The Mandatory Occurrence Reporting (Mor) Scheme
The Mandatory Occurrence Reporting (Mor) Scheme
The Mandatory Occurrence Reporting (Mor) Scheme
(MOR) SCHEME
1
CONTENTS
Paragraph Page
1. Introduction 3
4. Items to be Reported 3
5. Submission of Reports 4
6. Safety Resolutions 5
8. Channels of Reporting 5
2
OCCURRENCE REPORTING SCHEME
1. INTRODUCTION
1.1. The broad definition of this scheme is the preparation and submission of
reports by persons or organizations involved in occurrences that they have
experienced. For this Scheme, the term occurrence means any fault problem or
shortcoming of parts or people. In general terms, this covers hazardous occurrences
to all aircraft registered
in Malaysia.
3.1.1. To ensure that the Civil Aviation Authority of Malaysia (CAAM) is advised of
hazardous or potentially hazardous incidents and defects, hereafter referred to as
occurrences.
3.2. It is not the objective of the CAAM to determine or apportion any blame or
liability in connection with aviation occurrences.
4. ITEMS TO BE REPORTED
4.1.2. Any defect in or malfunctioning of any facility, on the ground used or intended
3
to be used for purposes of or in connection with the operation of such an aircraft,
being a defect or malfunctioning endangering, or which if not corrected would
endanger such an aircraft or its occupants.
4.1.3. It is of great importance to the success of the Scheme that Reporters keep
firmly in mind the criterion of danger to the aircraft, etc when deciding whether or not
a report is required. The over-enthusiastic reporting of minor occurrences will be
costly both to Reporters and to the CAAM and will tend, by the sheer volume of data
generated, to obscure the major safety items. Nevertheless, when in doubt, it will
normally be wiser to submit a report.
4.2. A report should also be submitted on any occurrences which involves, for
example, a defective condition or unsatisfactory behavior or procedure which did not
actually endanger the aircraft, but which if allowed to continue uncorrected or which,
if repeated in different, but likely circumstances, could create a hazard.
5. SUBMISSION OF REPORTS
5.1. When employees, e.g. aircraft commanders, engineers, and air traffic
controllers know, or have good reason to believe, that their company or parent
organization will transmit their occurrence reports to the CAAM, they should use the
appropriate company procedures for passing the required information concerning
reportable occurrences, which come to their notice. Employees may submit an
occurrence report direct to the CAAM should they wish, but are strongly advised, in
the interest of flight safety, also to notify their employer, except when confidentiality
is regarded as essential.
5.2. Reports are to be dispatched within 48 hours of the occurrence coming to the
knowledge of the person making the report. Should this report be incomplete, a
further report containing this information must be made within 48 hours of the
information becoming available.
5.3. As has previously been stated, the objective of the Occurrence Reporting
Scheme is to improve the level of flight safety not only from the lessons learned
from any subsequent follow-up action on a report, but also in the prompt alerting of
those organizations associated with the operation and maintenance of the same type
of aircraft or equipment, on which report has been submitted. The CAAM is
dependent upon those responsible for submitting reports to exercise their judgment
and, in those cases where it is considered that particularly potentially dangerous
circumstances exist, to pass such information to the CAAM by the fastest means
possible e.g. telephone, telex and to follow this by a completed form.
4
6. SAFETY RESOLUTION
6.1. CAAM shall review the report and provide the safety resolution. In the event of
serious safety concern or safety concern to the flight safety, CAAM shall take
corrective action by retraining and/or suspending the crew.
6.2. In the event of retraining, the final remedial check shall be carried out by CAAM.
7.2. Operators may wish to use report forms designed to meet their own
requirements, in such cases the form should as far as possible follow the general
format of the above forms in order to facilitate processing. Use of such forms will
require CAAM approval.
8. CHANNELS OF REPORTING
8.2. In some cases, particularly overseas, the use of telex, AFTN or cable may be
necessary to minimize delays in transmission of occurrence information. The CAAM
is contactable by:
8.3. When a report form is not available, the relevant information may be passed in
letterform. Should additional information be required the CAAM may send a standard
report form to the person initiating the report for completion.
8.6. Outside working hours, to fax Flight Operations Division, fax number 603-
88714334.
