orm CA/AA ote: AW or tenant pilots wishing to file an airproxy report on a non U asset please utilize this form as well as AT orm and forward both to the AW/ office for further staffing/coordination. AIPX PT (Pilots) Instructions for use Pilots (Military or Civil) should use this form to initiate or respond to an AIPX occurring within UK Airspace*. *UK Airspace comprises all Classes of airspace within the London and cottish Is, UIs, the hanwick ceanic I/UI and Channel Islands egulated Airspace. Initial report on T: The shaded areas of this form indicate those items that should ideally be stated in an initial T report. Civil pilots should complete both Parts and e-mail or AX the form to UKAB at the address below. Military pilots are to pass details at Part to adar Analysis Cell at LTCC Mil ( rac.mil@nats.co.uk Tel / ax ) within hrs of the event. Part is to be passed to the U within days with a copy (preferably electronic) to UKAB at the address below. The U will forward to the C. UK Airprox Board illingdon ouse A Uxbridge UB U -mail: ops@airproxboard.org.uk Tel: + () /// T: UKAB ax: + () T: AIPX UTI UK AIPAC Military pilots should contact the light afety (or ps) Branch of the appropriate Command/Q. Civil pilots should submit the original report to the relevant overseas authority with a copy to: CAA afety ata epartment, Aviation ouse, Gatwick Airport outh, West ussex Y Tel: + () / ax: + () otes: AIPX reporting procedures for civil pilots are promulgated in UK AIP ection.. AIPX reporting procedures for military pilots are detailed in UK AIP (MIL) ection.. Civil controllers/upervisors must send initial details by AT in the format of orm CAA. Military controllers should refer to JP.. for details of reporting procedures. Time f Incident AIPX investigation is hindered significantly by any delay in submitting a report and/or if the date or time of A joint Civil Aviation Authority / Ministry of efence service
the incident is not reported accurately. Please be accurate and make CTAI that you enter the correct AT and TIM in ection.
PAT *elect words as appropriate. Complete ALL fields use K if ot Known UKAB ref: AIPX eport from the A *eporting / eported pilot ame/mil ank of Pilot in Command B ) light deck crew complement ) pilot(s) navigator(s) others Civ perator / Mil Unit include address & telephone number (plus Mil tation & Command) C AT and TIM of Airprox ate: Time: *UTC / BT Aircraft registration & type eg: Type: Colour scheme & external lighting (strobes, ILs, nav lights etc) adio callsign ) In communication with Type of ATC service (if any) ) T frequency ) transponder ) Aerodrome of departure Aerodrome of first intended landing Classification of flight light ules at time of Airprox G I J ) *itted / ot itted *n / ff Code: Mode C: CMM AI TAPT Position of Airprox Bearing & range from reporting ) point/v/b or Lat/Long Aircraft heading L ) K *n / ff / ot itted ched *Pax / Cargo CIVIL T CMM AI TAPT True Airspeed ) Knots Mode : *n / ff / ot itted on-sched *Pax / Cargo *Commercial *xecutive *Club/Group *Private *Training *Gliding *ther MILITAY *Training *xercise *perational ormation *Yes / o *I / V / V CAP / PI iled? *Yes / o Low lying Booking o. light Level, altitude or height *L / eet Altimeter setting mb (*tandard / P / Q / Q ) Aircraft attitude M *Level / Climbing / escending / Turning (*ight / Left) Phase of flight light weather conditions at time of Airprox *Take-off Cruise n route descent Go around Initial Climb Aerobatics olding Circuit n route climb Gen handling inal descent Landing ) *IMC / VMC ) istance ft *Above / Below *Cloud / og / aze ) istance *km / nm horizontally from cloud ) In *ain / now / leet / og / aze / Cloud / Between layers ) lying *into / out of un ) light visibility *km / nm ) *ay / ight / Twilight
escription of other aircraft if seen: Type, high/low wing, number of engines adio callsign, registration ) Markings, colour, lighting ) Aircraft attitude, other details ) ) irst sighting distance / radar /ACA contact Minimum vert and hztl separation at time of Airprox orm of avoiding action taken: if none, please state reason Assessment of risk of collision ther factors workload etc Airborne Collision Avoidance ystem (e.g. TCA) P ) ) ft (vert) m/nm (hztl) ) ) *Low Medium igh Very igh ) ) *itted / ot itted TA indicated? *Y / A indicated? *Y / A followed? *Y / (if no state reason) ow did you report the Airprox or (reported pilot) hear about the Airprox report? Q *By radio? *Yes / o To / from whom? or *By phone / letter / other? To / from whom? req? CIPTI AIPX - Please continue on separate sheet if required To help the investigation please contact UKAB if you can offer chart fragments (or copy) with relevant tracks drawn, otams, U recordings etc ame / Mil ank e-mail tel number ignature: ate of completion of form:
PAT IAGAM AIPX UKAB ref: Mark passage of other aircraft relative to you, in plan on the left and elevation on the right, assuming YU AICAT is at the centre of each diagram. You may have to print this page to complete the diagram and then send separately. VIW M ABV VIW M AT U M T U T U MT U MT CIVIL PAT / MILITAY UIT CMMT Comment only if required etails of any investigation in progress; action taken to prevent recurrence etc ame/mil ank mail Telephone number Unit/Company ate