Da Form 2696 – Fill Out and Use This PDF

OPERATIONAL HAZARD REPORT

Requirements Control Symbol -

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

CSOCS-307

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)

2.

FROM: (Name and Address of Originator (Include 9-Digit ZIP

Aviation Safety Officer

(LCL Command)

Code)) (OPTIONAL - SEE INSTRUCTIONS)

3.

Date and Time of Occurrence

a.

YEAR

b.

MONTH

c.

DAY

d.

TIME (LCL)

e. CHECK ONE

(1) Day

(2)

Night

f.

USASC USE ONLY

(3) Dawn

(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

(1)

AIRPORT/INSTALLATION

c.

Uncontrolled Airspace

(2)

Hangar

(1)

NOE

(3)

Support Area

(2)

DISTANCE FROM N.M./DME

(2)

Low Level

i.

Field Site

d.

Terminal Control Area

j.

Obstacle

(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

k.

Controller

(2)

FAA

h.

Pilot Procedures/Tech.

(8)

Tower

(1)

Procedures

c.

Facilities

i.

Near Midair Collision

(9)

Radar Service

(2)

Technique

(1)

Airport/Heliport

j.

Air Traffic Control

(10) Publications/Flip

l.

Other

(2)

NAV Aids

(1)

Enroute

(11) Controlling Agency

m.

Armament

d.

Maintenance

(2)

Terminal Area

(a)

FAA

n.

Aviation Life Support

e.

Materiel

(3)

APP Control

(b)

Army

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.

Series

d.

Serial Number

m.

Serial Number

e.

Service, MACOM

n.

Service, MACOM

f.

Point of Departure

o.

Point of Departure

g.

Destination

p.

Destination

CHECK ONE

CHECK ONE

h.

Flight Plan

(1)

IFR

(2)

VFR

q.

Flight Plan

(1)

IFR

(2)

VFR

(3)

DVFR

(4)

SVFR

(3)

DVFR

(4)

SVFR

(5)

None

(5)

None

i.

Course/Heading

r.

Course/Heading

in Degrees

in Degrees

DA FORM 2696, OCT 2013

PREVIOUS EDITION IS OBSOLETE.

Page 1 of 2

7.

Meteorological Conditions

8.

Cloud Proximity (Check applicable blocks)

a.

Clear

g.

Fog

ITEM

AIRCRAFT 1

AIRCRAFT 2

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

f.

Snow

e.

In Clouds

9.

For Single Aircraft Hazards, Complete item d.

For Near Midair Collisions, Complete all Applicable Items.

a. What first directed your attention to Aircraft 2?

(5)

Another Crewmember/Pax

(3)

Same Altitude

(1)

Proximity Warning Device

(6)

Radar Service

(4)

Diverging

(2)

Conspicuity Markings

(7)

Radio Contact

(5)

Converging

(3)

Lighting

b. Proximity

(Ft.)

(6)

Aircraft Which Overtook the

(a)

NAV Lights

c.

Other (No. 2) Aircraft Sighted at

Other

(O'Clock Position)

(b)

Strobe Lights

(a)

Aircraft 1

(c)

Rotating Beacon

(1)

Above

(b)

Aircraft 2

(4)

Aircraft Profile

(2)

Below

d. AIRCRAFT 1