Printable Vendor Audit Checklist Template

De/Anti-icing International Vendor Audit Checklist July 1, 2012
De/Anti-icing International Vendor Audit Checklist

For companies providing De-icing/Anti-icing Services
and performing the Post De-icing/Anti-icing Check
Station Name: Completion Date:

(Dd-mmm-yyyy)
Type of check: Initial Annual Follow up Other:
Handling company performing de/anti-icing

Name of company :
Type of company:
Airline Ground Handling Other (specify):
Findings (for details see checklist and findings summary on last page):
No findings Minor findings Safety related findings

Alert letter to pool members is required.
Follow-up inspection to be decided by
auditor/ inspector.
Repeated Findings: Yes No
Restrictions: Yes No
(Specify if yes)
Corrective measures required prior to de-icing/anti-icing operation: Yes No
Follow-up audit required prior to de-icing/anti-icing operation: Yes No
Auditor Airline
(Print Name) Conducting Audit:
Signature: Date:
Page 1 of 1
De/Anti-icing International Vendor Checklist July 1, 2012
A. Contact Addresses:
Official Company Name:
Responsible Manager:
Department: Phone:
Mobile:
Street: Fax:
Zip-Code, City: SITA Telex:
Country: E-Mail:
Contact Person:
Same data as above: Yes No
Fill in any data that is different from above
Department: Phone:
Mobile:
Street: Fax:
Zip-Code, City: SITA Telex:
Country: E-Mail:
Page 2 of 1
B. Fluids
List all de-icing/anti-icing fluids likely to be used on aircraft by the previously named Handling Company.
De-icing / Anti-icing Fluids Fluid Type
Manufacturer Brand Name I II III IV
C. Miscellaneous
Discrepancies noted at the previous Winter-inspection Yes

have been corrected and reported by the handling No (report the reason under comments)
company? No discrepancies reported at previous
inspection.
Note:
Not applicable for initial inspection.
Page 3 of 1
D. STATION CHECKLIST - For companies providing De-icing/Anti-icing Services

and performing the Post De-icing/Anti-icing Check
Complete the following Audit Checklist during each winter period.
Questions must be answered with Y (yes), N (no), NA (not applicable), or if unsatisfactory with X (for findings).
Comments can be added to the answers if necessary.
Questions which are marked “For information only” must be answered with “Y” or “N”, or “NA”.
Certain other items call for specific values to be recorded.
All questions which are not marked with “For information only” must be answered with “Y”, “X” or “NA”.
(“N” is not permissible!).
Note:
All referenced documents in checklist (e.g. AEA, SAE, and ISO) are subject to revision. Always use the latest edition.
Answers marked with an asterisk (*) are safety related.
No Questions X Y N NA Comments
PR Procedures and Documentation

(For information only)
1. Are De-icing/Anti-icing procedure manuals available from
any Part 121 operating carriers.
If yes, list airlines, manual name and revision status:

2. Does the handling company have its own de-icing /anti-
icing procedures?
If yes, specify manual name and revision status:
(Safety related)
3. Are the procedures used by the handling company based *
on the approved Company manual?
Page 4 of 1
FL De-icing/Anti-icing Fluids
1. Are fluid release documents (Certificate of Conformance

or equivalent) received from the fluid manufacturer for
each fluid delivery/batch and retained by the consignee
for inspection, as necessary?
2. Are fluid delivery checks (incoming inspection) performed

and records retained?
3. Are concentration checks (refractive index checks) on

equipment carried out prior to first use of the day and
after each refilling on fluids? Are results recorded and is
the information available to operators?
Note:
For details and exceptions, refer to the International
Chapter (13.2.1.1)
(Safety related)
4. Are fluid laboratory checks carried out periodically on
fluid samples (Type II, III, and IV fluids), the result
recorded and is the information available to operators?
*
Note:
Fluid laboratory checks shall be performed at least at the
start of the winter de/anti-icing season.
Fluid samples shall be taken from all de/anti-icing vehicle
spraying nozzles and from all storage tanks.
5. Does the handling company apply an acceptable
procedure for fluid sampling and is this procedure
documented?
6. Does the handling company use degraded Type II or IV
fluid as a Type I fluid with the intent of applying Holdover
time?
7. Does the handling company use degraded Type IV fluid
as a generic Type II fluid?
If yes, is the fluid certified by the fluid manufacturer?
Page 5 of 1
TR Training and Qualification

(Safety related)
1. Do the personnel carrying out the de-icing/anti-icing *
operation receive training in cold weather operations?
(Safety related)
2. Do the personnel carrying out the Post De-icing/
Anti-icing Check receive training in cold weather *
operations?
(Safety related)
3. Are the training materials used by the handling company
based on the approved Company Manual? *

4. Is recurrent training conducted within 12 months of the
previous training (base month)? If training is conducted
one month prior or after base month it is considered to be
conducted within 12 months.
(Safety related)
5. Do all personnel mentioned in TR 1 and TR 2 receive *
annual refresher training?
6. Are training records and authorizations maintained?
(Safety related) BASIC TRAINING:

