SMS Pro Issue Reporting


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(If you have not completed SMS Induction continue to the bottom of the page) 

Issue Reporting Process  (Special Reporting Forms located in Policy/Documents)

  • Event Occurs/Hazard Detected
  • Fill out report online or send email to safety@globalxair.com
  • Any Report may be written and placed in the box located in front of the Director of Safety's office.
  • Report is automatically emailed to safety team
  • Initial Risk Assessment using risk matrix described in Section 3.6
  •  Confirm the Targeted Closure Date (desired due date per policy)
  • Assign responsible manager
  • Classify the issue
  • Determination of depth of the investigation (required or not required)
  • Develop corrective action plan (CPAs)
  • Review report at safety committee meeting/Safety Review Board
  • Email to Reporter with outcome
  • Feedback to Reporter (if external to SMS database)
  • Take Action/Alert employees of change
  • Communicate Lessons Learned via Lessons Learned Library in SMS database
  • Validation/review date entered into database for monitoring

 

(Rev F/03-10-2021)

Nature of Issue/Concern

Full Name:
Email:    

Select Base/Location
Select Vendor/Client
Select Type of Concern
Select Custom Report Type
Select Audit

Flight Safety/Near Miss Report

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

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

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

Captains Irregularity 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)
Ground Safety Report/Accident/Incident
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

IROP Report/Hazard/Occurrence

* 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?

The copy of this report will be automatically emailed to services@tc.gc.ca (if auto-forwarding is setup by Admin)

DIRECTED BRIGHT LIGHT ILLUMINATION INCIDENT REPORT/QUESTIONNAIRE
Please take a few minutes to complete this report and submit as soon as possible after the incident.
Person filing the Report
Name Telephone No.
Mailing Address Email Address
Crew Members (attach extra pages if necessary)
Name Age Glasses/Contact Lenses
Time of Incident
Date (yyyy-mm-dd) 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.
Aircraft Type Flight # or Call Sign
Location and Weather Conditions
Closest Airport or City VOR Radial or DME
Aircraft Altitude Pitch and Bank Angle
Phase of Flight Procedure Identifier
Weather Conditions Relative Darkness
Light Source Location: Position
Angle from aircraft?
How did it hit you? (Straight in the eyes or off axis?)
How did it enter the cockpit? (12 o'clock/left side window?)
Light Description
Colour, Static/Moving
Relative intensity (flashbulb, headlight)
Duration of Exposure
Light Description (cont'd)
Beam Angle from Ground
Steady or Flickering
Was light visible prior to the incident?
Effect on Crew Member(s)
Any after effects?
Post-flight medical attention sought? When, where?
What cockpit tasks were you performing when the exposure began?
Did the illumination startle you?
How long do you estimate your attention was partly or fully averted as a result of the illumination?
Remaining Characters: 170
After the initial illumination, were you able to concentrate fully on flying, or were you partially preoccupied by what happened?
Remaining Characters: 170
Did the illumination cause any interruption to your vision?
Could you see well enough during the illumination to adequately focus on instruments and outside references?
Remaining Characters: 170
Did the vision distraction cease immediately when you looked away from the source?
Did "spots" persist in your vision after you exited the light beam? For how long?
After leaving the light beam, was your vision "bleached" to the point where you could not adequately focus on objects inside or outside the cockpit? For how long?
Remaining Characters: 170
Were you distracted to the point where cockpit tasks were delayed or overlooked? Please elaborate.
Remaining Characters: 170
Were you visually or psychologically incapacitated to the point where you wanted to, or did, relinquish control of the aircraft to the other pilot?
Remaining Characters: 170
How long did this exist before you felt comfortable with resuming control of the aircraft?
Did the illumination interrupt the normal orderly flow of cockpit duties? Please elaborate.
Effect on Crew Member(s) (cont'd)
Did you experience eye pain?
Describe (location, intensity and persistence).
Did you rub or touch your eyes at the time of the incident?
Did you feel disoriented at any time? Vertigo?
Did the aircraft enter an unusual attitude?
If so, describe it.
How long did any symptoms you experienced from the exposure persist?
Did the light appear suddenly, and did it become brighter as you approached it?
Remaining Characters: 170
Was the light coming directly from the source, or did it appear to be reflected off other surfaces?
Remaining Characters: 170
Was there more than one source of light?
Describe any evasive maneuvering you attempted.
Did the beam follow you as you moved away?
Additional Comments
Remaining Characters: 1500
The copy of this report will be automatically emailed to services@tc.gc.ca (if auto-forwarding is setup by Admin)

This report type is not setup, use OLD ISSUE REPORTER

This report type is not setup, use OLD ISSUE REPORTER

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