Document
EXHIBIT XX Safety Management System (SMS), Flight Time, Accident History, and FAA Violation Question Form (Pre-Award Ver. 6.3 – 2026) This is an optional form to complete Exhibit XX – SMS Questionnaire as referenced in applicable DOI solicitations. Other formats are acceptable, but responses must include all the information requested. Refer to the SMS Questionnaire Supplement to aid in the completion of this form: https://www.doi.gov/aviation/library .
Refer to FAA Advisory Circular AC 120-92D and IS-BAO for additional SMS information.
For example, in the SMS Questionnaire, FAA Component Reference number (e.g., FAA 3.3) refers to the section in AC 120-92D, and the IS-BAO Element number (e.g., IS-BAO 3.1.3.1) st refers to the IS-BAO 21 Edition standard/protocol. These documents are intended to provide additional guidance to address the information requested in the Exhibit. If needed, continuation sheets are available at the end of the form.
SAFETY POLICY (QUESTIONS 1-12) Question 1 (FAA 3.3, IS-BAO 3.1.3.1): Provide reference to policy (company document(s)) which shows there is one individual responsible for the effective administration/implementation of the SMS (e.g., safety manager, director of safety). Provide evidence to show the position is filled.
Response: Question 2 (FAA 3.3, IS-BAO 7.2.1): Provide reference to and evidence from company document(s) that show SMS duties, authorities, and accountabilities for all employees Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 3 (FAA 3.3, IS-BAO 3.1.1.1): Provide reference to and evidence of a strong organizational commitment and clear statement (e.g., safety/SMS policy) about the provision of necessary resources for the SMS.
Response: Question 4 (FAA 3.3.3.2, IS-BAO 3.1.5.1): Provide reference to a policy/process showing the requirement to review and update the SMS Manual. Provide evidence the SMS Manual has been reviewed/updated in accordance with company requirements.
Response: Question 5 (FAA 3.3.1, IS-BAO 3.1.1): Provide reference to a company policy/process requiring the review and update of organizational safety objectives. Provide evidence of the current safety objectives (see #17 for targets and indicators).
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 6 (FAA 3.3, IS-BAO 6.1.1): Provide reference to and evidence of the company manual(s) that contain flight operational policy and aircraft maintenance policy.
Response: Question 7 (FAA 3.3, IS-BAO 6.2.1): Provide reference to the Operations Manual distribution policy. Provide evidence the current version of the Operations Manual is available to employees in accordance with company policy.
Response: Question 8 (FAA 3.3, IS-BAO 6.1.1): Provide reference to the Operations Manual revision policy. Provide evidence the Operations Manual has been revised in accordance with company policy.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 9 (FAA 3.3, IS-BAO 3.1.4.1): Provide reference to the Emergency Response Plan (ERP) and ERP revision policy. Provide evidence the ERP is up-to-date in accordance with company policy.
Response: Question 10 (FAA 3.3, IS-BAO 8.5): Provide reference to policy showing how aircrew member records (e.g., FAA certificates, medical, proficiency records) are maintained. Provide evidence the aircrew records are maintained in accordance with company policy.
Response: Question 11 (FAA 3.3, IS-BAO 15.2.3): Provide reference to company policy that ensures maintenance personnel are trained and approved to conduct specific maintenance (e.g., make/model). Provide evidence records are maintained in accordance with company policy.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 12 (FAA 3.3, IS-BAO 15.1): Provide reference to Operations Manual policy for obtaining aircraft maintenance services while away from home base. Provide evidence of aircraft maintenance received or denied in accordance with the policy.
Response: SAFETY RISK MANAGEMENT (QUESTIONS 13-16) Question 13 (FAA 3.4, IS-BAO 3.2.1.1): Provide reference to a risk management policy that includes: system analysis, hazard identification, risk analysis (exposure), risk assessment (severity and likelihood), decision making (mitigations and control), and validation of control (controls effective). Provide evidence the policy is in use.
Response: Question 14 (FAA 3.4, IS-BAO 3.2.1.1): Provide reference to policy for hazard/threat reporting and tracking. Provide evidence that the program is in use.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 15 (FAA 3.4, IS-BAO 3.2.1.1): Provide reference to company policy addressing the use of operational risk assessments and/or use of a flight risk assessment tool. Provide evidence of a recently completed risk assessment that shows the implementation of this policy.
Response: Question 16 (FAA 3.4, IS-BAO 3.1.2.1): Provide reference to company policy describing management approval requirements for operational risk assessments (e.g., FRAT) when risk reaches defined, elevated levels. Provide evidence of a completed elevated (e.g., medium, high) risk assessment showing approval in accordance with company policy.
Response: Safety Assurance (Questions 17-23) Question 17 (FAA 3.5, IS-BAO 3.3.1): Provide reference to a policy/company document describing safety performance targets (SPTs) and safety performance indicators (SPIs). Provide evidence showing SPTs/SPIs are current and being monitored (e.g., safety performance report, SMS dashboard screen capture).
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 18 (FAA 3.5, IS-BAO 3.3.2): Provide reference to a management of change (MOC) or change management policy. Provide evidence of the use of the change management policy (e.g., acceptance or rejection of a change).