7. Is the success of the training evaluated? Theoretical Test
Practical Assessment
Note:
Practical assessment is optional for the personnel * REFRESHER TRAINING:
performing the Post-De-icing/Anti-icing Check. Theoretical Test
Practical Assessment
8. Are passing rates established and documented

(min. 75%)?
Specify procedure reference:
9. Place a check mark for all fleet types that are trained:
ATR-72 A-300 A-310 A-318
A-319 A-320 A-321 A-330
A-340 A-380 B-1900 B-727
B-737 B-747 B-757 B-767
B-777 B-787 CRJ/CL65 DH-8
BEA146 E-135/145 E-170 Dor-328
Falcon F-100 Glfstrm Learjet
Jet-31/41 DC-8 DC-9 DC-10
MD-11 Saab-340 Shorts-360
Page 6 of 1
Post De-icing/Anti-icing Check and transmission
SV
of the Anti-Icing Code to the Commander
If No, specify who performs
1. Does the service provider perform the post de/anti-icing the post de/anti-icing check:
check?
If yes, answer questions 2-5 below:
(Safety related)
2. Are the responsibilities for the Post De-icing/Anti-icing
Check in compliance with the Company Manual?
*
Specify location if documented in handling company
manual
(Safety related)
3. Are communication between flight crew and the de-
icing/anti-icing company in compliance with the Company
Manual?
*
Specify location if documented in handling company
manual
(Safety related)
4. Are written procedures established for the Performance of
communication between the staff performing the De-Icing/Anti-Icing and
de-icing/anti-icing and the staff performing the Post De-Icing/Anti-Icing
Post De-icing/Anti-icing Check? Check is done by the
Specify procedure reference: * same person
Note:
Comment mandatory if not applicable.
(Safety related)
5. Where necessary, does the person performing the
Post De-icing/Anti-icing Check, have (access to)
equipment offering sufficient visibility of the aircraft
critical parts to be checked. *
Comments are mandatory.
Use comment box on last page to specify details.
Page 7 of 1
FA De-icing/Anti-icing Facilities
Gate
1. Where are de-icing/anti-icing operations carried out? After Pushback
Remote/Centralized
Specify if other: Position
End of Taxi-way
Other (specify)

2. If de-icing/anti-icing is carried out at an area away from
the gate, who certifies that the aircraft has been correctly
de-iced/anti-iced and that appropriate surfaces are free
of all forms of frost, ice, slush and snow?
Specify if applicable:

3. Do airline personnel have access to the remote
de-icing/anti-icing position(s)?

Fixed Tanks
4. How is the fluid stored? Mobile Tanks/Trailer
Cubitainer/Barrels

5. Is the fluid heated in the storage tanks?

6. If the fluid is heated in the storage tanks:
What method of heating is employed and to which
temperature is the fluid heated?
Method:
Temp. C:
7. Are all storage tanks and filling ports labeled for fluid
type/mix?
8. Are all components of storage facility constructed and
maintained in accordance with the Company Manual?
9. Are refractometers calibrated or functional checks calibrated

performed periodically and documented? functional checks
What is the interval?

10. Are de-icing/anti-icing vehicles available which are
reported not to be used by the handling company?
Specify if applicable
Manufacturer and Model:
ID number(s) of truck:
Number of vehicles:
Page 8 of 1
EQ De-icing/Anti-icing Equipment I
1. Specify vehicles of each separate type/modification
state:
Manufacturer:
Model:
Total number of
vehicles of this model:
Tank 1 Tank 2 Tank 3

Fluid Type:
Concentr:
Temp. C:
Fluid Temp.(C) at nozzle if available:
(Safety related)
2. Applicable for anti-icing with Type I Fluid only:
*
Is the temperature of the heated fluids and fluid mixtures
at or above 60 °C (140 °F) at the nozzle?
3. If the answer to question EQ 2 is “N/A”, this question is

optional. a)
If the answer to question EQ 2 is “Y” or “N”, this question is
mandatory. b)
(For information only) c)

How is ensured that the temperature of the heated fluids
and fluid mixtures is at or above 60 °C (140 °F) at the
nozzle?
a) a temperature sensor (e. g. a thermometer) is
installed at or near the nozzle;
b) the temperature of fluid water/mixtures in the tank
and at the nozzle is measured and recorded several
times during the season and both temperature
readings are correlated
c) other (please explain on comment page)
4. Are vehicle tanks / filling ports labelled for fluid type

and/or mixture rate?

