Performance Work Statement Attachment 8 DA FORM 2696

OPERATIONAL HAZARD REPORT

Requirements Control Symbol CSOCS-307

For use of this form, see DA PAM 385-10; the proponent agency is DAS.

An operational hazard is any condition or act that affects or may affect the safety of Army aircraft or associated personnel and equipment.

1. TO: (Include 9-Digit ZIP Code)

Aviation Safety Officer (LCL Command)

2. FROM: (Name and Address of Originator (Include 9-Digit ZIP Code))

3. Date and Time of Occurrence

a. YEAR

b. MONTH

c. DAY

d. TIME (LCL)

e. CHECK ONE

(1) Day
(3) Dawn

f. USASC USE ONLY

(2) Night
(4) Dusk

4. Location Where Hazard Occurred (Check all applicable items.) a. In Flight

h. Airfield/Heliport

k. This hazard occurred on or near

b. Airways

(1) Movement Area/Parking

c. Uncontrolled Airspace

(2) Hangar

(1) NOE

(2) DISTANCE FROM N.M./DME

(3) Support Area

(2) Low Level

i. Field Site

d. Terminal Control Area

j. Obstacle

(1) AIRPORT/INSTALLATION

(3) DIRECTION FROM DEGREES MAG

e. Traffic Pattern

(1) Trees

f. Control Zone

(2) Wires

g. On the Ground

(3) Building

5. This Hazard Pertains to

a. Procedures/Instructions

(1) Weather

(5) Ground Control

(d) USAF

b. Policies/Regulations

(2) Refueling

(6) GCA

(e) Host Nation

(1) Military

g. Communications

(7) ILS

(2) FAA

h. Pilot Procedures/Tech.

(8) Tower

(1) Procedures

i. Near Midair Collision

(9) Radar Service

(2) Technique

j. Air Traffic Control

(10) Publications/Flip

l. Other

(1) Enroute

(11) Controlling Agency

m. Armament

c. Facilities
(1) Airport/Heliport
(2) NAV Aids

k. Controller

d. Maintenance

(2) Terminal Area

(a) FAA

e. Materiel

(3) APP Control

(b) Army

n. Aviation Life Support
Equipment

f. Services

(4) DEP Control

(c) Navy

o. Night vision devise

6. If this Hazard Occurred in Flight, Complete the Following (if additional aircraft are involved, attach supplemental sheet) Aircraft 1

Aircraft 2 (Aircraft 2 is other aircraft, if applicable.)

a. Mission

j. Mission

b. Design

k. Design

c. Series

l.

d. Serial Number

m. Serial Number

e. Service, MACOM

n. Service, MACOM

f.

o. Point of Departure

Point of Departure

g. Destination
h. Flight Plan

Series

p. Destination

CHECK ONE

(1) IFR

(3) DVFR

(5) None

i. Course/Heading
in Degrees

DA FORM 2696, OCT 2013

(2) VFR

(4) SVFR

q. Flight Plan

CHECK ONE

(1) IFR

(3) DVFR

(5) None

(2) VFR

(4) SVFR

r. Course/Heading
in Degrees
PREVIOUS EDITIONS ARE OBSOLETE.

APD AEM v1.01

7. Meteorological Conditions

8. Cloud Proximity (Check applicable blocks)

a. Clear

g. Fog

b. Scattered

h. Haze

a. Above

c. Broken

i. Smoke

b. In/Out of Clouds

d. Overcast

j. Icing

c. Between Layers

e. Rain

k. Visibility (in miles)

d. Below

ITEM

f. Snow

AIRCRAFT 1

AIRCRAFT 2

e. In Clouds