Appendix 5. Checklist for Reported Headset Tone Incidents

This form will be completed by the operations supervisor (OS)/controller‐in‐charge (CIC) and must be retained by the employee's OS for a period of 1 year.

Checklist Requirement for Headset Tone Incidents

OS/CIC Initials

Ensure that Technical Operations is notified to evaluate the affected operational position and associated NAS equipment for normal operations as soon as possible.

 

Secure the affected headset for testing by facility Air Traffic Management.

The affected employee and their union representative will be given the opportunity to observe the headset testing.

 

Secure the audio recording of the headset tone incident.

NOTE-

FAA Tech Ops may use the recording to conduct a root‐cause analysis.

 

Record the incident on FAA Form 7230-4, Daily Record of Facility Operation, using the “E” entry. Carry the item on the facility log until headset testing has been completed.

 

When headset testing is complete, annotate the facility log using an “E” entry with the statement, “Tests complete. (Record test results).” Report any abnormal test results (headset or other communications equipment), as appropriate, on FAA Form 7230-4, Daily Record of Facility Operation.

The ATM must ensure headsets which fail the headset testing are secured and, within 30 days, contact the second level Engineering Office, AJW-173, at (405) 954-0066 for instructions to return the headset to the manufacturer.

 

Have the affected employee(s) complete OSHA Form 301 on ECOMP. Once the form is submitted, the employee may choose to file an OSHA CA-1 form.

 

If the employee is incapacitated, then management must complete the OSHA-301 form in ECOMP. Manager will receive an email detailing the next steps to review the incident in ECOMP.

 

Manager will receive an email from SMIS to review and complete the Supplemental 301.

 

NOTE-

OSHA forms and instructions are available on the Department of Labor Employees' Compensation Operations and Management Portal (ECOMP) located on the website https://www.ecomp.dol.gov/#/.