NSP Form T002 FSTD Evaluation Report and Missing Malfunctioning, or In

	Federal Aviation Administration National Simulator Program FSTD Evaluation Report and Missing Malfunctioning, or Inoperative (MMI) Component Reporting/Authorization Form *See page 6 for Instructions	Evaluation End Date:	Click to pick.
		FAA ID:	Enter.
		Make/Model/Series:	Enter.
		Sponsor:	Enter.
		Location:	Enter.
		Evaluating Inspector:
		Evaluation Type (See pg 6):
		Qualification Level Authorized:

Return Form To: NSP Team Inbox Please provide feedback concerning this evaluation

EVALUATION INFORMATION
FSTD Configuration(s) Evaluated	Enter engine types, propeller types, avionic suites or FMS, etc if applicable
Was New T001 Issued? (SOQ Cover Page)	☒ YES	☐ NO	Intentionally Blank
Was T001A Updated With New Info?	☐ YES	☒ NO	Intentionally Blank
Was This A BASA-SIP Evaluation?	☐ YES	☒ NO	For Which Authority:

EVALUATION TEAM MEMBERS
FAA Representatives (Other than Evaluating Inspector)	Sponsor Representatives
Enter Name.	Enter Name.
Enter Name.	Enter Name.
Enter Name.	Enter Name.

COMMENTS / NOTES

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NON-QUALIFIED TASKS
No.	Sponsor DR No.	Severity Level	Non-Qualified Task(s) / Discrepancy Description	Date Closed:	Corrective Action Taken:
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DISCREPANCIES
No.	Sponsor DR No.	Severity Level	Discrepancy Description	Date Closed:	Corrective Action Taken:
	Enter.		Enter.	Pick.	Enter.
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RECOMMENDATIONS for SPONSOR
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Sponsor Reportable MMI Components
No.	Sponsor DR or MMI No.	Discrepancy Description / Discrepancy Discovery Date*:	Work Accomplished to Date:	Training Restrictions or other Rationale	NSP Authorization
	Enter.	Enter.	Enter.	Enter.	Enter.
	Enter.	Enter.	Enter.	Enter.	Enter.
	Enter.	Enter.	Enter.	Enter.	Enter.
	Enter.	Enter.	Enter.	Enter.	Enter.
	Enter.	Enter.	Enter.	Enter.	Enter.

* The date entered should reflect the date that the discrepancy (MMI) was originally discovered, not the date reported to the NSP.

Terms and Definitions:

Evaluation Types

TYPE	CODE	REFERENCE	COMMENTS
Initial	I	Part 60.15	Initial evaluation for new simulator
Continuing	C	Part 60.19	Recurrent evaluation – usually every 12 months
Upgrade	U	QPS (11)	Changing simulator qualification from lower to higher level (ILC to Level D)
Special-Focus	SF	QPS (10b,11q)	Evaluation at the discretion of the NSPM to cover safety concerns (NTSB recommendation or problem are for example)
Special-Restore	SR	Part 60.27	Includes Move, Non-Use, Loss of Continuing Qualification, Missing QTG
Special-Surveillance	SS	QPS (11q)	Like SF, used to gather additional data on simulator and sponsor
Special-Update	SU	Part 60.16	Modifications
Special-Other	SO		Other – not mentioned above

Evaluation Information

FSTD Configuration

The FSTD configuration evaluated when variable FSTD configurations exist under one FAA ID number (i.e. engine types, propeller types, avionic suites or FMS, etc).

T001

Commonly referred to as the Statement of Qualification (SOQ). Check “Yes” if a new SOQ was issued. For most continuing and initial evaluations a new SOQ will be issued.

T001A

Sometimes referred to as the Configuration List. Check “Yes” if the T001A has been changed from the previous official version.

BASA-SIP

Bilateral Aviation Safety Agreement – Simulator Implementation Procedures. Click “Yes” if the evaluation you are performing will be sent to another National Aviation Authority. This is typically marked “No”. There are only two current agreements: UK CAA and Transport Canada.