5
APPENDIX A
1. GENERAL
1.1. The Reporters must provide the information required. This means that
wherever possible they should complete all sections of the form where the
information requested is relevant to a specific occurrence. Relevance is the
important aspect and where any of the information requested is clearly not relevant it
may be omitted, e.g. weather details when weather is in no way involved.
1.2. Individual "box" headings for all items of data are mostly self-explanatory, and
the form comprises a combination of blank boxes for entry of data and boxes listing a
number of alternatives for indication of which alternative are appropriate.
1.3. Space for “Date received by CAAM” and “CAAM Occurrence No” at the top of
the form are for CAAM use only.
1.4. The technical content of the form comprises simple basic occurrence
identification block, a narrative block and blocks for flight and engineering data to
support the narrative. These four blocks are arranged such that everything above the
narrative is relevant to an in-flight occurrence and the data should be readily
available to the aircraft commander.
2.2. Flight and weather details relate to in-flight occurrences only. Provides flight
data in support of the narrative.
2.3. The flight phases listed on the report are defined as follows:
6
CRUISE Top of climb to top of descent including any enroute climb or
descent.
2.4. The nature of flight descriptions listed on the report are defined as follows:
FERRY Ferry for technical reasons without revenue load, e.g. 3-engine
ferry to maintenance base.
7
TOWING Towing of gliders, banners, etc.
3.1. This should be a clear and concise description of the occurrence preferably
starting with a short title indicating the type of occurrence. It should contain details of
what happened or what was found; what immediate action was taken to contain the
situation; and any additional information, comments or recommendations which it is
considered might assist subsequent investigation.
4. ENGINEERING DETAILS
4.3. The ground phases listed on the Report Form are defined as follows:
Taxying While aircraft is moving under engine power for any purpose
other than those defined in "TAXING" in flight phases above.
4.4. The blocks headed “Maintce Prog” should be used to identify the Maintenance
Programme requirements appropriate to the component or part, i.e. “On Condition”,
“Condition Monitored” or “Hard Time”.
4.5. Aircraft or component times should be quoted in the parameters most relevant
to the occurrence or to the component function, e.g. flying hours/cycles/landings, or
a combination of each. Provision is made for total times and times since overhaul,
repair or inspection.
4.7. When such information, etc does exist the provision of the appropriate
reference No.(s) and the compliance status of the aircraft, equipment, facility or
organization is important both in terms of assessing the occurrence and
disseminating the details of it to others.
8
4.8. Manufacturers advised - this is to record whether or not the manufacturer has
been advised. Provision of this information is an important aspect of any occurrence
report relating to a specific aircraft or any item of aircraft equipment. Wherever
possible such information should be provided as this can significantly reduce any
requirements for follow-up activity.
5. NON-TECHNICAL DETAILS
5.3. The provision of the Reporter’s address and telephone number is optional and
is intended for an individual who may wish to be contacted by this means rather than
at his place of employment.
9
APPENDIX B
Although covering a wide range of items, this list must not be considered as
comprehensive and for many occurrences, the Reporter must exercise judgment to
establish if the required criteria are met or not.
1.1. This refers to damage, in flight or on the ground resulting from either
accidental causes or in-service deterioration, e.g. cracks, corrosion, permanent
deformation, etc.
1.2. Substantial damage which occurs between the time any person boards an
aircraft with the intention of flight until such time as all persons have disembarked is
required to be reported as a Reportable Accident in accordance with the regulation
167 of MCAR.
1.3. To avoid duplication in reporting, any event reported under the above
regulations need to be reported to CAAM under the Occurrence Reporting Scheme.
1.5. Any separation from the aircraft in flight or any part of the aircraft.
2. INJURY TO PERSON
2.1. Serious injury or death to flight crew or passengers which directly results from
the operation of the aircraft or its equipment (e.g. abrupt maneuvers, turbulence,
propeller or jet blast) is required to be reported as a Reportable Accident as above.
2.2. Any significant injury to any person, which directly results from the operation
of the aircraft or its equipment, but which is not considered to constitute a Reportable
Accident.
10
3. THE lMPAIRMENT DURING FLIGHT OF THE CAPACITY OF A MEMBER
OF THE FLIGHT CREW TO UNDERTAKE THE FUNCTIONS TO WHICH
HIS LICENCE RELATES
3.1. The requirements to report are equally relevant to impairment of ground staff if
this directly hazards the aircraft.
