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GACA العاليه للطيران المدني General Authority of Civil Aviation [Non-Text] GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td>Aerodrome</td><td></td></tr><tr><td>Aerodrome Emergency Plan Version No.</td><td>Request No.</td></tr><tr><td>Aerodrome Emergency Plan Version Date</td><td>Date of Review</td></tr></table> <table><tr><td colspan="2">1. PLAN MANAGEMENT</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>1.1</td><td>1.1 Plan Information (date of Plan preparation, number of current versions, plan approval):General information about the plan including, for example, department, person in charge of plan preparation, plan revision, plan approval, dates of preparation, revision and approval, and number of current updated version.</td><td></td><td></td></tr><tr><td>1.2</td><td>Date of next plan revision and persons assigned to the revision:Date of latest revision of the plan, timeline for plan revision or next revision date of the plan; department information and person in charge of revision.</td><td></td><td></td></tr><tr><td>1.3</td><td>Record of Changes:A record of changes is a containing a number assigned to any change, a description of the change, the date of the change, the date of actual entry into the plan, and the signature or initials of the person responsible for the change.</td><td></td><td></td></tr><tr><td>1.4</td><td>Plan distribution list:Employee information/departments/ agencies that have copies of the plan and have roles and responsibilities in it, locations of plan copies either electronic or paperback in order to ensure control of plan circulations, management; and ensure validity and symmetry with the latest revisions.</td><td></td><td></td></tr></table> <table><tr><td colspan="2">2. PLAN INTRODUCTION</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>2.1</td><td>Promulgation Document:Letter or form signed by the aerodrome operator authority gives the plan official status and provides both authority and responsibility for organizations to perform assigned tasks. The promulgation document can also discuss the tasked organizations' responsibility to prepare and maintain SOPs and commit them to the training, exercises, and plan maintenance efforts needed to support the plan.</td><td></td><td></td></tr><tr><td>2.2</td><td>Signature Page:A signature page of Aerodrome Emergency plan committee to show that all response organizations tasked in the plan have coordinated in the plan's development and are committed to its effective implementation.</td><td></td><td></td></tr><tr><td>2.3</td><td>Determination of plan objective:The strategic purpose of responding to emergency situations and recovery after emergency response, the plan is aiming to achieve.</td><td></td><td></td></tr><tr><td>2.4</td><td>Determination of plan framework:This part of the plan specifies potential risks that might result in an emergency</td><td></td><td></td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 1 of 8 GACA الطهاره للطهاره المطهاره General Authority of Civil Aviation [Non-Text] GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td></td><td>situation that demands plan activation.</td><td></td><td></td><td></td></tr><tr><td>2.5</td><td>Determination of plan goals:The group of goals that the plan is aiming to achieve the main purpose through.</td><td></td><td></td><td></td></tr><tr><td colspan="2">3. EVENTS AND SCENARIOS IN THE PLAN FRAMEWORK</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>3.1</td><td>Determination of events and scenarios undertaken in the plan:A list of planning presumptions based on risk analysis including emergency situations demanding plan activation, its causes, consequences, impact on society, health, environment, security, country's reputation, economic development, or the continuity of basic services or vital businesses.</td><td></td><td></td><td></td></tr><tr><td colspan="2">4. ROLES AND RESPONSIBILITIES</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>4.1</td><td>Appointment of members of emergency situation response team:In this section, members of the main team responsible for performing the tasks and responsibilities mentioned in the plan are appointed, data of the team is attached with supporting documents in the appendixes.</td><td></td><td></td></tr><tr><td>4.2</td><td>Assignment of roles and responsibilities for the emergency situation response team:In this section, roles and responsibilities for the emergency situation response team are assigned, including for example:- Appointing the main committees for the event leadership, location of meeting, and the alternative location.- The assignment of roles and responsibilities for teams and committees.- Determining the mechanism of obtaining logistic support to ease the response teams and committees' work.- Instructions that are associated with filling related forms, reports preparation, meetings records and symbols and abbreviations used in them.- Connection between teams or committees with emergency operations centers.