Submitter Instructions - Mark a checkbox for the event or issue you want to share/report from any of the following categories:
Safety of Flight, Ground Safety, Environmental, Health or Positive Observation
Complete the Submitter's Action Items section. Feel free to share as much or as little as you deem appropriate. Finally, choose ''Mark As Complete" and export the form to the Safety Officer.
Incorrect assembly of parts or components.
Any damage or deterioration.
Any condition in which an injury or potential injury was experienced.
Loss of any part from the aircraft on ground or during flight.
Non-compliance or significant errors in compliance with req'd servicing procedures.
Other Potential safety of flight issue.
PPE - Personal Protective Equipment, gloves, eye or ear protection utilized, etc.
PTP - Protect the Property, check that proper aircraft protection is being utilized and in place.
GSE - Ground Support Equipment, verify that GSE is in good operating condition and stored properly.
Lock Out / Tag Out - Ensure LO/TO is being properly used.
Slip / Trip / Fall - Any hazardous conditions that can contribute to slips, trips, or falls.
Other Safety related issue.
Hazardous Material - Haz Mat not stored correctly, not labeled correctly, leaks, expired, etc.
Energy Waste - Lights, shop air, equipment, Ground Support Equipment (GSE) left on, etc.
Water Waste - Include all water resources.
Solid Waste - Paints, adhesives, rags, etc. proper disposal or correctly utilized
Recycling - Recycling not being properly utilized, etc.
Other Environmental related issue.
Ergonomics - Proper body position, good lifting techniques, etc.
Ventilation - Check for proper ventilation, air quality, etc.
HVAC - Look for proper heating and air conditioning.
Noise Hazards - Check the high noise areas are properly identified, hearing protection available, etc.
Medical Service and First Aid - Eye wash stations clear, contact numbers available, first aid kits accessible, etc.
Other Health related issue
Great Team Effort
Excellent Meal Service
Great MX resolution of our issue
Do you have any positive observations you want to elaborate on about a situation, occurrence or team member?
Submitter's explanation/observation of safety issue
Submitter's recommendation to eliminate, correct, or minimize the issue/condition.
Submitter - 'Mark As Complete' at the bottom of the page and export this audit to the Safety Officer for coordination.
Safety Officer's investigation summary:
Tracking Number and/or Risk Code
Corrective Action Taken
Corrective Action Competed by: