GOSA

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PART 1: OBSERVATION LABEL

• OBSERVATION NO.

• OBSERVER ID

• DATE:

  Date

• START TIME:

  Date

• END TIME:

  Date

• STATION/LOCATION:

• GATE/RAMP POSITION:

• TERMINAL:

• ON TRAINING?

  Yes

  No

• CONTRACTOR?

  Yes

  No

• AIRCRAFT TYPE (if applicable):

  Select B787 A320 A321

  • B787
  • A320
  • A321

• ARRIVING FROM:

• DEPARTING(ED) TO:

• OBSERVATION TYPE:

  Select Arrival Unload Servicing Component Loading Departure Turnaround Other

  • Arrival
  • Unload
  • Servicing
  • Component
  • Loading
  • Departure
  • Turnaround
  • Other

• OBSERVATION AREA:

  Select Left Forward Wing Right Forward Wing Left Aft Wing Right Aft Wing

  • Left Forward Wing
  • Right Forward Wing
  • Left Aft Wing
  • Right Aft Wing

• TYPE OF OPERATIONS (Tick all that apply):

  Select Normal Disruption Domestic International

  • Normal
  • Disruption
  • Domestic
  • International

• LIGHTING CONDITIONS (tick all that apply):

  Select Daylight Night Dawn/Dusk Sunglare Artificial Light

  • Daylight
  • Night
  • Dawn/Dusk
  • Sunglare
  • Artificial Light

• ENVIRONMENTAL (tick all that apply):

  Select Clear Fog Windy Snow/Sleet/Ice High Humidity Rainy Dust Storm Extreme Heat Extreme Cold Lightning/ Electrical Strom

  • Clear
  • Fog
  • Windy
  • Snow/Sleet/Ice
  • High Humidity
  • Rainy
  • Dust Storm
  • Extreme Heat
  • Extreme Cold
  • Lightning/ Electrical Strom

• RAMP FLOOR CONDITIONS:

  Select Wet Dry Snow/Ice Contaminated N/A

  • Wet
  • Dry
  • Snow/Ice
  • Contaminated
  • N/A

PART 2: TEAM MEMBER DETAILS

TEAM MEMBER L/H

• JOB FUNCTION (tick all that apply):

  Select Marshalling Chocking Refueling Servicing Water/Lavatory Catering Unloading Loading Towing Pushback Leading Hand Boarding De-icing Pre-flight Walk

  • Marshalling
  • Chocking
  • Refueling
  • Servicing
  • Water/Lavatory
  • Catering
  • Unloading
  • Loading
  • Towing
  • Pushback
  • Leading Hand
  • Boarding
  • De-icing
  • Pre-flight Walk

• WORK EXPERIENCE:

  Select <6mos 6mos-1yr 1-2yrs 2-5yrs 5-10yrs >10yrs

  • <6mos
  • 6mos-1yr
  • 1-2yrs
  • 2-5yrs
  • 5-10yrs
  • >10yrs

• REGULAR WORKSHIFT:

  Select Day Night Relief Others

  • Day
  • Night
  • Relief
  • Others

• TIME IN CURRENT POSITION:

• Year(s)

• Month(s)

• Extended Shift?

  Yes

  No

• CONSECUTIVE NO. OF DAYS WORKED BEFORE THIS GOSA OBSERVATION:

TEAM MEMBER 2

• JOB FUNCTION (tick all that apply):

  Select Marshalling Chocking Refueling Servicing water/Lavatory Catering Unloading Loading Towing Pushback Disembarkation Boarding De-icing Pre-flight Walk Around

  • Marshalling
  • Chocking
  • Refueling
  • Servicing
  • water/Lavatory
  • Catering
  • Unloading
  • Loading
  • Towing
  • Pushback
  • Disembarkation
  • Boarding
  • De-icing
  • Pre-flight Walk Around

• WORK EXPERIENCE:

  Select <6mos 6mos-1yr 1-2yrs 2-5yrs 5-10yrs >10yrs

  • <6mos
  • 6mos-1yr
  • 1-2yrs
  • 2-5yrs
  • 5-10yrs
  • >10yrs

• REGULAR WORKSHIFT:

  Select Day Night Relief Others

  • Day
  • Night
  • Relief
  • Others

• TIME IN CURRENT POSITION:

• Year(s)

• Month(s)

• Extended Shift?

