplants. All fields are essential for traceability and regulatory compliance.


Aircraft Registration/Tail Number

Aircraft Manufacturer and Model

Engine Position Affected

Damaged Engine Serial Number

Damaged Engine Total Flight Hours

Damaged Engine Total Cycles


Replacement Engine Serial Number

Replacement Engine Total Flight Hours

Replacement Engine Total Cycles


Engine Type/Model (Both Units)

Date/Time of Bird Strike Incident (UTC)

Flight Number at Time of Incident

Flight Phase When Strike Occurred

Pilot Incident Report Summary

Maintenance Lead Name and License Number

Assigned Inspector Name and License Number

Maintenance Facility/Hangar Code

2. Section 2: Damage Inspection & Borescope Assessment Findings

Comprehensive documentation of foreign object damage assessment. Borescope inspection must cover all engine modules per manufacturer guidelines. All findings must be recorded with precise locations and measurements.


Bird Strike Details - Species/Size and Impact Location

Was the engine shut down immediately post-strike?


Post-incident boroscopic inspection performed within 24 hours?


Borescope Equipment Serial Number and Last Calibration Date


Fan Section Assessment (Station 0-2): Inspect all fan blades, spinner, and inlet guide vanes for impact damage, cracks, or deformation.


Fan Blade Damage Classification

Metallic debris detected in fan section?


Fan Section Detailed Findings and Measurements


Compressor Section Assessment (Station 3-9): Inspect all compressor stages for foreign object damage, blade tip clearance, and axial/radial blade play.


Compressor Stage Damage Summary

No Damage

Minor (<5% blade count)

Moderate (5-15% blade count)

Severe (>15% blade count)

Unserviceable

LPC Stage 1-3

LPC Stage 4-6

HPC Stage 7-9

Compressor blade tip rub detected?


Combustion Section Assessment (Station 10-11): Inspect combustion liners, fuel nozzles, and transition ducts for burning, cracking, or foreign object impact.


Combustion Section Condition


Turbine Section Assessment (Station 12-15): Inspect all turbine stages for blade condition, tip clearance, and thermal damage.


Turbine Blade Condition Assessment

Serviceable

Minor coating loss

Tip curl/deformation

Crack indications

Unserviceable

HPT Stage 1 blades

HPT Stage 2 blades

LPT Stage 1 blades

LPT Stage 2-5 blades

Oil contamination with metallic particles detected?


Vibration survey performed post-incident?


Summary of Unserviceable Components Requiring Replacement

Does damage exceed allowable limits per manufacturer AMM?


Upload Borescope Images and Video Files (All findings must be documented)

Choose a file or drop it here
 

I confirm that borescope inspection covers all mandatory zones per engine manufacturer maintenance manual

3. Section 3: Replacement Powerplant Airworthiness & Installation Checklist

Verification of replacement engine airworthiness status and comprehensive installation checklist. All torque values must be recorded and within specified limits.


Replacement engine received with valid maintenance release certificate?


Replacement Engine Last Shop Visit Date

Engine Shop Visit Workscope Number

All mandatory service bulletins and airworthiness directives complied with on replacement engine?


Replacement Engine QEC Kit Part Number and Serial Number

Pre-installation engine preservation status verified satisfactory?


Installation Torque Verification: All critical fasteners must be torqued using calibrated equipment. Record actual values and tool calibration dates.


Critical Fastener Torque Log

Fastener Location/Part Number

Torque Wrench ID/Serial

Wrench Cal Due Date

Specified Torque Value

Actual Torque Applied

Torque Within Tolerance?

Engine Mount Forward Bolt #1
TW-001
8/15/2025
450
448
Yes
Engine Mount Aft Bolt #2
TW-001
8/15/2025
450
452
Yes
Pylon Attach Bolt #3
TW-002
9/1/2025
380
381
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

I confirm all torque wrenches used were within calibration date and torque values recorded

Engine System Connections Verified (Select all completed)

Engine oil system serviced with correct type and quantity?


Oil Type and Part Number Used

Engine fuel system purged of air and contamination?


Thrust reverser actuation test performed successfully?


Engine installed with required witness/inspector present?


Upload Installation Photographs (Minimum: 4 sides, pylon interface, critical connections)

Choose a file or drop it here
 

I certify that replacement engine installation complies with all applicable airworthiness requirements and manufacturer specifications

4. Section 4: Ground Run-Up & Flight Systems Recalibration Log

Comprehensive ground run-up to verify engine performance and recalibrate integrated aircraft systems. All parameters must be within manufacturer-specified limits before flight release.


Ground Run-Up Test Date/Time (UTC)

Ground Run-Up Test Engineer Name and License

Ground Run-Up Type Performed

Ambient Temperature and Pressure Altitude

Pre-run leak check performed and passed?


Engine Performance Parameters - Record all values at stabilized conditions


Engine Run-Up Parameter Log

Power Setting

N1 (%)

N2 (%)

EGT (°C)

Oil Pressure (psi)

Vibration (units)

Within Limits?

Ground Idle
22
58
420
45
0.2
Yes
Takeoff Power
98
101
890
65
0.8
Yes
Max Continuous
95
98
860
62
0.7
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Engine reached rated takeoff thrust without anomalies?


Thrust reverser deployment and stowage functions normally?


Autothrottle system calibration required post-installation?


FADEC software version compatible and all sensors reading correctly?


Aircraft Systems Requiring Recalibration (Select all that apply)

Engine bleed air system provides proper pressure and temperature?


All engine instruments reading correctly on flight deck?


Engine vibration within acceptable limits at all power settings?


Engine oil system functions normally with no leaks?


Upload Ground Run-Up Data File (Digital engine monitor dump)

Choose a file or drop it here
 

I confirm ground run-up was performed per manufacturer test procedures and all parameters are within limits

5. Section 5: Chief Maintenance Inspector Clearance Sign-Off

Final verification and airworthiness certification by authorized maintenance inspector. This section confirms all required maintenance actions have been completed satisfactorily and the aircraft is safe for return to service.


All sections of this form completed in full?


All mandatory inspections and tests performed and passed?


Replacement engine logbook entries completed?


Aircraft maintenance logbook entry completed with correct references?


Weight and balance updated for new engine serial number?


Is a test flight required before return to commercial service?


Any operational limitations or monitoring requirements imposed?


Clearance Recommendation

Inspector Comments and Additional Notes

Chief Maintenance Inspector Name

Inspector Authorization/License Number

Inspector Clearance Date/Time (UTC)

Chief Maintenance Inspector Digital Signature

I certify that I have personally reviewed all documentation, inspections, and test results, and that the engine replacement has been accomplished in accordance with approved maintenance data and airworthiness requirements. The aircraft is approved for return to service subject to any limitations noted above.

What's the most fun thing we could possibly change on this form template? Edit this Emergency Turbofan Engine Swap Clearance Form
Want forms with tables that do the heavy lifting so your brilliant brain can focus on important stuff, like what socks to wear? Zapof lets you build your own with auto-calculation and spreadsheet superpowers – unleash the awesome data silliness!
This form is protected by Google reCAPTCHA. Privacy - Terms.
 
Built using Zapof