air traffic incident report form (for pilot) accident investigation board ... traffic information...
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AIP SWITZERLAND AIR TRAFFIC INCIDENT REPORT FORM - 1
SKYGUIDE, CH-8602 WANGEN BEI DÜBENDORF
AIR TRAFFIC INCIDENT REPORT FORM(for pilot)
Please forward written form to:
1 Airprox Procedure Facility TCAS / ACAS
2 Radio callsign of reporting aircraft: _______________________________________
Date and time of incident: Pilot: Aircraft registration:
_______________________UTC ________________________________ ________________________________
Time in min./sec. elapsed between first sighting and closest proximity: Avoiding action: If yes, based on TCAS:
________________________________ yes no yes no
Type of aircraft: Aerodrome of departure: Aerodrome of destination:
________________________________ ________________________________ ________________________________
In communication with: FIR and/or country: Frequency:
________________________________ ________________________________ ________________________________
Radar identified: Traffic information received: Transponder / SSR-code:
yes no yes no ________________________________
3 Position HDG or route: TAS
__________________________ ___________________________ ___________ kts
4 FL, altitude or height 1) At time of incident: Level flight Climb Descend
________________ m / ft / FL 2) At first sighting: Level flight Climb Descend Altimeter setting:
____________________ m / ft / FL ________________ hPa
5 Flight weather conditions 1) In general: IMC VMC
2) In particular: On top Below clouds In clouds Between layers In and out of clouds Sky clear
3) Distance from clouds Vertical: Horizontal: Sky coverage:
________________ m / ft _________________ m / ft / NM
4) Flight visibility: Into sun Out of sun In haze Remarks:
__________________ km / NM
Swiss Accident Investigation Board (SAIB)Aéropôle 1
1530 Payerne/SwitzerlandFax: +41 (0) 58 484 33 01
E-Mail: [email protected]
Federal Office of Civil Aviation (FOCA)Safety Risk Management (SRM)
3003 Bern/SwitzerlandFax: +41 (0) 58 463 59 83
E-Mail: [email protected]
and
SKYGUIDE, CH-8602 WANGEN BEI DÜBENDORF
AIR TRAFFIC INCIDENT REPORT FORM - 2 AIP SWITZERLAND
6 Description of other aircraft 1) Registration / RTF call sign: 2) Type of aircraft:
______________________________ ____________________________
3) Markings, colours and or lights: Camouflage: 4) Shape:
yes no
5) Low wing High wing Shoulder wing 6) Number and position of engines: 7) Estimated heading:
Turning left Turning right
8) Level flight Climb Descend 9) Other relevant information: SSR-code:
_________________________
7 Description of incident
8 Pilot's judgement: Risk of incident was: high low none
9 Information from ATC Unit 1) Traffic information issued: 2) Information issued:
yes no Direction Distance Heading
sertem fo sderdnuHsertem fo sderdnuH
10
9
8
7
6
5
4
3
2
1
0
1
2
3
4
5
6
7
8
9
10
14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 1410
9
8
7
6
5
4
3
2
1
0
1
2
3
4
5
6
7
8
9
10
14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14300
270
240
210
180
150
120
90
60
30
0
30
30
90
120
150
180
210
240
270
300
Hun
dred
s of
feet
MET
RES
Hun
dred
s of
feet
PLANVIEW PROFILEVIEW
Signature of reporting person: Date:
Please forward written form to:
20 NOV 2008
Swiss Accident Investigation Board (SAIB)Aéropôle 11530 Payerne/Switzerland Fax: +41 (0) 58 484 33 01E-Mail: [email protected]
Federal Office of Civil Aviation (FOCA)Safety Risk Management (SRM) 3003 Bern/SwitzerlandFax: +41 (0) 58 463 59 83E-Mail: [email protected]
and
In case of airprox/sighting: including relative flight path, vertical and horizontal distance to other aircraft at first sighting and at time of incident, executed and/or observed avoiding actions. If avoiding action was based on TCAS, state kind ofadvisory.