</td><td></td><td></td></tr><tr><td>4.3</td><td>Structuring of emergency situation management team and its correlation with other teams and departments:- This section explains the administrative structure of response to emergency situations and its extent of correlation with other administrative structures inside the organization, it also provides an explanation of specializations briefly, and the way in which roles are distributed inside and outside of the agencies associated with response. It is also essential to support this section of the plan by attaching the details of roles and responsibilities of each department to the supporting documents in the appendixes.- This section explains command personnel Identification system in the Incident, which is readily identifiable through an identification system such as reflective vests, functional badges, safety hard hats, or other distinguishing markings that clearly indicate their respective function.</td><td></td><td></td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 2 of 8 GACA الطاقات للطيران المدني General Authority of Civil Aviation [Non-Text] GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td></td><td>- This section explains Identify Emergency Operations Center to response and deal with disasters, emergency situations, and temporary closure of the airport or runway and is subject to the supervision and management of the Airports Authority, identify attendees of this center from the departments operating at the airport, which the airport authority considers the necessity of their presence in the center.</td><td></td><td></td></tr><tr><td>4.4</td><td>Roles and responsibilities of related parties (inside and outside the organization) and personnel in charge:Roles and responsibilities are explained to departments and agencies related to plan implementation according to pre-planned presumptions, including roles and responsibilities divided as follows:-Inside the organization: such as emergency situation watch centers or report receiving call centers, other operations centers within the organization, mutual support services.-Outside the organization: all parties participating or supporting in the implementation.-Aerodrome operator should include a copy of the signed Mutual aid agreements between the Aerodrome operator and the organizations that provide emergency response services to the airport in the emergency plan and reviewed annually.-The plan must include the availability of and coordination with appropriate specialist rescue services to be able to respond to emergencies in difficult environments where an aerodrome is located close to water and/or swampy areas and where a significant portion of approach or departure operations takes place over these areas.</td><td></td><td></td></tr></table> <table><tr><td colspan="2">5. MAIN REQUIREMENTS FOR RESPONSE AND RECOVERY OPERATIONS</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>5.1</td><td>Required logistics and necessary abilities to enable the response and recovery team to perform its tasks:This section of the plan includes requirements and enables necessary to provide logistic support for response and recovery operations within the plan framework, including but not limited to: providing primary operations rooms and centers for management of emergency situation and alternative locations for them, providing support for teams and committees reporting, transportation and continuity of work 24 hours if needed, in addition to providing technologies, communication means and procedures that ease coordination of teams and committees work, and providing support and services for report preparation and meetings records and its distribution, approval and sharing.</td><td></td><td></td></tr><tr><td colspan="2">6. DETAILED PLANS (PROCEDURES) FOR EACH PHASE OF THE RESPONSE AND RECOVERY OPERATION</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 3 of 8 GACA المناعه للطيران المدني General Authority of Civil Aviation [Non-Text] GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td>6.1</td><td>The detailed plan of the alerting and notification phase:This section of the plan includes information on:-The mechanism of monitoring, prediction, and early alert.-Alert of upgrade and downgrade of level of situation, and the source of alert.-Agencies in charge of alerting the audience.-The mechanism of reporting sharing inside the organization and outside.</td><td></td><td></td></tr><tr><td>6.2</td><td>The detailed plan of information and reports collection, evaluation and analysis:In this section, the following details are clarified:-The mechanism of collection of information related to the emergency situation description and its level.-The mechanism of decision making of response to emergency situation and plan activation.-The mechanism of increasing the public awareness of the procedures that must be taken by each person in society, and the determination of authorized persons.</td><td></td><td></td></tr><tr><td>6.3</td><td>The detailed plan for the response and containment:This section of the plan includes the mechanism of execution and implementation of tasks and procedures, and providing support to the people affected as a result of the emergency situation in accordance with the pre-planned presumptions determined prior.</td><td></td><td></td></tr><tr><td>6.4</td><td>The detailed plan for recovery phase-returning back to norm:The inclusion of standards and procedures for evaluation of the termination of the response situation and the transition to recovery phase and the return back to norm and determining the mechanism of reporting to agencies inside and outside of the organization about the transition to the recovery phase, including the estimation of costs accompanying with the recovery phase and providing technical and financial consultations about it, along with the clarification of the roles of participating committees and agencies in this phase</td><td></td><td></td></tr></table> <table><tr><td colspan="2">7. REFERENCE DOCUMENTS</td><td rowspan="2">STATUS</td><td rowspan="2">COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>7.1</td><td>List of internal and external communication information:The list includes a statement showing the people in charge of management of the plan elements or cooperation and support from inside or outside the agency according to the plan's framework which includes for instance:-Name of the main member and the substitute.-Name of the agency/department/center.-Primary or alternative communication means.</td></tr><tr><td>7.2</td><td>Maps of alternative locations:Presenting detailed description of the alternative locations for the main emergency management center in order to ensure readiness for emergency situation management and communication with sectors related to the agency and the other</td><td></td><td></td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 4 of 8 GACA الط膝盖ه للطيران المدني General Authority of Civil Aviation [Non-Text] GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td></td><td>agencies associated</td><td></td><td></td><td></td></tr><tr><td>7.3</td><td>Data list of critical infrastructure exposed to effects of events and scenarios included in the plan:The list contains a statement of all information necessary about the infrastructure expected to be affected according to the scenarios determined prior.</td><td></td><td></td><td></td></tr><tr><td>7.4</td><td>Relation with emergency plans and related documents:Providing description of the plan correlation with other emergency plans and documents related.</td><td></td><td></td><td></td></tr><tr><td>7.5</td><td>Media and Information Management Plan:Presenting detailed description about Media and Information Management Plan, includes public information officer should be designated, and specific place for Media Centre, for release of accident information, escorting the news media to the accident/incident location.</td><td></td><td></td><td></td></tr><tr><td>7.6</td><td>Family Assistance Program:Aerodrome policy and procedures for providing support facilities and resources to the “Air Carries Family Assistant Program, includes air Carriers Responsibilities, Aerodrome Supporting Responsibilities & Requirements (agencies, facilities & communications, resources, staffing)</td><td></td><td></td><td></td></tr><tr><td>7.7</td><td>Emergency Medical Management Plan:Aerodrome policy and procedures for providing emergency medical care in time of emergency, to include specifics on triage areas, permanent care facilities, (holding areas), and activation / request of assistance and medical transport requirements.</td><td></td><td></td><td></td></tr></table> <table><tr><td colspan="2">8. EVALUATION OF RESPONSE AND RECOVERY PROCEDURES, AND DETERMINING THE LESSONS LEARNED AND CHANCES FOR IMPROVEMENT</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>8.1</td><td>In this section, it is mandatory to explain:-The mechanism of documentation of response and recovery procedures implemented.-Forms related to the documentation of response and recovery procedures.-The mechanism of collecting, archiving and sharing of information and documents with stakeholders.-The mechanism of studying the results of response and recovery evaluation and taking advantage out of them in improving response and</td><td></td><td></td></tr></table> <table><tr><td colspan="2">9. TRAINING AND EXERCISES</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>9.1</td><td>Training mechanism for agencies on planning tasks:This section includes clarification of training mechanisms on tasks assigned to participating agencies outside of the organization, including training of agencies' envoys and correlation elements on mutual tasks and the method of reports</td><td></td><td></td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 5 of 8 GACA الطاقعه للطيران المدني General Authority of Civil Aviation [Non-Text] GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td></td><td>preparation, providing information, statistics, passing of reporting, and more.