AVIATION SAFETY REPORTING FORMFAQs For UseATTENTION!Pilots, Air Carriers, Owners and Other Holders of FAA Licenses -Do You Depend on Your License or Certificate For Your Livelihood?•If you have made a mistake and inadvertently violated the FARs, the FAA maytake enforcement action in the form of suspension, revocation, or civil penalties.This Aviation Safety Report (ASR) Form can be submitted in confidence, toNASA to obtain “Sanction Immunity.”•If the FAA proves you committed the violation, it may go on your record, but the“sanction” such as revocation, will be avoided if you properly file this form.•Recommendation:1. Download Tracking Log to maintain a record of submittal of ASR Form(compliments of The Phillip J. Kolczynski Law Corporation).2. Download the ASR Form3. Download Adobe Acrobat Reader (free reader from Adobe, Mac orWindows) to print out both the Tracking Log and ASR Form and keep yourairplane or briefcase in the event that you make a mistake.•If you think you may have inadvertently committed an airspace, separation,communication or any other unintentional violation - FILE the ASR Form!WARNING! An FAA License or Certificate Holder must prove that the ASR Form wasdelivered or postmarked, within ten (10) days of the incident in order toqualify for sanction immunity.FAA Advisory Circular No. 00-46c, explains that you cannot claim “Sanction Immunity“by means of an Aviation Safety Report in any of the following circumstances:•Deliberate actions which violate the Federal Aviation Regulations•Criminal Activity - Remember - Don’t do the crime if you can’t do the time!•Aviation Accidents (an “accident,” distinguished from an “incident” is defined in49 C.F.R. 830.2 as involving death, serious injury or substantial aircraft damage)•FAA confirmed violations within the last five (5) years•Actions revealing a lack of competency or qualifications to hold a licenseWARNING! If you think any of these exceptions may apply to you, retain an AviationLawyer to obtain attorney-client privileged advice before you file the form.If you are involved in criminal activity - Do NOT file the form, contact aCriminal Law Specialist. The form might be used against you if there is anaccident or criminal activity. FAR 91.25.Page 1 of 2
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AVIATION SAFETY REPORT TRACKING LOGCompliments of: The Phillip J. Kolczynski Law CorporationE-mail:
[email protected]RL:
http://www.aviationlawcorp.comDIRECTIONS FOR USE:1.Download the ASR Form from NASA, then print it from your computer. Youwill need Adobe Acrobat Reader which can be obtained FREE from Adobe at“
http://www.adobe.com/Acrobat/readstep.html”2.Do not worry if this form comes out on two or three pages. Use plain paper toamplify the description, if necessary. Simply fasten together the official NASAportions and fill them out by hand. (The Government Form is not designed to becompleted on a computer).3.Make sure you fill in the Identification Strip so that NASA can return it to you,confirming receipt of your report. Don’t rely on the Identification Strip alone asproof of filing. What if NASA doesn’t receive it, and ten (10) days pass --You’llhave no way of proving you satisfied the ten (10) day requirement!4.Recommendation: SUBMIT THE ASR Form to NASA by Certified Mail.Why take a chance on First Class Mail or other delivery methods (ManyCommercial Delivery Services do not certify overnight delivery to P.O. Boxes).Remember, the burden is on the License Holder to prove that the form waspostmarked or delivered to NASA, at the appropriate address listed below, withinten (10) days of the incident.5.Keep a copy of this Tracking Log in your airplane, briefcase, glove compartment,etc.6.Place the correctly addressed NASA ASR Form in a mailing envelope and preparethe envelope in accordance with U.S. Post Office instructions for delivery via“Certified Mail - Return Receipt Requested.” Mail it within ten (10) days of theincident to:NASA Aviation Safety Reporting ProgramP.O. Box 189Moffett Field, California 94035-9800LOGDATE and approximate time OF INCIDENT______/_____/19____Approximate LOCATION of incident______/_____/19____DATE OF CERTIFIED MAILING with Return Receipt______/_____/19____Double check NASA ADDRESS on mailing envelopeCHECK BELOW:YES, I DID _____DATE of return of Certified Mail RETURN RECEIPT ______/_____/19____DATE stamped on IDENTIFICATION STRIP from NASA ______/_____/19____Page 2 of 2
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