ATFT-SF

Aviation Training and Flight Testing Ltd: Safety Form
ATFT-SF
Occurrence Serial Number
From Safety Manager or leave blank
Date of Report
DayMonthYear
Date
Submitter's Name:
(Leave Blank for Anonymous Submission)
Date of Occurence:
DayMonthYear
Date
Is the Issue Reportable?
Type of Issue (Ops)
Type of Issue (Worksafe)
Type of Issue (Q/A)
Take Photo
Details of Issue and Suggested Fix:
Your Assessment of Present Risk (see Matrix Below)
Part B (to be completed by Safety Manager). If SM assesses risk less than reporter SM must discuss with submitter to ensure no material issues have been missed:
Investigation Results (If applicable):
Corrective and/or Preventative Action Required:
Assessment of Residual Risk
Resources Required:
Responsibility for Action:
Follow-up Action Required:
What is the Follow-up Action?
Who is Responsible?
Complete by When?
DayMonthYear
Date
Hazard Log Updated by:
On:
DayMonthYear
Date
CAA or Worksafe Report submitted by:
On:
DayMonthYear
Date
Safety feedback disseminated to Company, Third Party, and wider aviation community, as appropriate:
Safety Report # Closed
On:
DayMonthYear
Date
Should be Empty: