068-document-initial-review-form-sms-part-151

gaca_gov_sa · form · processed · 6 chunks

GACA
العلنيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
DOCUMENT INITIAL REVIEW FORM - SMS
(GACAR PART 151)
<table><tr><td>Document(s)</td><td>Safety Management System Manual (SMS)</td></tr><tr><td>Organization</td><td></td></tr><tr><td>Issue Date</td><td></td></tr><tr><td>Review Date</td><td></td></tr></table>
<table><tr><td>Conformance</td><td>S = Satisfactory</td><td>U = Unsatisfactory</td><td>X = Not Applicable</td></tr></table>
<table><tr><td>Item</td><td>Subject / Subtopic</td><td>S</td><td>U</td><td>X</td></tr><tr><td>1.</td><td colspan="4">General / Administration</td></tr><tr><td>1.1</td><td>Issue/Edition number and Effectivity/Validity Date</td><td></td><td>□</td><td>□</td></tr><tr><td>1.2</td><td>Company Name, Location and Contact Details</td><td></td><td>□</td><td>□</td></tr><tr><td>1.3</td><td>Scope, Size, &amp; Complexity of Organization</td><td></td><td>□</td><td>□</td></tr><tr><td>1.4</td><td>List of Effective Pages</td><td></td><td>□</td><td>□</td></tr><tr><td>1.5</td><td>Record of Revision (Date &amp; Page included)</td><td></td><td>□</td><td>□</td></tr><tr><td>1.6</td><td>Distribution list</td><td></td><td>□</td><td>□</td></tr><tr><td>1.7</td><td>Table of Contents</td><td></td><td>□</td><td>□</td></tr><tr><td>1.8</td><td>Definitions / Abbreviations</td><td></td><td>□</td><td>□</td></tr><tr><td>1.9</td><td>Appendices / List and Sample of Forms</td><td></td><td>□</td><td>□</td></tr><tr><td>1.10</td><td>Manual Review and Amendment procedure including the Notification to the President for Acceptance of Revisions</td><td></td><td>□</td><td>□</td></tr><tr><td>1.11</td><td>Document Administration and Control Procedures</td><td></td><td>□</td><td>□</td></tr><tr><td>1.12</td><td>SMS Duties &amp; Responsibilities (SMS Organizational Chart)</td><td></td><td>□</td><td>□</td></tr><tr><td>1.13</td><td>Accountable Executive has Ultimate Responsibility for the SMS</td><td></td><td>□</td><td>□</td></tr><tr><td>1.14</td><td>Key Person/Management Representative Responsible for the Administration &amp; Maintenance of the SMS (Day-to-Day Implementation of the SMS)</td><td></td><td>□</td><td>□</td></tr><tr><td>1.15</td><td>Competencies for Key Safety-related Positions</td><td></td><td>□</td><td>□</td></tr><tr><td>1.16</td><td>Safety Accountabilities of Management and Non-management Personnel</td><td></td><td>□</td><td>□</td></tr><tr><td>2.</td><td colspan="4">SMS Component One – Safety Policy and Objectives (ICAO Doc 9859)</td></tr><tr><td rowspan="7">2.1</td><td>Safety Policy Includes Commitment to:</td><td></td><td>□</td><td>□</td></tr><tr><td>(a) Provide all Resources Needed to Implement &amp; Maintain SMS</td><td></td><td>□</td><td>□</td></tr><tr><td>(b) Continuously Improve the Level of Safety</td><td></td><td>□</td><td>□</td></tr><tr><td>(c) Manage Safety Risks</td><td></td><td>□</td><td>□</td></tr><tr><td>(d) Comply with all Applicable Regulatory Requirements</td><td></td><td>□</td><td>□</td></tr><tr><td>(e) Adopt a Non-punitive Approach &amp; Encourage Employees to Report Safety Issues (Incidents/Accidents, Near-misses, Hazards)</td><td></td><td>□</td><td>□</td></tr><tr><td>2.2 Safety Objectives</td><td></td><td>□</td><td>□</td></tr><tr><td>2.3 Promotion of Positive &amp; Just Safety Culture</td><td></td><td>□</td><td>□</td><td>□</td></tr><tr><td>3.</td><td colspan="4">SMS Component Two - Safety Risk Management (ICAO Doc 9859)</td></tr><tr><td>3.1</td><td>Hazard Identification Process</td><td></td><td>□</td><td>□</td></tr><tr><td>3.2</td><td>Safety Targets (Acceptable Level of Safety Risks)</td><td></td><td>□</td><td>□</td></tr><tr><td>3.3</td><td>Safety Risk Analysis &amp; Assessment (definition of Severity &amp; Likelihood matrix)</td><td></td><td>□</td><td>□</td></tr><tr><td>3.4</td><td>Safety Risk Control &amp; Mitigation Process</td><td></td><td>□</td><td>□</td></tr><tr><td>3.5</td><td>Secondary Risks Identification</td><td></td><td>□</td><td>□</td></tr></table>
GACA-AVSES-AGA-F068
Rev: 2, Date: 08 Oct 25
Page 1 of 3

