NCAA Confidential & Voluntary Reporting Form

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Please complete all required fields!

NCAA Confidential and Voluntary Reporting Form

This form is for submitting confidential or voluntary occurrence reports or hazard reports to NCAA incidents department, Any safety related queries should be sent to incidents@ncaa.na.

For mandatory occurrences please use the full report, FSS-GEN-FORM-014 available at Document Downloads Page

Date and Time, UTC, of Occurrence or Observation(*)

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Location (airport, co-ordinates, etc)(*)

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Aircraft involved (callsign, registration, type for each aircraft)(*)

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Narrative of Occurrence or Hazard (please include all pertinent details)(*)

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Do you have any information about the root cause of the occurrence or hazard?(*)

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Do you have any suggestions for resolution, prevention, or mitigation?(*)

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What would be the most likely outcome(*)

Catastrophic (aircraft destroyed, fatalities)

Hazardous (major damage, permanent injury)

Major (minor damage, injuries requiring medical attention)

Minor (nuisance, disruption, use of emergency procedures)

Negligible (little or no consequences)

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Rate the Likelihood of reoccurrence(*)

Frequent (very likely to occur or has occurred many times, e.g. one a month or more)

Occasional (likely to occur sometimes or has occurred infrequently, eg once in any three month period)

Remote (unlikely to occur but possible, has occurred rarely, e.g. once a year)

Improbable (very unlikely, not known to occur, e.g. once in any three year period)

Extremely Improbable (almost inconceivable, intervals greater than once in three years)

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If you wish to have feedback on this issue, please provide your name and email/phone number, note: this detail can also help us considerably with the investigation, (this field is optional)

Full Name

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Cellphone

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Email Address

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How should we contact you?

E-mail

Phone

When would you like to be contacted?(*)

Please select a date when we should contact you.

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