  Yes

  No

• CONSECUTIVE NO. OF DAYS WORKED BEFORE THIS GOSA OBSERVATION:

TEAM MEMBER 3

• JOB FUNCTION (tick all that apply):

  Select Marshalling Chocking Refueling Servicing water/Lavatory Catering Unloading Loading Towing Pushback Disembarkation Boarding De-icing Pre-flight Walk Around

  • Marshalling
  • Chocking
  • Refueling
  • Servicing
  • water/Lavatory
  • Catering
  • Unloading
  • Loading
  • Towing
  • Pushback
  • Disembarkation
  • Boarding
  • De-icing
  • Pre-flight Walk Around

• WORK EXPERIENCE:

  Select <6mos 6mos-1yr 1-2yrs 2-5yrs 5-10yrs >10yrs

  • <6mos
  • 6mos-1yr
  • 1-2yrs
  • 2-5yrs
  • 5-10yrs
  • >10yrs

• REGULAR WORKSHIFT:

  Select Day Night Relief Others

  • Day
  • Night
  • Relief
  • Others

• TIME IN CURRENT POSITION:

• Year(s)

• Month(s)

• Extended Shift?

  Yes

  No

• CONSECUTIVE NO. OF DAYS WORKED BEFORE THIS GOSA OBSERVATION:

TEAM MEMBER 4

• JOB FUNCTION (tick all that apply):

  Select Marshalling Chocking Refueling Servicing water/Lavatory Catering Unloading Loading Towing Pushback Disembarkation Boarding De-icing Pre-flight Walk Around

  • Marshalling
  • Chocking
  • Refueling
  • Servicing
  • water/Lavatory
  • Catering
  • Unloading
  • Loading
  • Towing
  • Pushback
  • Disembarkation
  • Boarding
  • De-icing
  • Pre-flight Walk Around

• WORK EXPERIENCE:

  Select <6mos 6mos-1yr 1-2yrs 2-5yrs 5-10yrs >10yrs

  • <6mos
  • 6mos-1yr
  • 1-2yrs
  • 2-5yrs
  • 5-10yrs
  • >10yrs

• REGULAR WORKSHIFT:

  Select Day Night Relief Others

  • Day
  • Night
  • Relief
  • Others

• TIME IN CURRENT POSITION:

• Year(s)

• Month(s)

• Extended Shift?

  Yes

  No

• CONSECUTIVE NO. OF DAYS WORKED BEFORE THIS GOSA OBSERVATION:

ARRIVAL

• A1. Pre-flight briefing (a.k.a. huddle) held

• SAFTEY RISK

  Safe

  At Risk

  N/A

• ERRROR CODE (See Annex A for Codes

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A2. Airside crew ready prior to A/C arrival

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A3. Arrival FOD/trash walk complete
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A4. Gate area cleared (clean and orderly)

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A5. Aerobridge staged/stowed properly

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A6. Equipment staged properly outside clearance area

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A7. Marshaller/wingwalkers in position for A/C arrival with proper wands

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A8. Stop line identified

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A9. Proper hand signals used

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A10. Tow-in/tow-on procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A11. A/C was "safe to approach" (e.g., engines spooled down, rotating beacon off)

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A12. A/C properly chocked

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A13. Wing tip/engine markers properly placed before GSE approaches A/C
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A14. Head set fitted whilst aircraft occupied by technical crew
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A15. GPU disconnected from tractor prior to connecting to A/C
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A16. Fixed GPU properly connected to A/C