Sponsor Feedback

Sponsors are encouraged to leave Feedback for the NSPM concerning this evaluation or other matters. Select the Feedback link on this page or go to the NSP Homepage.

NSP Evaluation Discrepancy Instructions:

• The report must be updated with the sponsor’s designated DR number for each discrepancy and be submitted as soon as practical.

• Sponsors should use this form to report discrepancy closures when required. To indicate discrepancy closure, enter the current “Corrective Action Taken,” “Sponsor DR Number”, and the “Date Closed.”

• Where the sponsor is operating under an NSPM-Authorized/Accepted DPS, an update reflecting current status must be submitted if a self-authorized extension is being exercised.

Severity Levels:

• Each NQT & DR must be assigned a severity level by the Evaluation Team Lead using the following table as a guide:

Severity Level	Description	Example(s)
0	No severity.	Research and correct DRs that are still open, i.e. sponsor has not yet made determination of the issue. FSTD evaluation findings or observations which require no corrective action
1	Least severe. Very minor issue with no FSTD fidelity impact.	Dirty windscreens, worn seats, worn seatbelts, one bulb (of two bulbs) burned out, scratched smoke googles, etc.
2	Minor Visual issue or lights burned out (both bulbs), missing emergency equipment, etc.	Blend zones, color balance, aliasing, missing large/major geographical items.
3	Single minor sub-system inoperative (most normal DRs).	Electrical, Air Systems, Hydraulic, Auto-flight, navigation (FMS), systems inoperative or malfunctions not working correctly (possibly affecting training requiring restriction or work-around). Any single QTG failure not resolved during evaluation.
4	Single major FSTD system failure during evaluation (with reset).	Motion, Visual or Control Loading failure during evaluation with a reset. Also, include any cockpit freeze-ups requiring a system reset, reposition, or reload. Multiple QTG failures not resolved during evaluations.
5	Most severe. Multiple major FSTD system failures during evaluation.	Multiple (two or more) major system failures with possible resets or any one failure unable to be reset. Also, FSTD AOG before or during the evaluation.

Discrepancy Closure Not Requiring NSP Notification:

• The NSP does not require notification of a discrepancy closure if designated as “Close per Sponsor’s SQMS.” In these cases, the sponsor will document the discrepancy in the sponsor’s discrepancy log, prioritize, and take corrective actions in accordance with their Simulator Quality Management System (SQMS).

Sponsor Reportable MMI Instructions:

Sponsors should use this form to report MMI status in accordance with §60.25 when an MMI condition has exceeded 30 days and the sponsor is seeking authorization to operate the FSTD. If you are unsure whether a reportable MMI situation exists? See FSTD Guidance Bulletin 08-01 at MMI Guidance Bulletin.

• Sponsors shall forward a copy of the report to the local Training Program Approval Authority (TPAA)

• MMI conditions corrected within the 30-day window do not require NSP notification.

• Sponsors should complete the first four fields. The date entered should reflect the date the discrepancy (MMI) was originally discovered, not the date reported to the NSP.

• The NSP will respond within five business days. Authorization is implied during this time period.

Returning the Form:

• Do not alter the format of the NSP Evaluation Report from a Microsoft Word document. PDF files of this form are not acceptable.

• Sponsors may return this form by e-mail to the NSP at [email protected] . Please include the FAA FSTD ID number in the email subject line. If you are unable to e-mail the report, please fax it to the NSP at 404-474-5656.

Additional References:

• NSP Guidance Bulletin 07-01, Discrepancy Closure and Request for Due Date Extension

• NSP Guidance Bulletin 08-01, Missing, Malfunctioning, or Inoperative (MMI) Component Reporting

Page 3 of 10 NSP Form T002: 11/30/2022

OMB Control Number 2120-0680: Expiration Date 11/30/2025

Completion of this letter is voluntary. You are not required to respond or use this template unless it displays a currently valid OMB control number.