Response: Question 19 (FAA 3.5, IS-BAO 3.3.3): Provide reference to the SMS continuous improvement policy. Provide evidence the SMS is being monitored and assessed in accordance with the policy.
Response: Question 20 (FAA 3.5, IS-BAO 3.5): Provide reference to company policy establishing required intervals for SMS audits (e.g., monthly, quarterly). Provide evidence of the current audit schedule demonstrating compliance with the policy (e.g., audit calendar, scheduled audit tracking document).
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 21 (FAA 3.5, IS-BAO 3.5): Provide reference to policy that shows SMS audits must be documented. Provide evidence of the most recently completed audit (i.e., audit report).
Response: Question 22 (FAA 3.5, IS-BAO 3.5): Provide reference to policy which requires SMS audit findings (e.g., deficiencies, nonconformities) to be addressed. Provide evidence of a finding being addressed, or corrective action being implemented.
Response: Question 23 (FAA 3.3, IS-BAO 15.1): Provide reference to the maintenance control system (method of documentation, tracking, scheduling, and recording). Provide evidence of the maintenance control system in use.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 SAFETY PROMOTION (QUESTIONS 24-30) Question 24 (FAA 3.3, IS-BAO 4.1): Provide reference to policy showing Emergency Response Plan roles (i.e., key personnel), responsibilities, and duties. Provide evidence that training has been provided for these personnel to accomplish the duties.
Response: Question 25 (FAA 3.3, IS-BAO 4.3): Provide reference to policy showing the Emergency Response Plan must be exercised (drill/test/exercise) at least annually and documented. Provide evidence of the most recent ERP exercise.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 26 (FAA 3.6, IS-BAO 3.4.2): Provide reference to the SMS safety communication policy. Provide evidence the policy describes the types of information to be communicated and how it will be communicated (e.g., method, frequency, responsibility).
Response: Question 27 (FAA 3.6, IS-BAO 3.4): Provide reference to approved company safety information sharing methods (e.g., intranet, bulletin board). Provide evidence of recent safety lessons learned shared with personnel.
Response: Question 28 (FAA 3.3.2, IS-BAO N/A): Provide reference to a safety award/incentive program. Provide evidence of the most recent award.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 29 (FAA 3.6, IS-BAO 8.1): Provide reference to the company training program (FAA and internal) that ensures ground crew and air crew are trained and competent to perform their assigned duties. Provide evidence that personnel have been trained and are competent to perform their duties.
Response: Question 30 (FAA3.6, IS-BAO 3.4.1): Provide reference to policy showing initial (new employee) and recurrent SMS training requirements. Provide evidence of the most recent SMS training record (initial or recurrent).
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 FLIGHT TIME, ACCIDENT HISTORY, AND FAA VIOLATIONS (FIVE YEARS: 10/1/XX – 9/30/XX) (QUESTIONS 31-33) Question 31 (FAA/IS-BAO N/A): Total number of flight hours during the five years defined in the Exhibit. Flight hours must be separated by year and category: fixed-wing, rotary-wing, and uncrewed aircraft system (UAS).
Example: 10/1/20__ - 9/30/20__: total _____ (separate by category as applicable: fixed, rotor, UAS) 10/1/20__ - 9/30/20__: total _____ (separate by category as applicable: fixed, rotor, UAS) 10/1/20__ - 9/30/20__: total _____ (separate by category as applicable: fixed, rotor, UAS) 10/1/20__ - 9/30/20__: total _____ (separate by category as applicable: fixed, rotor, UAS) 10/1/20__ - 9/30/20__: total _____ (separate by category as applicable: fixed, rotor, UAS) Five-year total: ________________ Response: Question 32 (FAA/IS-BAO N/A): Total number of accidents (aircraft accident as defined within 49 CFR 830.2) during the five years defined in the Exhibit. Accident details must be provided for each accident listed (e.g., date, NTSB accident number, registration number).
If the Offeror had an accident in the five years identified, provide an accident prevention plan.* The prevention plan must include the following elements: a) summary of accident (i.e., what happened?), b) description of mitigation(s) to prevent future occurrence (i.e., how was it corrected?), and c) description of assurance methods used to validate the effectiveness of mitigation measures (i.e., how do you make sure it doesn't happen again?).
*The submission of an accident prevention plan is not required, but if provided, may positively impact the offer.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 Question 33 (FAA/IS-BAO N/A): Total number of FAA violations (Civil Penalty) during the five years defined in the Exhibit. If violations were reported, Case information must be provided.
Response: SMS Questionnaire Form, Ver. 6.3 - 2026 CONTINUATION SHEET (1-33) Question ___, continued Response: Question ___, continued Response: Question ___, continued Response: SMS Questionnaire Form, Ver. 6.3 - 2026 CONTINUATION SHEET (1-33) Question ___, continued Response: Question ___, continued Response: Question ___, continued Response: SMS Questionnaire Form, Ver. 6.3 - 2026 CONTINUATION SHEET (1-33) Question ___, continued Response: Question ___, continued Response: Question ___, continued Response: SMS Questionnaire Form, Ver. 6.3 - 2026