Fillable Printable Hazard Report Form - The Ohio State University

Hazard Report Form - The Ohio State University

The Ohio State University Airport Safety Management Systems

HAZARD REPORTING FORM

Employees, users, and associated organizations of The Ohio State University Airport are

encouraged to use this form to submit safety hazards that may have been observed or

encountered. Information collected on these hazards will be used to determine trends and

hotspots that could be potential safety risks. The form can be submitted anonymously, if

desired. The system is designed to be non-punitive, and the information collected will

remain internal. Please complete the form and submit via the provided envelope..

Date/Time of Observation: ________________________________________________

Reported By (optional): ________________________________________________

Dept./Org. (optional): ________________________________________________

Location Description: ________________________________________________

________________________________________________

Location on Crash Grid: ________________________________________________

(refer to back of form)

HAZARD DESCRIPTION

Please Check One

Wildlife Incursion [ ]

Aircraft Incursion [ ]

Ground Vehicle/Pedestrian Incursion [ ]

Ramp Safety [ ]

Other [ ]

Objects Involved: ________________________________________________

________________________________________________

Persons Involved: ________________________________________________

________________________________________________

Wildlife Involved: ________________________________________________

________________________________________________

Description: ________________________________________________

________________________________________________________________________

The Ohio State University Airport Safety Management Systems

Instructions for Use of Hazard Reporting Form

Please complete all fields with as much detail as possible about a hazard that was

encountered. The hazards could be anything that was seen or encountered on the ramp or

airfield of the OSU Airport that you felt was a threat to safety.

Examples of hazards could be vehicles seen driving too fast, confusing taxiway/runway

intersections, confusing/unsafe procedures, wildlife incidents, or anything that was felt to

be a threat to safety.

Use of this hazard reporting form is completely voluntary, and is non-punitive. It may

also be completed anonymously, if desired. The goal of this hazard reporting process is

to gather data from users of the OSU Airport in an effort to increase safety. OSU Airport

is in the process of a Safety Management Systems (SMS) Implementation Study, which

has been commissioned by the Federal Aviation Administration. Input from stakeholders

like you is critical to obtaining an accurate picture of where safety risks exist.

Once you have completed your form, please return it to Dale Gelter via the Customer

Service Desk, fax it to 614-292-5159, or email to [email protected].

Thank you for your time, participation and commitment to aviation safety!