GACA
العلنيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
DOCUMENT INITIAL REVIEW FORM - SMS
(GACAR PART 151)
<table><tr><td>3.6</td><td>F.O.D. Prevention Program</td><td>□</td><td>□</td><td>□</td></tr><tr><td>4.</td><td colspan="4">SMS Component Three - Safety Assurance (ICAO Doc 9859)</td></tr><tr><td>4.1</td><td>Voluntary Safety/Hazard Reporting System</td><td>□</td><td>□</td><td>□</td></tr><tr><td>4.2</td><td>Mandatory Occurrences Reporting System</td><td>□</td><td>□</td><td>□</td></tr><tr><td rowspan="3">4.3</td><td>Occurrence Investigation Procedures include:</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(a) Root Cause Analysis (RCA)</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(b) Corrective &amp; Preventative Actions</td><td>□</td><td>□</td><td>□</td></tr><tr><td>4.4</td><td>Monitoring / Measurement of Safety Performance Indicators (SPIs)</td><td>□</td><td>□</td><td>□</td></tr><tr><td>4.5</td><td>Safety Data Collection / Incident &amp; Accident Database</td><td>□</td><td>□</td><td>□</td></tr><tr><td>4.6</td><td>Management of Change</td><td>□</td><td>□</td><td>□</td></tr><tr><td rowspan="4">4.7</td><td>Continuous Safety Improvement:</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(a) Safety Committee Meetings</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(b) SMS Internal Review</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(c) Follow up of Corrective &amp; Preventative Actions</td><td>□</td><td>□</td><td>□</td></tr><tr><td>5.</td><td>SMS Component Four - Safety Promotion (ICAO Doc 9859)</td><td colspan="3"></td></tr><tr><td>5.1</td><td>Training Program for Safety Personnel</td><td>□</td><td>□</td><td>□</td></tr><tr><td>5.2</td><td>Review &amp; Update of Training</td><td>□</td><td>□</td><td>□</td></tr><tr><td>5.3</td><td>Safety Communication/Promotion</td><td>□</td><td>□</td><td>□</td></tr><tr><td>5.4</td><td>SMS Implementation Plan</td><td>□</td><td>□</td><td>□</td></tr><tr><td>6.</td><td>Local SMS Supplement (where applicable)</td><td colspan="3"></td></tr><tr><td>6.1</td><td>Local Key Person/Management Representative Responsible for the Administration &amp; Maintenance of the SMS (Day-to-Day Implementation of SMS)</td><td>□</td><td>□</td><td>□</td></tr><tr><td>6.2</td><td>Local SMS Duties &amp; Responsibilities of Safety Personnel</td><td>□</td><td>□</td><td>□</td></tr><tr><td>6.3</td><td>Local Safety Performance Indicators (SPIs) Measurement &amp; Monitoring</td><td>□</td><td>□</td><td>□</td></tr><tr><td>6.4</td><td>Local Hazard Identification (documented)</td><td>□</td><td>□</td><td>□</td></tr><tr><td>6.5</td><td>Local Safety Risk Assessment &amp; Mitigation</td><td>□</td><td>□</td><td>□</td></tr><tr><td>6.6</td><td>Special SMS Procedures/SPIs not Described in the Generic SMS Manual.</td><td>□</td><td>□</td><td>□</td></tr></table>
GACA-AVSES-AGA-F068
Rev: 2, Date: 08 Oct 25
Page 2 of 3

GACA
الهميه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
DOCUMENT INITIAL REVIEW FORM - SMS
(GACAR PART 151)
<table><tr><td>Item(Above)</td><td>Reference(in the Manual)</td><td>Findings / Observations / Remarks</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>
GACA-AVSES-AGA-F068
Rev: 2, Date: 08 Oct 25
Page 3 of 3