gaca_gov_sa · form · processed · 4 chunks
GACA الهييه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] SAFETY MANAGER ACCEPTANCE APPLICATION FORM A. FOR APPLICANT USE <table><tr><td colspan="2">1. ORGANIZATION AND APPLICANT DETAILS</td></tr><tr><td>Organization Name</td><td></td></tr><tr><td>Organization Address</td><td></td></tr><tr><td>Nominated Safety Manager Name</td><td></td></tr><tr><td>Email address</td><td></td></tr><tr><td>Contact Number</td><td></td></tr></table> <table><tr><td>2. APPLICANT QUALIFICATIONS</td></tr></table> <table><tr><td>3. APPLICANT WORK EXPERIENCE</td></tr></table> <table><tr><td>4. APPLICANT TRAINING RELEVANT TO MANAGEMENT SYSTEMS</td></tr></table> <table><tr><td rowspan="2" colspan="2">5. MINIMUM QUALIFICATIONS & EXPERIENCE FOR THE SAFETY MANAGER POSITION</td><td colspan="2">COMPLAINT</td></tr><tr><td>YES</td><td>NO</td></tr><tr><td>a.</td><td>Hold or have held an Airline Transport Pilot License (ATPL) for Air Operators and Pilots training organizations, or</td><td>□</td><td>□</td></tr><tr><td>b.</td><td>Aviation Maintenance Engineer Certificate/Airframe & Power plant License/Certificate for repair stations (Approved Maintenance Organizations) or aircraft manufacturers;</td><td>□</td><td>□</td></tr><tr><td>c.</td><td>At least 3 years' experience and expertise in the aviation Safety Management System (implementation and improvement) of which one (1) year managerial experience (manager or supervisor);</td><td>□</td><td>□</td></tr><tr><td>d.</td><td>Operational experience related to the service provided by the certificate holder;</td><td>□</td><td>□</td></tr><tr><td>e.</td><td>At least five years' experience in the aviation industry, of which two years in the related field (e.g., Air Operators, Training Organization, etc.)</td><td>□</td><td>□</td></tr><tr><td>f.</td><td>Technical background to understand the systems that support the Certificate holder's operations;</td><td>□</td><td>□</td></tr><tr><td>g.</td><td>Experience and qualifications in conducting safety/quality audits and inspections</td><td>□</td><td>□</td></tr><tr><td>h.</td><td>Experience in Aircraft Accident Investigation</td><td>□</td><td>□</td></tr><tr><td>i.</td><td>Quality Management System experience is highly recommended;</td><td>□</td><td>□</td></tr></table> GACA-AVSES-SRM-F001 Rev: 5, Date: 19 Mar 25 Page 1 of 4 GACA المنيه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] SAFETY MANAGER ACCEPTANCE APPLICATION FORM <table><tr><td>j.</td><td>Understanding of human factors principles;</td><td>□</td><td>□</td></tr><tr><td>k.</td><td>Analytical and problem-solving skills;</td><td>□</td><td>□</td></tr><tr><td>l.</td><td>Communication skills.</td><td>□</td><td>□</td></tr><tr><td>m.</td><td>Project management skills;</td><td>□</td><td>□</td></tr><tr><td>n.</td><td>Applicants are not a part of any other system of the concerned Organization.</td><td>□</td><td>□</td></tr></table> <table><tr><td rowspan="2" colspan="2">6. MINIMUM COMPLETED TRAINING PROGRAMS FOR THE SAFETY MANAGER POSITION</td><td colspan="2">COMPLAINT</td></tr><tr><td>YES</td><td>NO</td></tr><tr><td>a.</td><td>Safety Management System</td><td>□</td><td>□</td></tr><tr><td>b.</td><td>Safety Risk Management</td><td>□</td><td>□</td></tr><tr><td>c.</td><td>Emergency Response Plan/Crisis Management</td><td>□</td><td>□</td></tr><tr><td>d.</td><td>Quality Management System</td><td>□</td><td>□</td></tr><tr><td>e.</td><td>Audit Techniques</td><td>□</td><td>□</td></tr><tr><td>f.</td><td>Human Factors</td><td>□</td><td>□</td></tr><tr><td>g.</td><td>Accident Investigation</td><td>□</td><td>□</td></tr></table> <table><tr><td colspan="3">7. DECLARATION BY THE NOMINATED SAFETY MANAGER</td></tr><tr><td colspan="3">I hereby declare that the information given in this form is true, correct, and complete.