(This Line is for Safety Department Use Only) PRIORITY CONTROL NO. FROM: DATE: (Name and Base) TO: Safety Department. 1. This Report Concerns:

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Mabel Clark
5 years ago
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1 Hazard / Deficiency Report Form When a hazard cannot be immediately addressed or corrected (whether potential or real) that can cause harm in any way to people, assets, or the environment, any member of the organization can use this form to report this issue to the Safety Department for follow-up. (This Line is for Safety Department Use Only) PRIORITY CONTROL NO. TO: Safety Department FROM: DATE: (Name and Base) 1. This Report Concerns: HAZARD DEFICIENCY 2. Aircraft/Vehicle Type: Location: 3. Description of Hazard or Deficiency: Identification Number: 4. What is your Recommendation or Suggestion: 5. Outside agency and official notified: (If none, state "NONE") 6. If aircraft related, how was the flight effected? 7. Name of each Witness: (If none, state "NONE") 8. Supervisor Comments/Actions: By filling in your name in the signature block, you acknowledge having received this form. Revised February 2007 Print Supervisor's Name: AL Form HSE-2.2

2 HAZARD/DEFICIENCY REPORT LOG Submit Date Date Rec'd Submitted By Group Phone Number Address Report Concerns BASE Notification By By Mail Phone Jun-07 3-Jul-07 Mech Name Mech Mech Phone Mech Address A/C parking pads on ICY "A" ICY 16-Jul-07 Row needs to be extended Jul-07 2-Jul-07 Pilot Name Pilot Pilot Phone Pilot Address Hover area hazard at HMA Base HMA Jul-07 3-Jul-07 Annonymous Admin No letter sent Sharp Drop-off on Ramp by Fuel Piping NO Jun Jun-07 Admin Name Admin Admin Phone Admin Phone Provide offsite customer manifest Excel form ICY NO Jul Jul-07 Pilot Name Pilot Pilot Phone Pilot Address S-76 baggage compartment GNO edge needs non-skid surface Jul Jul-07 Pilot Name Pilot Pilot Phone Pilot Address HSAC altitudes need to be changed Jun Jun-07 Mech Name Mech Mech Phone Mech Address S76 Pax side trim panels are overheating Jul Jul-07 Pilot Name Pilot Pilot Phone Pilot Address Accessibility of Apical float 30-Jul-07 deployment handle Jul-07 7-Aug-07 Admin Name Admin Admin Phone Admin Phone Overloading of radio Operators ICY 30-Jul-07 are with flight plans at sunrise Jul-07 7-Aug-07 Mech Name Mech Mech Phone Mech Address Wash rack area is flooded with 7-Aug-07 liquids Jun-07 7-Aug-07 Safety Dept SMS Safety Case Adverse weather conditions at the Base All Bases Jun-07 7-Aug-07 Safety Dept SMS Safety Case Structural fire in the maintenance All Bases hangar Jun-07 7-Aug-07 Safety Dept SMS Safety Case Aircraft accident at the base All Bases Jul Jul-07 Pilot Name Pilot Pilot Phone Pilot Address Cyclic stick guard is not installed CRE 21-Aug-07 on the cyclic Shading indicates completed Updated 8/24/2007 9:34 AM Page 1

3 S-76 Baggage Compartment Edge Needs Non-Skid REPORT NUMBER: DATE OPENED: 7/17/2007 SUSPENSE DATE: 9/17/2007 RISK LEVEL: LOW TO: Safety Dept FROM: Pilot's Name / GNO Base SUBMITTED: 7/17/2007 THIS REPORT CONCERNS: Hazard Aircraft/Vehicle Type: S-76 S-76 baggage compartment edge needs non-skid surface applied Identification Number: 863AL Location: GNO Description of Hazard or Deficiency: During Preflight of A/C, I climbed up to inspect the inside bull wing cowling. I stepped on the outside edge of the baggage compartment. Due to moisture on the metal edge strip my foot slipped. Had I not been holding on at the engine compartment fire fighting access hole, I would have fallen to the pavement. What is the Submitter's Recommendation or Suggestion? A non-skid surface should be applied to that strip on all baggage entrance areas on all S-76 aircraft to prevent slipping which will result in injury. If Aircraft Related, How was the Flight Effected? No effect. Name of Each Witness: Supervisor Comments: The edge on this arm is stainless steel and can be painted or taped to prevent the slipping of flight crews and Maintenance personnel. Page

4 MANAGER'S ACTION Safety Manager's Action: Person Responsible and Action Taken to Reduce the Risk Level: Action for Safety Newsletter: New Report Manager's Comments: Actions Completed Which Allow Safety to Close this Report: CATEGORY: Flight ROUTING DEPARTMENT NOTIFICATION ROUTING Copy To: DATE SENT OUT Flight Safety Officer 7/17/2007 DATE RETURNED COMMENTS Director of Maintenance 7/17/2007 8/14/2007 I concur with this suggestion. Repair Station Manager 8/8/2007 Page

5 July 17, 2007 Pilot s Name Pilot s Address Broussard, LA SUBJECT: HAZARD / DEFICIENCY REPORTS Report Number: Report Concern: S-76 baggage compartment edge needs non-skid surface applied Date Received: 15-Jul-2007 Date Initiated: 17-Jul-2007 Dear Pilot: The Safety Department has received the Hazard / Deficiency Reports that you submitted as referenced above. We appreciate you bringing this to our attention and take every concern seriously whether big or small. Feel free to contact the Safety Department to request an update on your concern at any time in the future. Please reference the assigned report number listed above when doing so. We will be publishing a list of all Open Hazard, Deficiency, and Suggestion Reports as a supplement to the Safety Newsletter published quarterly. These concerns will be listed by the assigned record number listed above. Sincerely, Industrial Safety Manager

UNMANNED AERIAL SYSTEM (UAS) POLICY

UNMANNED AERIAL SYSTEM (UAS) POLICY Colby College 5500 Mayflower Hill, Waterville, ME 04901 REVISION HISTORY The UAS Policy will be reviewed and revised annually by the EHS Director. Additional revisions