TCAS ATC Questionnaire (Completion Optional)
TCAS ATC Questionnaire (Completion Optional)
Please enter as much information as you can
Name (optional)
Email (optional)
Date
/
MM
/
DD
YYYY
Time (UTC)
Facility
Region
TCAS AIRCRAFT
ID (Flight #)
A/C Type
Transponder Code
Actual Altitude at RA (FT)
Clearance Altitude (FT)
Estimated range between TCAS & Other A/C at RA
Position (VOR/RADIAL/DME)
OTHER AIRCRAFT
Is the Aircraft TCAS Equipped
Yes
No
ID (Flight #)
A/C Type
Transponder Code
Actual Altitude
Phase of Flight
Departure (Takeoff to 10,000 FT)
Climb (10,000 FT to TOC)
Cruise
Descent (TOC to 10,000 FT)
Approach (Below 10,000 FT)
Was there a clearance deviation by the TCAS aircraft?
Yes
No
Altitude Deviation (FT)
Did this involve:
Loss of separation with 3rd aircraft
Yes
No
Near Mid Air Collision
Yes
No
Phantom Target
Yes
No
Course Deviation
Yes
No
Delay in accepting ATC clearance
Yes
No
Missed Approach
Yes
No
What was the closest proximity of the two a/c? (FT/NM)
Was there any communication regarding the TCAS maneuver?
Yes
No
When did communications take place?
Before
During
After
Did the TCAS maneuver require other a/c to deviate?
Yes
No
Was TCAS Disruptive to:
Traffic flow?
Yes
No
Your plans?
Yes
No
Did Conflict Alert activate?
Yes
No
Was the TCAS maneuver the same one you would have issued?
Yes
No
Description of Event/Remarks
Type the letters you see in the image below.