By vehicle proportional
5. How is fluid mixed? mix system
Manually in vehicle
In storage facilities
Premix from
manufacturer
Page 9 of 1
EQ De-icing/Anti-icing Equipment I (continued)

(Safety related)
6. Perform a refractive index check during the audit on
vehicles selected for fluid sampling.
Measure refractive index of undiluted fluids
(Type II, III, and IV) and/or fluid/water mixtures * N/A is only acceptable if the
normally used (Type I, III, II and IV).
truck is empty or contains
water.
Is the refractive index of samples taken from undiluted
fluids and fluid/water mixtures within the required limit?
(Safety related)
7. Can Type II, III, or IV fluid (undiluted or hot mix) be
sprayed without degrading the fluid beyond required limits? *
(Refer to question FL 4)
8. Can the de-icing fluid spray reach all appropriate parts of

the aircraft?
Indicate maximum size/category of aircraft that can be
de-iced/anti-iced:
9. Are spraying nozzles and/or fluid selection switches/panels

as appropriate, properly marked with mixture rate and/or
fluid type, when more than one
nozzle is installed?
10. Does the vehicle have a two-way communication system

between basket and driver cabin?
(Safety related)
11. Are the vehicles free of discrepancies, which could affect
the safe operation (e.g. flat tires, defective lighting *
system, defective boom, etc.)?
12. Are vehicles maintained to a maintenance schedule,

the results recorded and is the information available
to operators?
13. If fluid is mixed by vehicle proportional mixing-system:

Is the mixing-system checked according to a
maintenance schedule and are the check records
maintained?
What is the check interval:
Page 10 of 1
EQ De-icing/Anti-icing Equipment II
state:
Manufacturer:
Model:
Total number of

Fluid Type:
Concentr:
Temp. C:
(Safety related)
*

optional. a)
mandatory. b)

nozzle?


Manually in vehicle
Premix from
manufacturer
Page 11 of 1
EQ De-icing/Anti-icing Equipment II (continued)

(Safety related)
water.
(Safety related)

the aircraft?
de-iced/anti-iced:


(Safety related)

to operators?

maintained?
Page 12 of 1
EQ De-icing/Anti-icing Equipment III

state:
Manufacturer:
Model:
Total number of

Fluid Type:
Concentr:
Temp. C:
(Safety related)
*

optional. a)
mandatory. b)

nozzle?


Manually in vehicle
Premix from
manufacturer
Page 13 of 1
EQ De-icing/Anti-icing Equipment III (continued)

(Safety related)
water.
(Safety related)

the aircraft?
de-iced/anti-iced:


(Safety related)

to operators?

maintained?
Page 14 of 1
Comments
FINDINGS Summary (Request remedial actions for findings by a B-Letter)
Q-No. Findings description
Page 15 of 1
Corrective Action Responses
Q-No. Corrective Action Response
Page 16 of 1

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De/Anti-icing International Vendor Audit Checklist July 1, 2012

De/Anti-icing International Vendor Audit Checklist

Station Name: Completion Date:

Type of check: Initial Annual Follow up Other:

Handling company performing de/anti-icing

Airline Ground Handling Other (specify):

No findings Minor findings Safety related findings

Repeated Findings: Yes No

Corrective measures required prior to de-icing/anti-icing operation: Yes No

Follow-up audit required prior to de-icing/anti-icing operation: Yes No

Official Company Name:

Zip-Code, City: SITA Telex:

Same data as above: Yes No

Fill in any data that is different from above

Zip-Code, City: SITA Telex:

De-icing / Anti-icing Fluids Fluid Type

Manufacturer Brand Name I II III IV

Discrepancies noted at the previous Winter-inspection Yes

D. STATION CHECKLIST - For companies providing De-icing/Anti-icing Services

Complete the following Audit Checklist during each winter period.

Answers marked with an asterisk (*) are safety related.

PR Procedures and Documentation

(For information only)

1. Are fluid release documents (Certificate of Conformance

2. Are fluid delivery checks (incoming inspection) performed

3. Are concentration checks (refractive index checks) on

If yes, is the fluid certified by the fluid manufacturer?

TR Training and Qualification

(For information only)

(Safety related) BASIC TRAINING:

8. Are passing rates established and documented

If yes, answer questions 2-5 below:

(For information only)

(For information only)

(For information only)

(For information only)

(For information only)

9. Are refractometers calibrated or functional checks calibrated

What is the interval?

Tank 1 Tank 2 Tank 3

3. If the answer to question EQ 2 is “N/A”, this question is

(For information only) c)

4. Are vehicle tanks / filling ports labelled for fluid type

(For information only)

EQ De-icing/Anti-icing Equipment I (continued)

8. Can the de-icing fluid spray reach all appropriate parts of

9. Are spraying nozzles and/or fluid selection switches/panels

10. Does the vehicle have a two-way communication system

12. Are vehicles maintained to a maintenance schedule,

13. If fluid is mixed by vehicle proportional mixing-system:

What is the check interval:

Tank 1 Tank 2 Tank 3

3. If the answer to question EQ 2 is “N/A”, this question is

(For information only) c)

4. Are vehicle tanks / filling ports labelled for fluid type

(For information only)

EQ De-icing/Anti-icing Equipment II (continued)

8. Can the de-icing fluid spray reach all appropriate parts of