3750 edition 6 PDF [263.5 KB] - Ministry of Defence

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D - MISCELLANEIOUS 1. Information regarding reporting aircraft a) Aircraft registration ______________________________________________________________ b) Aircraft type ____________________________________________________________________ c) Operator _______________________________________________________________________ d) Aerodrome of departure __________________________________________________________ e) Aerodrome of first landing _____________________ destination ________________________ f) Type of air traffic service _______________________ # g) RT frequency ________________ SSR code ___________________ # h) Reported by radio or other means to _____________ (name of ATS uniti) at time _________UTC i) Date / time / place of completion of form _______________________________________________ 2. Function, address and signature of person submitting report a) Function _________________________________________________________________________ b) Address _________________________________________________________________________ c) Signature ________________________________________________________________________ d) Telephone number ________________________________________________________________ 3. Function and signature of person receiving report a) Function ________________________ b) Signature _____________________________________ E. SUPPLEMENTARY INFORMATION BY ATS UNIT CONCERNED 1. Receipt of report a) Report received via AFTN / radio / telephone / other (specify)* ____________________________ b) Report received by _______________________________ (name of ATS unit) # Addition to the ICAO form. A - 3
2. Details of ATS action Clearance, incident seen (radar/visually, warning given, result of local enquiry, etc.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ DIAGRAMS OF AIRPROX Mark passage of other aircraft relative to you, in plan on the left and in elevation on the right, assuming YOU are at the centre of each diagram. Include first sighting and passing distance. A - 4
Page 3 and 4: AGREEMENT N° Reference/ date of Am
Page 5 and 6: 4. Air Traffic Incidents are design
Page 7 and 8: E2 Include details of ATS unit such
Page 9: 3. Other aircraft a) Type and call
Page 13 and 14: Department of Accident Investigatio
Page 15 and 16: NO Headquarters Defence Command Nor

3750 edition 6 PDF [263.5 KB] - Ministry of Defence

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