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A17. Conditioned air properly connected

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A18. Aerobridge guide/crew stairs procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A19. Aerobridge pre-use check completed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A20. Aerobridge positioning procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A21. Inspection of the passenger door and surrounding area completed before opening
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A22. Passenger stairs pre-use check completed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A23. Passenger stairs positioning procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A24. Inspection of the passenger door completed before opening
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A25. Passenger doors opened and secured properly

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A26. Team member wearing PPE

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A27. Team member exhibits appropriate work behaviour (e.g., no "horseplay")
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• A28. All traffic regulation procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

UNLOADING

• U1. Beltloader approach procedures followed
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U2. Beltloader positioning and set up procedures followed
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U3. Cargo door/sills/locks checked prior to GSE approaching A/C
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U4. GSE operated properly (e.g., speed, safety zones)

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U5. Dollie locks are properly set prior to approach to container loader
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U6. Baggage/package, including specials, properly handled

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U7. All cargo properly handled during unload

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U8. Cargo hold/CLS systems visually checked for damage after unloading
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U9. If A/C left unattended all security procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U10. Container loader approach procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U11. Container loader positioning procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U12. Loader/ULD operating procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U13. Dollie ULD locks checked during offload

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U14. Team member use correct manual handling, proper lifting practices

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• U15. Team member avoid walking under fuselage (except as authorized) or
  stepping over towbar

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

LAVATORY SERVICING

• LA1. Lavatory vehicle operating procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• LA2. Lavatory servicing procedures followed (including hygene)
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

POTABLE WATER SERVICING

• P1. Water vehicle operating procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• P2. Water servicing procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• P3. Potable water units kept away from other sources of contamination

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

LOADING

• L1. Ramp free of any items that could interfere with the safe operation of GSE or cause FOD

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L2. Beltloader operating procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L3. Beltloader positioning and configuration procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L4. Beltloader removal procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L5. All traffic regulation procedures followed
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L6. Baggage/package, including specials, properly handled
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L7. All cargo is properly transported

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L8. Hard copies of LIR/ULA available and followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L9. Cargo hold/CLS systems visually checked for damage before loading

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L10. Cargo door/sills/locks check observed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L11. Required locks set/cargo nets/barriers installed and secured before doors closed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L12. Cargo door closure procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L13. Container loader approach procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L14. Container loader positioning procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• L15. Container loader removal procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

DEPARTURE

• D1. Pre-departure walkaround performed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D2. Steering by-pass pin installed and towbar hooked up

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D3. Correct size of tractor and towbar used for pushback

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D4. Pushback briefing held as necessary

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D5. Passenger door not secured until approval from cabin crew received

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D6. Passenger doors closed and secured properly

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D7. Aerobridge procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D8. Passenger stairs procedures followed
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D9. Ground power removal procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D10. Pre-pushback procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D11. Agent remains at a safe position on the bridge until the A/C clears the gate
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D12. If headset inoperative, prior to A/C departure, flight crew briefed about
  the use of hand signals during departure pushback

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D13. Wingwalking procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D14. Pushback procedures followed

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D15. Steering by-pass pin & towbar disconnect procedure followed
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D16. Final dispatch/release procedures Followed
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D17. Wingwalkers conducted a FOD walk while walking back into the gate area
  
  

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D18. Gate area verified ready for next arrival

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• D19. Crew debrief as necessary

• SAFETY RISK

  Safe

  At Risk

  N/A

• ERROR CODE (See Annex A for Codes)

• THREAT CODE (See Annex A for Codes)

• THREAT MANAGED EFFECTIVELY? (Tick Y/N)

  Yes

  No

• ERROR OUTCOME

  Inconsequential

  Undesired State

  Additional Error

• COMMENT (Guide Questions: How did Team Member manage/mismanage threats? Describe crew errors?)

• Add signature

  Sign