Notify AAT-200, WOC & ATD through the ROC within 3 hours.

Instructions For FAA Form 7210-2, Preliminary Operational Error/Deviation Investigation Report

REPORT NUMBER:

FAC ID: Enter the facility three-character identifier. 

TYPE: Enter the type of facility ("T" – Terminal, "R" – TRACON, "C" – En-Route, and “F" - Flight Service)

NOTE - Use "R" for stand alone radar facilities assigned a separate facility three-character identifier

CY: Enter the last two digits of the calendar year in which the incident occurred.

E/D: Enter "E" for an error or "D" for a deviation.

SEQ.#: Enter the sequential number of the incident for the calendar year.

NOTE - Each calendar year operational errors will start with 001 and operational deviations will start with 001 (however, they are counted separately).  e.g., ZDC-C-01-E-005.

Block 1 Date and Time of Occurrence: Date is based on local time only, enter time in Local and time in UTC.

Block 2 Date and Time Initial Investigation Started: Date is based on local time; enter time in Local and time in UTC.

Block 3 Facility: Check “FACILITY” if your facility personnel initially reported this incident or check “OTHER” if equipment (i.e. OEDP, CA), another facility, pilot or organization reported this incident.

Block 4 Involved Facilities: List all other facilities that may have contributed to this incident.

Block 5 Altitude: Enter "SFC" if this is a surface incident; otherwise enter altitude at which loss of separation occurred.

Block 6 Location: Use a VOR Fix/Radial/Distance that is compatible with the appropriate altitude stratum. For surface events, use runway numbers, taxiway names, or other

locations found on airport diagrams. For Oceanic events use Latitude & Longitude.

Block 7 Closest Proximity: Do not leave blank. Indicate Feet, Miles or Minutes. This IS the closest proximity, not just the first hit under the required loss of separation or OEDP. If estimated, indicate method in Summary, Block 21. Where no other aircraft were involved, as in closed-runways or MVA incidents, indicate and explain in Summary, Block 21.

Block 8 Alerts: Check "ACTIVATED" if an alert was generated during the incident.

Check "NOT ACTIVATED" if this feature is installed and functioning, but did not generate an alert during the incident.

Check "NOT AVAILABLE" if this feature is installed, but was not available during the incident.

Check “SUPPRESSED” only if this feature was suppressed.

Check "NOT INSTALLED" only if the facility does not have this feature.

Block 9 TMU: Complete each item that applies to your facility, otherwise leave blank.

Item a. Enter Monitor Alert Parameter (MAP) or other automated alert function, for the sector/position(s) involved. Item b. Check “ACTIVATED” if an alert was generated during/or before the incident.

Check “ NON-ACTIVATED” if this feature is installed and functioning but did not generate an alert.

Check “NOT AVAILABLE” if this feature is installed at the facility, but was not available during the incident.

Item c. Were any initiatives in place in response to sector/position volume or complexity, check Yes or No and explain why if volume or complexity may have contributed to this incident?

Blocks 10:

Item a. Traffic Volume: Enter the number of aircraft for which the controller had separation responsibility, including point outs. For incidents involving tower cab local controllers, do not count aircraft waiting in line for departure unless the controller was, for some reason, responsible for separation.

Item b. Traffic Complexity: Circle traffic complexity with “Low” being number 1, “Moderate” as number 3 and “High” as number 5.

Block 11 Type of Control: Check “RADAR” if the incident occurred within a radar environment.

Check “NON-RADAR” if incident occurred within a non-radar environment.

Check “OCEANIC” if the incident occurred within an oceanic environment.

Check "TOWER" if incident occurred within a tower environment (also check "RADAR," if the cab controller had radar available).

Check “AFSS/FSS” if the incident occurred within a flight service environment.

Block 12 Required Separation: Check "FAA DIRECTIVE" if the required separation was from an FAA directive such as FAA Order 7110.65, or a facility directive. List specific paragraph that was violated/misapplied.

Check "LETTER OF AGREEMENT" if the required separation was from a letter of agreement with another facility or organization, (e.g., An LOA requiring 8 miles separation between aircraft in specified areas). List specific paragraph that was violated/misapplied.

Block 13 Controller Information: Item a. Enter last six digits of the employees Social Security Number (DO NOT ASK THE EMPLOYEE), e.g., 55-1234

Item b. Enter Title/certification status, e.g., "CPC/OS/CIC/OM/DEV/TMC/TMS/ATM/SS”.

Item c. Enter time on position, e.g., 75 (in minutes).

Item d. Enter Area and Sector or Position Designation, e.g., "Area A-R71/D71" or "South Satellite."

Enter ALL SECTORS/POSITIONS that were combined to the position at the time of the incident. 

Item e. Enter date of last certification, and include Initial or Recertification, e.g., I 1+07 (year+months)

Item f. Enter all previous Errors and/or Deviations within the last 2-½ years, including dates. Explain factors identified in previous errors in Summary, Block 21.

Block 14 Hand Off Position: Item a. Was a RA/D-side/Tracker/HO or Coordinator assigned to this radar position? If no and volume or complexity may have been a factor, explain in Summary, Block 21.

Item b. Was a Local or Ground Associate assigned to the Tower position? If no and volume or complexity may have been a factor, explain in Summary, Block 21.

Block 15 Staffing: List Staffing levels at time of incident.  Note: this applies to staffing in the specific function/area that this incident occurred in, e.g., combined TRACON/Towers, incident occurred in TRACON, list only the staffing for employees assigned to the TRACON at the time of the incident. Only list CIC’s if that individual has been assigned CIC duties for the shift.

Block 16 Position Profiles: List position/sector(s) available in the area, radar room, sector or tower cab, WHERE the incident occurred.

Block 17 Operational Supervision: Item a. Identify if an OS or a CIC was in charge, when the incident occurred.

Item b. Describe the OSIC/CIC actual activity when the incident occurred. Be Specific, e.g., on the phone, coordinating with TMU about the no notice hold into EWR.

Block 18 Weather Sequence: Provide the most applicable weather sequence (nearest in location and time to the OE/D), identifying the source and time. List all PIREPS/SIGMETS /AIRMETS valid for the area.

Block 19 Aircraft Information: Items a – c Enter the involved Aircraft’s callsign, type aircraft, and equipment suffix. Check “NRP” if the aircraft was on a filed National Route Program flight plan (not just issued “direct”).