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c) Aircraft climbing or descending
( ) Level flight ( ) Climbing ( ) Descending
( ) Unknown
d) Aircraft bank angle
( ) Wings level ( ) Slight bank ( ) Moderate bank
( ) Steep bank ( ) Inverted ( ) Unknown
e) Aircraft direction of bank
( ) Left ( ) Right ( ) Unknown
f) Lights displayed
( ) Navigation lights ( ) Strobe lights ( ) Cabin lights
( ) Red anti-collision lights ( ) Landing / taxi lights ( ) Logo (tail fin) lights
( ) Other ( ) None ( ) Unknown
g) Traffic avoidance advice issued by ATS
( ) Yes, based on radar ( ) Yes, based on visual sighting ( ) Yes, based on other information
( ) No ( ) Unknown
h) Traffic information issued
( ) Yes, based on radar ( ) Yes, based on visual sighting ( ) Yes, based on other information
( ) No ( ) Unknown
i) Avoiding action taken
( ) Yes ( ) No ( ) Unknown
* Delete as appropriate
A4-4 Air Traffic Management (PANS-ATM)
1/11/01
4. Distance
a) Closest horizontal distance ___________________________________________________________________________________________
b) Closest vertical distance _____________________________________________________________________________________________
5. Flight weather conditions
a) IMC / VMC*
b) Above / below* clouds / fog / haze or between layers*
c) Distance vertically from cloud __________ m / ft* below __________ m / ft* above
d) In cloud / rain / snow / sleet / fog / haze*
e) Flying into / out of* sun
f) Flight visibility _______ m / km*
6. Any other information considered important by the pilot-in-command
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
D — MISCELLANEOUS
1. Information regarding reporting aircraft
a) Aircraft registration _________________________________________________________________________________________________
b) Aircraft type _______________________________________________________________________________________________________
c) Operator _________________________________________________________________________________________________________
d) Aerodrome of departure _____________________________________________________________________________________________
e) Aerodrome of first landing _______________________ destination ___________________________________________________________
f) Reported by radio or other means to _______________________________________ (name of ATS unit) at time _________________ UTC
g) 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 ________________________________________________________________
* Delete as appropriate
Appendix 4 A4-5
1/11/01
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)
2. Details of ATS action
Clearance, incident seen (radar/visually, warning given, result of local enquiry, etc.)
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
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