3.2. Impairment of any member of the flight deck operating crew, including those
which occur prior to departure if it is considered that it could have resulted in
incapacitation after take-off.
3.3. Impairment of any member of the cabin crew which renders him unable to
perform his essential emergency duties.
3.4. Impairment of any member of ground staff (e.g. ATC, maintenance and
engineering staff, etc) when as a consequence, an aircraft was or could have been in
danger.
4.1. The use in flight or on the ground of any emergency equipment or prescribed
emergency procedures.
4.2. The use of any non-standard procedure adopted by the flight crew to deal with
an emergency.
NB: This section covers failures or malfunctions which occur in flight and on the
ground. It must be appreciated that a particular failure or malfunction may be
considered reportable on one type of aircraft, and not on another.
a. Any loss or significant malfunction of more than one main system, sub-
systems, or sets of equipment, e.g. hydraulic power, flight control
systems, electrical power, air systems, ice protection, communications
systems, navigation systems and instruments, warning systems and
devices, brake systems, wheels/tyres on each landing gear, etc.
a. Fire or explosion.
13
Fire or smoke } It is evident to the crew that
warning } the indication is false.
}
Stall warning } It is confirmed as false
} after landing provided that
Door warning } no hazard resulted or could
} have resulted from crew
Ground proximity } Unless workload or actions of the
Warning } crew in response to the
} warning.
Rotor or transmission condition }
warning, etc }
}
5.3.4. Unintentional contact with the ground, including touching down before the
runway threshold.
14
5.3.8. Loss of control from any cause, e.g. turbulence.
5.3.9. Occurrence of stall or a “stick push” operation, other than for training or test
purpose.
5.3.11. Reversion to manual control of powered primary controls, other than for
training or test purposes.
The occurrence scheme is in essence related to aircraft operating under the control
of a Malaysian operator. It is recognized that air traffic services and airport
authorities will have no option when reporting occurrences involving both ground
facilities and aircraft than to report all aircraft, irrespective of nationality.
15
6.2.6. Incorrect transmission, receipt or interpretation of significant messages.
6.2.7. Separation between aircraft of less than that prescribed for the situation.
6.3.7. Collision between a moving aircraft and any other aircraft, vehicle or other
ground object.
6.3.8. Moving aircraft inadvertently leaving the paved surfaces, which results in or
could had resulted in a significant hazard.
7.1. Loading of incorrect fuel quantities likely to have significant effect on aircraft
endurance, performance, balance or structural strength.
16
7.6. Inadequate securing of cargo containers or significant items of cargo.
7.7. Incorrect stowage of baggage or cargo likely in any way to hazard the aircraft,
its equipment or occupants or to impede emergency evacuation.
Note: In such cases it is expected that the Reporter will submit a single occurrence
report together with the supporting evidence of high frequency and/or rate when it is
considered that such a situation has been reached.
8.5. A skyjack.
8.6. A lighting strike which results in significant damage to the aircraft, loss or
malfunction of any essential services or injury or impairment to the occupants.
17
8.7. In-flight fuel quantity critically low or exhausted.
18
To be sent to:
OCCURRENCE REPORT (CAAM Borang 9 - OR)
Flight Operations Division
Civil Aviation$XWKRULW\RI Malaysia CIVIL AVIATION AUTHORITY OF Fax to: +603 8871 4334
N0 27 Persiaran Perdana or e-mail to
Level 2, Block Podium B, Percinct 4 MALAYSIA [email protected]
62618 PUTRAJAYA
PARKED PAX
FLIGHT AND WEATHER DETAILS
TAXYING FREIGHT
NARRATIVE
ENGINEERING DETAILS
Unattended
CYCLES YES
LANDINGS NO
Is there any published Airworthiness Information or control YES Reference No and Compliance Status of Aircraft or Equipment
procedures (e.g. AD, SB etc) relevant to occurence
NO
Report If report is submitted Voluntarily i.e. not subject to mandatory requirements
ORIGINAL
SUPP
NIL
YES NO
OPEN
Organisation
CLOSED
NO
Address (if reporter wishes to be contacted privately)
Tel No
Name