</td></tr><tr><td>Name</td><td>Signature</td><td>Date</td></tr><tr><td></td><td></td><td></td></tr></table> <table><tr><td colspan="3">8. DECLARATION BY THE ORGANIZATION ACCOUNTABLE EXECUTIVE</td></tr><tr><td colspan="3">I hereby certify that the applicant meets GACAR Part 5, eBook Volume 2 and other GACA requirements for the SMS Manager (Representative) acceptance, does not hold any operational responsibilities, and I am satisfied that the information contained in this application is true, correct and completed</td></tr><tr><td>Name</td><td>Signature</td><td>Date</td></tr><tr><td></td><td></td><td></td></tr></table> GACA-AVSES-SRM-F001 Rev: 5, Date: 19 Mar 25 Page 2 of 4 GACA الهميه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] SAFETY MANAGER ACCEPTANCE APPLICATION FORM B. FOR GACA USE ONLY <table><tr><td rowspan="2" colspan="2">1. ASSESS THE APPLICANT KNOWLEDGE AND FAMILIARITY WITH THE FOLLOWING AREAS</td><td colspan="2">COMPLAINT</td></tr><tr><td>YES</td><td>NO</td></tr><tr><td>a.</td><td>GACAR-PART 5 and other applicable GACARs. The SMS related areas in eBook Volumes (2, 3, 4, 12, etc.), AC 005-01, Guidance materials, Process and procedures.</td><td>□</td><td>□</td></tr><tr><td>b.</td><td>Comprehensive knowledge for the Organization's Manuals (Operations, Training, QMS, etc.).</td><td>□</td><td>□</td></tr><tr><td>c.</td><td>Thorough knowledge of the Organization's Safety Management System (Manuals, Policy and Objectives, Reporting System, Safety Promotion, etc.)</td><td>□</td><td>□</td></tr><tr><td>d.</td><td>Be able to demonstrate relevant knowledge, background and appropriate experience related to the activities of the organization;</td><td>□</td><td>□</td></tr><tr><td>e.</td><td>General Knowledge of the Safety Management System (Objectives, Pillars, Elements, Responsibilities, Accountabilities, Management, Personnel, etc.)</td><td>□</td><td>□</td></tr><tr><td>f.</td><td>The Objectives and Purposes of the Safety Management System</td><td>□</td><td>□</td></tr><tr><td>g.</td><td>Safety policy, objectives and strategy</td><td>□</td><td>□</td></tr><tr><td>h.</td><td>The primary role and responsibilities of the Safety Manager and Safety team.</td><td>□</td><td>□</td></tr><tr><td>i.</td><td>Safety Management System scope of operations.</td><td>□</td><td>□</td></tr><tr><td>j.</td><td>Safety Management system feedback system.</td><td>□</td><td>□</td></tr><tr><td>k.</td><td>Safety Assurance Program (Plan, team, process and procedures, tools, records, etc.).</td><td>□</td><td>□</td></tr><tr><td>l.</td><td>Safety and Quality Assurance Responsibility for Sub-Contractors.</td><td>□</td><td>□</td></tr><tr><td>m.</td><td>State Safety Program (SSP).</td><td>□</td><td>□</td></tr></table> <table><tr><td rowspan="2" colspan="2">2. ASSESS THE APPLICANT SKILLS FOR</td><td colspan="2">COMPLAINT</td></tr><tr><td>YES</td><td>NO</td></tr><tr><td>a.</td><td>The ability and confidence to communicate directly to the accountable executive as his advisor and confidante;</td><td>□</td><td>□</td></tr><tr><td>b.</td><td>The ability to communicate at all levels both inside and outside the company</td><td>□</td><td>□</td></tr><tr><td>c.</td><td>The ability to be firm in conviction, promote a “just and fair culture” and yet advance an open and non-punitive atmosphere for reporting</td><td>□</td><td>□</td></tr><tr><td>d.</td><td>Well-developed communication skills and demonstrated interpersonal skills of a high</td><td>□</td><td>□</td></tr><tr><td>m.</td><td>The ability and confidence to communicate directly to the accountable executive as his advisor and confidante;</td><td>□</td><td>□</td></tr></table> <table><tr><td colspan="2">NOMINATED SAFETY MANAGER ACCEPTANCE</td></tr><tr><td>□ Accepted</td><td>□ Rejected</td></tr></table> <table><tr><td>No.</td><td>Remarks</td></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr></table> GACA-AVSES-SRM-F001 Rev: 5, Date: 19 Mar 25 Page 3 of 4 GACA الحييه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] SAFETY MANAGER ACCEPTANCE APPLICATION FORM <table><tr><td></td><td></td></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr><tr><td></td><td></td></tr></table> <table><tr><td>Inspector Name</td><td>Signature</td><td>Date</td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr></table> Supporting Documents 1- The official requesting/cover letter. 2- Copy of Applicant C.V. 3- Copy of the relative and required certificates, Licenses, Training, etc. 4- Prof of the relative Qualifications & experience. 5- Copy of Passport/ID 6- ID Photo GACA-AVSES-SRM-F001 Rev: 5, Date: 19 Mar 25 Page 4 of 4