Airprox Section
Original Reference Number
Date Of Occurrence
Details of reporter
Title/Post
Rank & Title/Initials/
Name
Contact Details
Role During Occurrence
Colour scheme & external lighting (strobes, HISLs, nav lights etc) F
1
Radio call sign
In communication
2
Type of ATC service
3
RT Frequency
4
G
5
SSR Transponder
1
Classification of flight
J
2
3
Flight Rules at time of Airprox
K
Position of Airprox
CANP Filed
1
L
Aircraft Heading
e.g. GIMLI, 56N30W, MID360/10
2
Altimeter setting
Aircraft attitude
Formation
1
M
2
1. Distance
ft
2. Distance
Horizontally from cloud
3. In
Flight weather conditions at time of Airprox
N
4. Flying
5. Flying
Km
6.
Distribution:
Version 2.0
MAA:
Internal: maa-asims
External:
[email protected]
Page 1 of 3
Description of other aircraft if seen:
Type, high/low wing, number of engines
Radio callsign, registration
1
Markings, colour, lighting
O 2.
3
Aircraft attitude - other details
4
First sighting distance/radar/TCAS/TAS contact
1
Minimum horizontal & vertical separation at time of Airprox
2.
3
Form of avoiding action taken; if none, state reason
P
Assessment of risk of collision
4
Other relevant factors, i.e. workload, emergencies, vision
from cockpit, etc.
5.
Airborne collision avoidance system (e.g. TCAS)
6.
TA Indicated
RA
RA
1.
How did you report the Airprox, or hear about the
Airporx report
Q
By
To/From whom?
FREQ?
2.
By phone
To/From whom?
Distribution:
Version 2.0
MAA:
Internal: maa-asims
External:
[email protected]
Page 2 of 3
Diagrams of Airprox
Mark passage of other aircraft relative to you, in plan on the left and in elevation on the right, assuming YOUR Airaft is at the centre
of each diagram.
View from Above
Distribution:
Version 2.0
MAA:
Internal: maa-asims
View from Astern
External:
[email protected]
Page 3 of 3