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Service Letter: Maintenance Alert

The attached form provides a convenient way for dealers, service centers, and repair centers to make an initial report to Piper Aircraft of any accidents or incidents involving Piper airplanes. The form collects key details about the event such as location, aircraft information, pilot details, injuries, damage, and reporting person contact information. Instructions require immediately calling Piper's 24/7 toll-free number and emailing the completed form to Piper, with the original mailed overnight. Timely reporting is important for Piper's compliance with safety regulations and to improve service, reliability, and continued operational safety.

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100 views3 pages

Service Letter: Maintenance Alert

The attached form provides a convenient way for dealers, service centers, and repair centers to make an initial report to Piper Aircraft of any accidents or incidents involving Piper airplanes. The form collects key details about the event such as location, aircraft information, pilot details, injuries, damage, and reporting person contact information. Instructions require immediately calling Piper's 24/7 toll-free number and emailing the completed form to Piper, with the original mailed overnight. Timely reporting is important for Piper's compliance with safety regulations and to improve service, reliability, and continued operational safety.

Uploaded by

Svtorrent Svtorrent
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SERVICE 1041A NO.

Piper Aircraft, Inc.


2926 Piper Drive
LETTER
Vero Beach, FL, U.S.A. 32960
Date: March 17, 2020 (S) (M)

MAINTENANCE ALERT
Service Letter (SL) 1041A supersedes SL 1041 in its entirety.

SUBJECT: IN-SERVICE SAFETY EVENT REPORTING

REASON FOR REVISION: SL 1041A updates Piper contact and other information,
and provides an improved Form 420-01. Other changes
update the document to the current Piper format.

MODELS AFFECTED: SERIAL NUMBERS AFFECTED:


All Models All

COMPLIANCE TIME: Upon knowledge of an incident or an accident

PURPOSE: The instructions in this service letter are to be used by all dealers, service centers
and repair centers in the event of an accident or incident involving any Piper
airplane.
Some past incidents and accidents have either gone unreported to Piper Aircraft,
or were not reported in a timely fashion. To improve Piper’s service, reliability
and continued operational safety, all incidents and accidents must be reported
immediately. In order to expedite reporting to Piper, attached to this service letter
is an improved, interactive Form 420-01.
NOTE: The reporting of accidents and incidents is vital to Piper’s compliance
with FAR Section 21.3, “Reporting of failures, malfunctions, and
defects.”

COMPLIANCE WITH THIS SERVICE LETTER IS IN ADDITION TO


MANDATORY REPORTING TO THE NATIONAL TRANSPORTATION SAFETY BOARD (NTSB)
AS REQUIRED BY 49 CFR PART 830.

ATA/JASC: N/A

(OVER)
SERVICE LETTER NO. 1041A PAGE 2 of 2

INSTRUCTIONS:

1. All dealers, service centers and repair centers must call Piper at 1-877-879-0275 (toll free) immediately upon
knowledge of an incident or accident. The line is monitored every day, 24 hours a day. (For convenience, the
phone number is also included on Form 420-01.)
2. After calling Piper, complete Form 420-01, attached, in it’s entirety (preferably, typed). The form is an interactive
PDF, so you may fill it out using Adobe Acrobat Reader or similar software, or print a hard copy and fill it out
legibly by hand. Immediately email the completed PDF form to [email protected].
3. Overnight the original, completed Form 420-01, signed and dated, to the following address:
Piper Aircraft, Inc.
Att’n: Customer Service
Re: Form 420-01
2926 Piper Drive
Vero Beach, FL 32960

MATERIAL REQUIRED: N/A

AVAILABILITY OF PARTS: N/A

EFFECTIVITY DATE: This service letter is effective upon receipt.

SUMMARY: The attached Form 420-01 offers a convenient way to make an initial report to
Piper Aircraft, Inc., of any accidents or incidents that occur involving any Piper
airplane.

NOTE: Please notify the factory of any address/ownership corrections. Changes should include aircraft model,
serial number, and current owner’s name and address.

Corrections and/or changes should be directed to:


PIPER AIRCRAFT, INC.
Att’n: Customer Service
2926 Piper Drive
Vero Beach, FL 32960
or:
[email protected]
Please include in subject line: “Aircraft ownership update”
In-Service Safety Event Report
Piper Aircraft, Inc. • Vero Beach, Florida, USA
1-877-879-0275 (24-hour, toll-free) • [email protected]

Event Event Date (MM/DD/YYYY) Event Time


Location

Piper Model Number Serial Number Registration Year Manufactured

Departure Destination Flight Plan


 IFR  VFR
 None  Unk

Pilot Owner

Operator (Business) Insurer(s)

Personal
Injuries # Fatal Serious Minor  None Occupants #

Aircraft Damage  Destroyed  Substantial  Minor  None  Unknown Fire  Yes  No  Unk

Person Reporting Event Piper Use Only Piper Use Only Piper Use Only
Name: Ph.: Receipt (Name, Date, Time)
Address:

Investigator (PAC)

Investigating Office
Reporting Person’s Signature Date (MM/DD/YYYY)

Witness Report Name:


Address: Ph.:
Comments:

If additional space is required, please use additional forms including, at a minimum, the event date and time and aircraft S/N on each form after the first.

Dept. of Record: Technical Publications Retention No.: 2291.020 Form 420-01 (Rev. 3/01/2020)

In-Service Safety Event Report PAGE 1 of 1

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