NameThis field is for validation purposes and should be left unchanged.The details on this form must be completed by all external agencies/individuals when requesting release of operational safety related information from Airservices Australia (Airservices), including those agencies subject to existing agreements related to sharing of operational safety related information. Airservices operational safety information will not be released without the provision of the details on this form. Information provided as a result of this request is copyright to Airservices and may not be reproduced or copied in any form or by any means or otherwise disclosed to any third party external to Airservices without the prior written consent of Airservices. Privacy of individual officers is paramount, and where information identifying individual officers is provided, it must remain secure and must not be released to third parties. Information provided may only be used for purposes indicated - use of information for purposes other than those indicated on this form must be subject to an additional data request.Details of the operational safety information requestedName of requesting agency*Requesting officerName* First Last PositionPhone Business Mobile Email* Occurrence report type and referenceDate and time of occurrence (required)*IMPORTANT: Date and time must be as specific as possible. Where possible, please provide both Universal Time Coordinated (UTC) and Local time, giving consideration to the status of Daylight Saving (where applicable). NOTE: Inaccurate date/time entries will result in significant delays or the inability to fulfill the data request. UTC (Date) UTC (Time) Local (Date) Local (Time) Brief description of incidentPurpose of the request*Type of operational safety information requested(list requirements under the relevant headings)Recorded information(e.g. surveillance tapes, communication tapes, ATIS, MET, NOTAM etc)Flight information(e.g. flight plan, flight progress strips, SAR details etc)Reports(e.g. transcripts, investigation reports, fault reports, hazard log etc)Staff access(e.g. Interview phone/in person, statement electronic/written/verbal etc)Requested by (date)Note: Ten working days from receipt for ATSB or CASA and 15 working days for all other agenciesI'm not a robot Δ
