Aviation Safety Management - SMS Pro Site

SMS Pro Issue Reporting

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To enter an ASAP report complete the following procedure:

1. Open the "Submit New Issue" page;

2. Ensure the "Select Type of Concern" is "Safety";

3. Select "ASAP Report" in the "Select Custom Report Type";

4. Fill in all information with as much detail as possible. Use the " Officer Details / Comments" for any other information you can provide.

Rev-Orig

Nature of Issue/Concern

Full Name:
Email:

Notify me when issue is closed
Notify me when comments are added to issue

Select Base/Location

Select Vendor/Client

Select Type of Concern

Select Custom Report Type

Select Audit

Or Add New Audit Name :

Flight Safety/Dispatch

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

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Cabin Activity

Passenger Involved

Injury

Fire/Smoke

Evacuation

Captains Irregularity Report

Flight Date

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Aircraft

Flight #

Crew

Flight Type

FreighterPassengerCharterFerry

Irregularities

YesNo

Description

Captain's Name

Chief Pilot's Name

Interference With a Crewmember

Flight #

Aircraft Type

Aircraft Registration

Date of Occurrence

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Time of Occurrence

Location

Crewmember Names

Captain

Flight Attendant 1

First Officer

Flight Attendant 2

Level Category

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

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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)

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 YesNo

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

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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:

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Person Reporting:

Check Type of Reports:

Injury/Illness

Property Damage

Equipment

Hazard

Violence

Fuel Spill

Near-Miss

Vehicle

Aircraft

Other

Occurrence date:

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(if different from report date):

Time:

Hours

Minutes

AMPM

General Area:

Specific Location:

Employee Report

Name:

Occupation:

Description of Incident / Accident / Hazard / Near-miss / Workplace Violence:

PPE Available?

Used?

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? YesNo

Date reviewed:

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Employee WCB Report forwarded to supervisor? YesNo

Note: Employee WCB report must be submitted within 72 hours

IROP Report/Hazard/Occurrence

Date/Time Unknown

* Required

Date/Time Occurred

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UTCLocal

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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

Alt

A/C Technical Log no

Configuration

Auto Pilot

Gear

Flaps/Slats

Spoiler

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

ASAP 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

Personnel Fatigue Report

* Required

Name:	Telephone:

Reason for Report:

Related Company Report ref:

Called in fatigued for an assigned duty
Fatigue associated with a safety-related event
General Fatigue concern

Event Date:

Event Time:

Base:

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Flight No:

Destination:

Check-In Time:

Check-Out Time:

Employee Type
PilotCabin CrewMaintenanceDispatch/Ops personnelOther
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:
Multiple consecutive dutiesStart Time Hotel rest (noisy / temp / other)Insufficient rest time Finish timeChange of Standby / Reserve period Re-assignment / Irregular OpsWorkload - Overload Long duty dayDuty in WOCL (Window of Circadian Low 0200 - 0600) Multiple flying legsHome issues HealthNight Duty Long-term fatigueOther (detail below) AM / PM / Redeye mixing
Other:

Physical Symptoms:

NO PHYSICAL SYMPTOMS NOTEDLong blinks
Rubbing eyesDifficulty keeping eyes open
YawningHead nodding
Frequent blinkingOther (detail below)
Staring blankly

Other:

Cognitive Symptoms:

NO COGNITIVE SYMPTOMS NOTEDImpaired problem solving
Impaired attentionImpaired situational awareness
Impaired memoryOther (detail below)
Reduced communication

Other:

How did you feel?

Fully alert / Wide awakeModerately tired, let down
Very lively. Responsive, but not at peakExtremely tired. Very difficult to concentrate
OK, Somewhat freshCompletely exhausted
A little tired. Less than peak

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
		YesNo
		YesNo
		YesNo

Time of Incident

Date (yyyy-mm-dd)

Time

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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?	YesNo

Effect on Crew Member(s)
Any after effects?	YesNo
Post-flight medical attention sought? When, where?
What cockpit tasks were you performing when the exposure began?
Did the illumination startle you?	YesNo
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

Passenger Accident/Incident Report

Aircraft Type

Aircraft Registration

Date of Occurrence:

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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?

Operator
Aircraft Make/Model
Engine Make/Model
Aircraft Registration
Time of Day	--- --- --- Dawn Day Dusk Night
Airport Name
Runway Used
Location
Height AGL (ft)
Speed (IAS) (kt)
Flight Phase	--- --- --- Parked Taxi Take-off Run Climb Enroute Descent Approach Landing Roll

Birdstrike Status	ConfirmedUnconfirmedNear Miss
Radome	StruckDamagedNo
Windshield	StruckDamagedNo
Nose (excluding above)	StruckDamagedNo
Engine #1	StruckDamagedNo
Engine #2	StruckDamagedNo
Engine #3	StruckDamagedNo
Engine #4	StruckDamagedNo
Propeller	StruckDamagedNo
Wing/Rotor	StruckDamagedNo
Fuselage	StruckDamagedNo
Landing Gear	StruckDamagedNo
Tail	StruckDamagedNo
Lights	StruckDamagedNo
Other (specify)	StruckDamagedNo
Effect on Flight	--- --- --- None Aborted Take-off Precautionary Landing Engines Shut Down Other (specify)
Sky Condition	--- --- --- Clear Partly Cloudy Overcast
Precipitation	--- --- --- Fog Rain Snow
Bird Species
Number of birds seen	--- --- --- --- ---- ---- 1 2-10 11-100 more
Number of Birds Struck	--- --- --- --- ---- ---- 1 2-10 11-100 more
Size of Birds	--- --- --- Small Medium Large
Pilot Warned of Birds	YesNo
Person Preparing Report
Reporter Title
Department

	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)

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Nature of Issue/Concern

Flight Safety/Dispatch

Maintenance Report Form

Cabin Safety Form

Bird Strike Reporting Form

Captains Irregularity Report

Interference With a Crewmember

Crewmember Names

Bird / Other Wildlife Strike Report

DAMAGE / COST INFORMATION

IROP Report/Hazard/Occurrence

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

ASAP Report

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This report type is not setup, use OLD ISSUE REPORTER

Personnel Fatigue Report

Employee Type

Contributory factors

Last Duty Period

Previous Duty Period

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This report type is not setup, use OLD ISSUE REPORTER

Passenger Accident/Incident Report