SECTION 1 –
Date (mm/dd/yyyy):	Location:
Aircraft Name:	Registration #:
Total sUAS Hours:	Maintenance Technician:
Person Reporting/Requesting Maintenance:
UAV Airworthiness:	In-service	Out-of-service
Maintenance Type:	Scheduled	Unscheduled	Repair	Crash
Components Involved:
Components Replaced/Repaired:
sUAS Returned to Service:	Yes	No	Date (mm/dd/yyyy):
Additional Comments:
SECTION 2 – Signatures
Requestor of Maintenance (Print)	Requestor of Maintenance (Signature)
Maintenance Technician (Print)	Maintenance Technician (Signature)
sUAS Program Manager (Print)	sUAS Program Manager (Signature)