</td><td></td><td></td></tr><tr><td>9.2</td><td>Mechanism of exercise implementation, convening periods and training types:Mechanism of exercise implementation aims to examine the efficiency of emergency planning with all agencies assigned with tasks and responsibilities in the plan, including:- Examining the extent of comprehension and the availability of capabilities among all agencies for the implementation of tasks and responsibilities assigned to them efficiently.- Scheduling and periods of training convening, and its type (e.g.: tabletop, hypothetical, practical... etc.).</td><td></td><td></td></tr><tr><td>9.3</td><td>Evaluation mechanism for exercises and examinations, and determination of lessons learnt, documentation, and improvement of plans:This section includes the mechanism of exercises and presumptions evaluation, evaluation committees, and forms related to determination of strengths and weaknesses and chances of improvement and lessons learnt from exercises, with determining the mechanism of investment from those lessons in improvement of emergency plans and the efficiency of response and recovery procedures.</td><td></td><td></td></tr></table> <table><tr><td colspan="2">10. ESCALATION</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>10.1</td><td>Upgrade of emergency situation standards and procedures:This section includes a presentation of detailed description on:- Standards of upgrade of emergency situation.- Sequence of on-site leadership.- Mechanism of upgrade to a higher level, if necessary (or when the situation exceeds capabilities and authority for each level), for example:☐ Number of casualties.☐ Number of harmed people.☐ Amount of expected financial losses.☐ The effect of the situation over more than one sector.☐ Geographic space effected.☐ The effect of the situation on political and diplomatic relations.☐ Expected time period of the breakdown of services.☐ The effect of the situation on general opinion.☐ The effect of the situation on the country's reputation.</td><td></td><td></td></tr><tr><td>10.2</td><td>Downgrade of emergency situation standards and procedures:This section includes a presentation of detailed description on:- Standards of downgrade of the emergency situation.- Return of leadership to local levels after control of the situation or after receiving support or required authority.</td><td></td><td></td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 6 of 8 GACA العامه للطيران المدني General Authority of Civil Aviation [Non-Text] GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td colspan="2">11. FORMS</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>11.1</td><td>Reports passing forms, exchange of data and reports, upgrade and downgrade of emergency situation:The plan must include unfired forms for passing reports, data and reports exchange, upgrade or downgrade of emergency situation, and request of assistance and support.</td><td></td><td></td></tr><tr><td>11.2</td><td>Events record form used by the agency to document activities and works accomplished during the response and recovery phases:The plan must include unfired forms for events records that the agency uses to document the activities and works accomplished during the response and recovery phases.</td><td></td><td></td></tr><tr><td>11.3</td><td>Damage evaluation form:Attaching a form for the purpose of evaluation and conceiving of damage resulted from the emergency situation</td><td></td><td></td></tr></table> <table><tr><td colspan="2">12. OTHER SUPPORTING DOCUMENTS</td><td>STATUS</td><td>COMMENTS OR MODIFICATIONS NEEDED</td></tr><tr><td>12.1</td><td>This section includes supporting documents like (agreements, other plans, and documents related) etc.,</td><td></td><td></td></tr></table> <table><tr><td colspan="2">GENERAL REMARKS</td></tr><tr><td>1</td><td></td></tr><tr><td>2</td><td></td></tr><tr><td>3</td><td></td></tr></table> <table><tr><td colspan="2">GENERAL REQUIREMENTS</td><td>Satisfactory</td><td>Unsatisfactory</td></tr><tr><td>1</td><td>Aerodrome Emergency Plan Completeness</td><td></td><td></td></tr></table> <table><tr><td colspan="2">OVERALL RECOMMENDED ACTIONS</td></tr><tr><td>1</td><td>Acceptance for Approval</td></tr><tr><td>2</td><td>Acceptance for Approval with Follow-up Action within xxx Months</td></tr><tr><td>3</td><td>Non-Acceptance. Required action needed & resubmit</td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 7 of 8 GACA العاليه للطيران المدني General Authority of Civil Aviation GACA AERODROME EMERGENCY PLAN – EVALUATION / REVIEW CHECKLIST <table><tr><td colspan="4">Inspector(s) Completing Worksheet</td></tr><tr><td>Name</td><td>Signature</td><td>Position</td><td>Date</td></tr><tr><td></td><td></td><td>Aerodrome Inspector</td><td></td></tr><tr><td></td><td></td><td>Aerodrome Inspector</td><td></td></tr><tr><td colspan="4">Verification by Section Head</td></tr><tr><td>Name</td><td>Signature</td><td>Position</td><td>Date</td></tr><tr><td></td><td></td><td>Section Head</td><td></td></tr></table> GACA-AVSES-AGA-F018 Rev: 6, Date: 16 Apr 25 Page 8 of 8