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Civil Aviation Safety Authority
Form 920
SCHEDULE OF EXPERIENCEENGINE GROUP 21 or 22
ENGINE TYPE: ..........................................................................................................................
APPLICANT’S NAME: ...........................................................................................................................
ARN / LICENCE No: ...........................................................................................................................
ATA Chapter
BaseHours
ReducedHours
HoursAchieved(AWI Use)
ATA Chapter
BaseHours
ReducedHours
HoursAchieved(AWI Use)
ATA Chapter
BaseHours
ReducedHours
HoursAchieved(AWI Use)
26 72 78
36 73 79
49 74 80
61 75 81
71 76 82
ATA Chapter
Acceptance of Experience
(Airworthiness Inspector)
ATA Chapter
Acceptance of Experience
(Airworthiness Inspector)
ATA Chapter
Acceptance of Experience
(Airworthiness Inspector)
26 Name: ......................... Airport:................................
Signature: ....................... Date:................................72 Name: ......................... Airport:................................
Signature: ....................... Date:................................
78 Name: ......................... Airport:................................
Signature: ....................... Date:................................
36 Name: ......................... Airport:................................
Signature: ....................... Date:................................73 Name: ......................... Airport:................................
Signature: ....................... Date:................................
79 Name: ......................... Airport:................................
Signature: ....................... Date:................................
49 Name: ......................... Airport:................................
Signature: ....................... Date:................................74 Name: ......................... Airport:................................
Signature: ....................... Date:................................
80 Name: ......................... Airport:................................
Signature: ....................... Date:................................
61 Name: ......................... Airport:................................
Signature: ....................... Date:................................75 Name: ......................... Airport:................................
Signature: ....................... Date:................................
81 Name: ......................... Airport:................................
Signature: ....................... Date:................................
71 Name: ......................... Airport:................................
Signature: ....................... Date:................................76 Name: ......................... Airport:................................
Signature: ....................... Date:................................
82 Name: ......................... Airport:................................
Signature: ....................... Date:................................
Fire Protection – ATA Chapter 26 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Pneumatic – ATA Chapter 36 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
APU – ATA Chapter 49 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Propellors & Propulsors – ATA Chapter 61 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Power Plant – ATA Chapter 71 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Engine General – ATA Chapter 72 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Engine Fuel & Control – ATA Chapter 73 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Ignition – ATA Chapter 74 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Air – ATA Chapter 75 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Engine Controls – ATA Chapter 76 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Exhaust – ATA Chapter 78 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Oil – ATA Chapter 79 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Starting – ATA Chapter 80 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Turbines (Supercharges) – ATA Chapter 81 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Water Injection – ATA Chapter 82 Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
Supplement – ATA Chapter .... Verifi cation
A/C Reg No &Work Ref No
Type of Work Carried Out Time Taken (hours)
Signature Licence No Date
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