SMS Pro Issue Reporting


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At Aero Contractors Nig. (ACN), our objective is to cultivate and foster a generative safety culture in which employees and customers are comfortable and encouraged to bring safety concerns to the attention of management.
Non-punitive Reporting Policy
  1. No person will be penalized or retaliated against for bringing safety issues to the attention of management.
  2. Safe flight operations are World Aviation’s most important commitment. To ensure this commitment, it is imperative that we have uninhibited reporting of all incidents and occurrences that compromise the safety of our operations.
  3. We ask that each employee accept the responsibility to communicate any information that may affect the integrity of flight safety. Employees must be assured that this communication will never result in reprisal, thus allowing a timely, uninhibited flow of information to occur
  4. All employees are advised that ACN will not initiate disciplinary action against an employee who discloses an incident or occurrence involving flight safety. This policy cannot apply to criminal, international or regulatory infractions
  5. ACN has developed safety reports to be used by all employees for reporting information concerning flight safety. They are designed to protect the identity of the employee who provides information. These forms are readily available in your work area.
  6. We urge all employees to use this program to help ACN continue its leadership in providing our customers and employees with the highest level of flight safety.

Nature of Issue/Concern

Full Name:
Email:    

Select Base/Location
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
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Cabin Activity
Passenger Involved
Injury
Fire/Smoke
Evacuation

OSHA Form

Select Establishment
Completed by
If not you, enter name
Title
Phone
Date Reported
RadDatePicker
RadDatePicker
Open the calendar popup.
If not today
What was the employee doing just before the incident occurred? Describe the activity, as well as the tools, equipment, or material the employee was using. Be specific. Examples: "climbing a ladder while carrying roofing materials"; "spraying chlorine from hand sprayer"; "daily computer key-entry."
What happened? Tell us how the injury occurred. Examples: "When ladder slipped on wet floor, worker fell 20 feet"; "Worker was sprayed with chlorine when gasket broke during replacement"; "Worker developed soreness in wrist over time."
What was the injury or illness? Tell us the part of the body that was affected and how it was affected; be more specific than "hurt," "pain," or sore." Examples: "strained back"; "chemical burn, hand"; "carpal tunnel syndrome."
What object or substance directly harmed the employee? Examples: "concrete floor"; "chlorine"; "radial arm saw." If this question does not apply to the incident, leave it blank.

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.
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
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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
Additional Information
Crew Suggestions or Opinions

Bird/Wildlife Strike Report

Note: If field is unknown please select unknown from the pick list, but if field is unreported please leave blank.
Please enter your name
Telephone number
Type of Report
Reporting Source
Operator
Date (yyyy/mm/dd)
RadDatePicker
RadDatePicker
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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.
Height AGL (ft)
Local Time (hhmm) (24 hour time)
Time Zone
Speed (IAS) (kt)

Aircraft Information
Model
Make
Engine Type
Engine Make
Registration
Flight No.
Airport Information
Airport Name
Phase of Operation
Province
Region
Runway
If En Route, distance from airport
Parts Struck/Damaged
Radome
Windshield
Nose (excluding above)
Engine #1
Engine #2
Engine #3
Engine #4
Propeller
Wings
Rotor
Fuselage
Landing Gear
Tail
Lights
Pitot Static
Tail Rotor
Other

Effects on Aircraft/Flight










Light Condition
Sky Condition
Precipitation
Bird/Mammal Information
Species Common Name
Size of Birds
Number of birds seen
Number of Birds Struck
Bird Remains Submitted for Identification?
Pilot Warned of Birds
Additional Information
Cost Information
Aircraft Time out of Service
  Hours
Estimated Cost of Repairs or Replacement
  CDN $ in thousands
Damage Category (DND)
Estimated Other Costs (loss of revenue, hotels)
  CDN $ in thousands

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.
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.
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
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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
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Person Reporting:
Check Type of Reports:
Occurrence date:
RadDatePicker
RadDatePicker
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(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
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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
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:
 (time)

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