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                  MALFUNCTIONING ENGINE STATISTICAL SURVEY
 
Return to:     MESS Survey
               NAR Headquarters
               PO Box 177
               Altoona, WI  54720

Or Email to:   kane@draper.com
	       (Jack Kane, S&T)
 
ENGINE DATA:
 
       Manufacturer____________________ Engine Type_______________________
 
       Date or Other Coding on Casing_____________________________________
 
       Date of Failure____________________________________________________
 
       Place of Failure___________________________________________________
 
       Have you notified the manufacturer?____ Do you have the casing?____
 
TYPE OF MALFUNCTION (check one)
 
       Nozzle Blown Out_________________________
 
       Detonation (split casing)________________
 
       Burning Propellant Ejected_______________
 
       No Ejection Charge (cap retained)________
 
       Casing Burned Through____________________ Describe where___________
 
       Other Failure Type (describe)______________________________________
 
       ___________________________________________________________________
 
       Comments. Also, please describe how long into the motor burn the
       failure occurred.
 
       ___________________________________________________________________
 
       ___________________________________________________________________
 
       ___________________________________________________________________
 
REPORTED BY:
 
       Name:______________________________________________________________
 
       Address:___________________________________________________________
 
       City/State/Zip: ___________________________________________________


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