| Data Element | Description | 
| Reporting entity designator: | Designator (or PRD equivalent) of the air carrier or operator entering the record (automatically populates with assigned credential) | 
| Reporting entity name: | Name of the certificate holder or operator as it appears on the certificate or is otherwise recorded in the FAA records. (automatically populates with assigned credential) | 
| Other DOT Agency entity name*: | 
 | 
| Regulating Agency (Non-FAA)*: | 
 | 
| Pilot certificate number: | Certificate number of the pilot receiving the action | 
| Pilot last name: | Name of the pilot as it appears on their certificate | 
| Date of test or occurrence: | Date | 
| Record Type: | Valid options: 
 | 
| Report Type*: | See Table B-2 (these options change based on selection above) | 
| Type of Test*: | See Table B-2 (these options change based on selection above) | 
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Morris, Christopher (FAA) | 
| File Modified | 0000-00-00 | 
| File Created | 2024-11-09 |