英国空中交通管理调查表格

CAA Occurrence Number ATS OCCURRENCE REPORT NOTES: (i) See Instructions and Explanatory Notes. (ii) When completed, please send to: Safety Data, Civil Aviation Authority, Safety Regulation Group, Aviation House, Gatwick Airport South, West Sussex, RH6 0YR. e-mail: sdd@caa.co.uk Fax: 01293 573972 Tel: 01293 573220 (iii) Fill in boxes 1-56 as required. When completed, print this form and send it to the above address by fax or post. CATEGORIES OF OCCURRENCE 1 ACCIDENT AIRPROX INCIDENT ABANL (CA939 Action YES NO) INFRINGEMENT NB Signal action is required for Accident and AIRPROX as per MATS Part 1 Section 6. 2 Occurrence Position 3 FL ALT/HT (FT) 4 Date (dd/mm/yyyy) 5 Time - UTC (HH:MM) 6 Day Night OPERATOR CALLSIGN/REGN TYPE FROM TO SSRCODE MODE C DISPLAYED IFR/VFR/SVFR 7 8 9 10 11 12 13 YES NO 14 15 16 17 18 19 20 21 YES NO 22 23 24 25 26 27 28 29 YES NO 30 31 RTF Frequencies 32 Radar Equipment 33 Equipment Unserviceabilities 34 QNH 35 Runway in use 36 CLASS & TYPE OF AIRSPACE 37 ATS PROVIDED 38 SID/STAR/ROUTE 39 Was prescribed separation lost? YES NO 40 Min Separation Horizontal ............NM Vertical ................ft 41 Alert Activation Collision Conflict Alert TCAS STCA SMF 42 Traffic info given by ATC? YES NO 43 Avoiding action given by ATC? YES NO 44 BRIEF TITLE Summary 45 NARRATIVE - use a diagram if necessary (Aerodromes submit weather report including local and regional QNH). continue on a separate sheet if necessary. 46 Name ................................................... 47 On duty as ....................................... 48 ATS Unit .................................................... 49 Time since last break ..................... 50 Start time of shift (UTC) .......................... 51 Radar recordings held YES NO 52 RTF recordings 53 List other agencies advised 54 Date (dd/mm/yyyy) Page 1 of 2Form SRG 1602 (CA 1261) June 2012 held YES NO ............................................................................................................. ............................................................................................................. SRG 1603 (CA 1262) action? ............................................................. 55 Address ................................................................................................................................................................................................................................ 56 Email Address ............................................................................................................................. Telephone ........................................................................ ADVICE ON THE COMPLETION OF THE CAA OCCURRENCE REPORT FORM SRG1602 Page 2 of 2Form SRG 1602 (CA 1261) June 2012 USE AND EXPLANATION OF TERMS IN BOX 1 ACCIDENT: A UK reportable accident. AIRPROX: A situation in which, in the opinion of a pilot or a controller, the distance between aircraft as well as their relative positions and speed have been such that the safety of the aircraft involved was or may have been compromised. INCIDENT: Any Occurrence not appropriate to the other categories. ABANL: An Alleged Breach of Air Navigation Legislation, as a Supplementary Report whenever CA939 action is taken. INFRINGEMENT: An alleged unauthorised infringement of regulated airspace. EXPLANATORY NOTES (Please also refer to MATS Part 1, Section 6) GENERAL: Try to complete ALL boxes. If NOT APPLICABLE use N/A, or if NOT KNOWN use N/K. Avoid use of technical jargon, hieroglyphics and abbreviations. BOX 1: Should the Occurrence involve more than one category (e.g. an ABANL could arise from an INFRINGEMENT), tick both categories. BOXES 7 TO 14 } BOXES 15 TO 22} These boxes cater for up to three involved aircraft. Use the narrative for additional aircraft. BOXES 23 TO 30} BOX 39: Must be completed if prescribed separation was required to be achieved in accordance with MATS Part 1 or 2. BOX 40: Should contain your estimate, where possible, of the minimum separation achieved and must be completed for an AIRPROX. This will be coded for computer input purposes and amended if necessary after investigation. BOX 44: This box should contain a simple, one-line statement summarising the Occurrence, i.e. 'Co- ordination problems', 'Level bust', 'Overload' etc. BOX 51/52: Relevant RTF and Radar recordings can be vitally important to subsequent investigations. Retention action should be considered for all reports and is to be in accordance with MATS Part 1 and any local procedures. BOX 53: It is important to ensure that any involved agency (e.g. Pilot, Operator, ATSU) is informed of the reporting action. This box should also indicate those organisations required by MATS Part 1 to be informed (e.g. AAIB for an aircraft accident). REPORTING TIME Reports must be despatched within 96 hours of the event unless exceptional circumstances prevent this. ACKNOWLEDGEMENT OF REPORTS Acknowledgement of reports (other than CONFIDENTIAL – see below) is normally given via Safety Data’s monthly list of 'ATC Reported Occurrences'. If, exceptionally, individual acknowledgement is required, please contact Safety Data direct. UNIT MANAGEMENT ACTION Reporters are requested to send a copy to the Unit Management. This is for local assessment and any immediate follow-up action. Additional input and/or covering comment from Unit Management is highly desirable for both Safety Data evaluation and any follow-up investigation. CONFIDENTIAL REPORTS A report may be submitted confidentially. Please clearly annotate the top of the form 'CONFIDENTIAL'. The second copy need not be forwarded to local management. BOXES 46 to 56 should be completed. The CAA will respect the confidentiality and the Head of Safety Data will contact you personally. meta: FormID: 39 VersionNo: 2 FormType: E cmd: Submit: auto: ReferenceNumber: SubmittedDate: app: OccPosn: Height: Date1: Time: 00:00 Operator1: 0: 1: 2: Callsign1: 0: 1: 2: Type1: 0: 1: 2: From1: 0: 1: 2: To1: 0: 1: 2: SSRCode1: 0: 1: 2: IFRVFRSVFR: 0: Please select 1: Please select 2: Please select RTFFreq: RadarEquip: EquipUnserv: QNH: RwayInUse: ClassofAirspace: Please Select TypeofAirspace: Please Select ATSServiceProvided: Please Select SIDSTARRoute: HSep: AlertCollision: AlertConflict: VSep: AlertTCAS: AlertSTCA: AlertSMF: Summary: Narrative: Name: OnDutyAs: ATSUnit: TimeSinceBrk: 00:00 StrtTime: 00:00 AgencyAdv1: AgencyAdv2: Date2: Check Box25: Address1: Telephone: Airprox: Incident: Accident: Infringement: ABANL: CA939: ModeC1: ModeC2: ModeC3: Avoid: RadioHeld: Altitude: DayorNight: Info: RadarHeld: No Separation: pers: EmailAddress: