SMS Pro Issue Reporting


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No Non-Punitive Reporting Policy Available in English

Nature of Issue/Concern

Full Name:
Email:    

Select Type of Concern
Select Custom Report Type
Select Audit

Flight Safety Form

Reporter
Experience
  years
Airspace
Weather
Light
ATC Advisory
Altitude
  ft.
Miss Distance Horizontal (ft.)
 ft.
Miss Distance Vertical (ft.)
 ft.
Evasive Action Taken
TCAS Factor
GPWS Active

Air Traffic Control Form

Reporter
Experience
  years
ATC Control Position
Instruction Factor
Airspace
Weather
Light
Altitude
 ft.
Miss Distance Horizontal (ft.)
 ft.
Miss Distance Vertical (ft.)
 ft.
Evasive Action Taken
TCAS Factor
Conflict Alert Active

Maintenance Report Form

Reporter
Experience
  years
Instruction Factor
Other Factors
Items Involved
When Problem Detected
Deferred Maintenance
Outcome
Airworthiness
Mission
ATA Code

Cabin Safety Form

Reporter
Experience
  years
Weather
Light
Flight Phase
Tail #
Flight #
Flight Date
RadDatePicker
RadDatePicker
Open the calendar popup.
Cabin Activity
Passenger Involved
Injury
Fire/Smoke
Evacuation

OSHA Form

Establishments are not yet configured. OSHA reports belong to establishments, which are unique business locations.

SMS Admins configure establishments in the OSHA 300 module on the Establishments tab.

Bird Strike Reporting Form


Operator
Aircraft Make/Model
Engine Make/Model
Aircraft Registration
Time of Day
Airport Name
Runway Used
Location
Height AGL (ft)
Speed (IAS) (kt)
Flight Phase
Birdstrike Status
Radome
Windshield
Nose (excluding above)
Engine #1
Engine #2
Engine #3
Engine #4
Propeller
Wing/Rotor
Fuselage
Landing Gear
Tail
Lights
Other (specify)
Effect on Flight
Sky Condition
Precipitation
Bird Species
Number of birds seen
Number of Birds Struck
Size of Birds
Pilot Warned of Birds
Person Preparing Report
Reporter Title
Department

Captain's Trip Report

Flight Date
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
Aircraft
Flight #
Crew
Flight Type
Irregularities
Description
Captain's Name
Chief Pilot's Name

Interference With a Crewmember

Flight #
Aircraft Type
Aircraft Registration
Date of Occurrence
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
Time of Occurrence
Location

Phase of Flight






Crewmember Names

Captain
Flight Attendant 1
First Officer
Flight Attendant 2


Suspected Factors That May Have Caused the Interference Event
Nature of Obvious Injuries to Passenger(s) Onboard
Nature of Obvious Injuries to Crewmember(s) Onboard
Actions Taken by Captain and Crewmembers
Name of Law Enforcement Agency Contacted
Passenger identity (if known)
Crew Suggestions or Opinions
Additional Information

Bird / Other Wildlife Strike Report

1. Name of Operator:
2. Aircraft Make/Model
3. Engine Make/Model
4. Aircraft Registration
5. Local Date/Time of Incident
Date/Time Occurred
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
6. Time of Incident
select
7. Airport Name
8. Runway Used
9. Location if Enroute
(Nearest Town/Reference & State)
10. Height AGL (ft)
11. Speed (IAS) (kt)
12. Phase of Flight
select
13. Part(s) of Aircraft Struck or Damaged
  Struck Damaged
A. Radome
B. Windshield
C. Nose (excluding above)
D. Engine No. 1
E. Engine No. 2
F. Engine No. 3
G. Engine No. 4
  Struck Damaged
H. Propeller
I. Wing/Rotor
J. Fuselage
K. Landing Gear
L. Tail
M. Lights
N. Other (specify)

14. Effect on Flight
select

15. Sky Condition
select
16. Precipitation
select
17. Bird Species
18. # birds seen and/or struck
Seen
select
Struck
select
19. Size of bird
select
20. Pilot warned of birds
21. Remarks (Describe damage, injuries, and other pertinent information)

DAMAGE / COST INFORMATION

22. Aircraft time out of service:
 Hours
23. Estimated cost of repairs (U.S. $):
24. Estimated other Cost
(U.S. $)(e.g. loss of revenue, fuel, hotels):
Reported by (Optional)
Title
Date
RadDatePicker
RadDatePicker
Open the calendar popup.
SAFETY MANAGEMENT SYSTEM (SMS)
INCIDENT/ACCIDENT/HAZARD/NEAR-MISS REPORT
This SMS Report is for reporting airside incidents / accidents / hazards or near-misses that may result, or have resulted in damage to Authority equipment / property or personal injury or third party vehicle / property damage.
Date of Report:
RadDatePicker
RadDatePicker
Open the calendar popup.
Person Reporting:
Check Type of Reports:
Occurrence date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
(if different from report date):
Time:
Hours
Minutes
General Area: Specific Location:
Employee Report Name: Occupation:
Description of Incident / Accident / Hazard / Near-miss / Workplace Violence:
Description of direct (root) cause(s):
Description of indirect (root) cause(s):
Description of injury / illness:
Object / Equipment / Substance causing Incident / Accident / Injury / Illness:
Employee WCB Report completed? Date reviewed:
RadDatePicker
RadDatePicker
Open the calendar popup.
Employee WCB Report forwarded to supervisor?
Note: Employee WCB report must be submitted within 72 hours

Airport Initial Safety Report

Report company  
Airport
Name  
Incident / Accident title
Occurrence airport
Airport
Occurrence time
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.

Incident / Accident type:


















Cause:

              

# of Persons Injured

Death
Serious injured
Slightly injured

Brief Description:

Determine responsibility:




Incident level:




Hazard/Occurrence Form

* Required
Date/Time Occurred
RadDatePicker
RadDatePicker
Open the calendar popup.
Leave date blank if unknown
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
Flight Details
Flight no
Met Conditions
select
A/C Registration
select
Turbulence
select
Departure Airport
Flight Phase
select
Destination Airport
Type of approach
select
Diverted Airport
Runway
Pilot Flying
select
Speed
kts
Location
A/C Mass
kg
FL
Alt
ft
A/C Technical Log no
Configuration
Auto Pilot
select
Gear
select
Flaps/Slats
select
Spoiler
select
Aerodrome Information
Wind
e.g. 09015, VRB05, 25015G30
Temp
e.g. 25-02
Visibility
e.g. 3500, CAVOK
Dew Point
e.g. 25-02
Weather
select
QNH
3 or 4 digits
Cloud 1
select
Cloud 2
select
Cloud height ft.
Cloud 3
select
Additional information (RWY cond, BA, ILS U/S, DME U/S, etc)

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

Security Officer Report

Reporter Name
Internal ID#
Incident Report ID

Incident Summary
Remaining Characters: 1000
Who, What, When, etc.
Remaining Characters: 2000

Incident Location
Incident Type
If Other, What Type

Officer Details / Comments
Remaining Characters: 3000

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

Personnel Fatigue Report

* Required
Name: Telephone:
Reason for Report: Related Company Report ref:


Event Date: Event Time: Base:
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
Flight No: Destination: Check-In Time: Check-Out Time:
Employee Type
Contributory factors
Contributory factors:
Timing of most recent sleep period: Timing of second most recent sleep period:
Start (reference time) End (reference time) Start (reference time) End (reference time)
Contributory factors:
Last Duty Period
Duty Period - Start: Flight Duty Period - Start: Flight Duty Period - End Duty Period - End
Previous Duty Period
Duty Period - Start: Flight Duty Period - Start: Flight Duty Period - End Duty Period - End
Contributory factors:








Other:
Physical Symptoms:




Other:
Cognitive Symptoms:



Other:
How did you feel?



What did you do?

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

Fatigue Report

* Required
Name:
Email:
Related Company Report ref:
Reason for Report:



Date of Fatigue:
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
* Base:
Flight No:
Destination:

Employee Type:

Contributory factors

Sleep
Timing of most recent sleep period:
Start (reference time)
End (reference time)
Timing of second most recent sleep period:
Start (reference time)
End (reference time)
Contributory factors:






Signs of Fatigue




Other:
How sleepy were you?





Please describe what happened, providing as much information as possible. Please also suggest what action is necessary to prevent it happening again.

Request Document Change

Document Title: 
Section(s) - Clause(s) or Paragraph(s)
Location of Discovery: 
Request Type:





Description of Issue or Required Change
Reason

Passenger Accident/Incident Report

Aircraft Type
Aircraft Registration
Date of Occurrence:
RadDatePicker
RadDatePicker
Open the calendar popup.
Safari users have to manually input the date in yyyy-MM-dd format (e.g. 2016-01-31), or switch to another browser (e.g. Chrome or Firefox). Leave blank if unknown.
Time of Occurrence

Passenger Name
Telephone number
Address
City
State, Zip, Country
Age
Occupation

Nature of Incident/Injury
Captain
Flight Attendant 1
First Officer
Flight Attendant 2

Ground Assistance Required?
Detailed Description of Occurrence

General Issue Details with Suggested Corrective Action

Provide Short Title of IssueRequired
(Example: Go-around at Las Vegas, Unstabilized Approach)
Describe Issue, including any factors you feel contributed (4000 characters max)Required
Remaining Characters: 4000
How severe or critical is this issue?
Initial actions taken to correct problem or prevent recurrence (250 characters max)
Remaining Characters: 250
Suggestions to correct problem or prevent recurrence (250 characters max)
Remaining Characters: 250

Where & When Occurred

Location
(Hangar / Runway / Office / Flight 321 / etc.)
Date/Time Occurred
RadDatePicker
RadDatePicker
Open the calendar popup.