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APPENDIX G.5

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Page 1: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

APPENDIX G.5

Page 2: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

< * ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPORT

„ N a m e

. 4 Weathe r hgVFR U MVF R a IF R n Othe r

5 Workloa d • Ligh t

i ^ f Moderat e • Heav y

2 Dat e |

6 Complexit y • No t Difficul t J 3 . Occasionall y Difficu l • Mostl y Difficul t D Ver y Difficul t

9 Purpos e S ' O J T D OJ F • Familiarizatio n Q Instructiona l Q Evaluatio n Scenario Scenari o Scenari o

D Skil l Chec k Q Certificatio n Q Recertificatio n D Skil l Enhancemen t D Othe r 11

Job Tas k

A Separatio n

B Coordinatio n

C Contro l Judgement

i i !

D Method s an d Procedures

) 4

u a.

} i*AA

E Equipmen t

F Communicatio n

G Othe r

Form 3120-2M5-98) 5

Job Subtasl -

1 Separatio n i s ensure d

2 Safet y alert s are provide d 3 Perform s handoffs/pointout s

4 Require d coordinations ar e performe d

5 Goo d control judgement i s applied 6 Pnorrt y of duties i s understoo d 7 Positiv e contro l is provide d 8 Effectiv e traffi c flo w is maintaine d

9 Aircraf t identit y i s maintaine d

10 Stri p posting is complete/correc t

11 Clearanc e delivery is complete/correct an d timel y

12 LOAs/directive s are adhered to

13 Additiona l services are provide d

14 Rapidl y recovers from equipment failure s and emergencie s

15 Scan s entire control environmen t

16 Effectiv e working speed is maintaine d 17 Equipmen t status information is maintaine d

18 Equipmen t capabilities are utilized/understoo d

19 Function s effectivel y a s a radar/tower team membe r

20 Communicatio n i s dear and concise

21 Use s prescribed phraseolog y

22 Make s only necessary transmission s

23 Use s appropnate communications metho d

24 Relie f bnefings are complete and accurat e

25 Visua l Separation i s applied correctl y

upcrscdcs Previous 1 dition (Electronic )

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Page 3: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12. Comment s 12A. Reference s

Signature: Date: f/ndo 13. Recommendatio n D Certificatio n Skill Check D Certificatio n

D Continuatio n of OJT Q Skil l Enhancement Training Q Suspensio n of OJT

14. Employee' s Comments:

This report has been discussed with me (Signatur Date: 3 iih O

15. Certification/Recertificatio n I certify that this employee meets qualification requirements and is capable of working under general supervision.

Signature of Certifier: Date:

FAA Form 3120-2 5 (5-98) Supersedes Previous Edition (Electronic ) NSN:OO52-OO->">90-:M;

Page 4: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

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ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPOR T >C / !

2 Dat e 3 &cena r o Pes*'on s

6 Uomple > ity Q No t Difficul t

| " 0 Occasional!/Difficul t D Mostl y Dif t ic j l t P Ver y Diff>cL< "

3 Fc'c' l H.urs Thi s °i <

9 Purpos e S ' OJT j OJ F C I Familiarization __ , Instructional Q Evaluatio n Scenario Scenari o Scenari o

• Skil 1 Cneck Q Cert'ficatio n Q Recertificatio n Q Skil l Enhancemen t P o t h e r

10 Rch ' i u

Job Tas k

reparation

B Coordinatio n

C Contro l Judgemeni

D Method s and Procedures

E Equipmen t

r uonunun i rtiu n

G Othe r

Job Subtas k

Separation i s ensure d

Saiety alert s are provided

Performs handoffs-pointoui s

Required coordinaton s ar e performed

5 Goo d contro l judgement is > appliec 6 Priorit y o f duties i s understoo d 7 Positiv e contro l i s provide d 8 Eftectiv e traffi c flo w i s maintaine d

I 9

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14

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Aircraft identit y i s maintaine d

Strip postin g i s complete/correc t

Clearance deliver y i s comolete'correct and timel y

LGAs/direUives are adhei^d to

Additional service s are provided

Rapidly recover s fro m equipmen t failure s and emergencies

Scans entii e contro l environmei t

16 Effectiv e workin g spee d i s mairtained Equipment statu s informatio n i s maintaine d

Equipment capabilitie s ar e utilized/understood Functions effectivel y a s a radarvtov/er team membe r

Communication i s clear an d concise

Uses prescribe d phraseolog y

Makes onl y necessar y tiansrwssion s

Uses appropriat e communication s metho d

Relief briefing s ar e complete and accurate

Visual Separation i s applied ccrrecll y

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Page 5: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

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Page 6: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

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ATCT/ARTCC OJ T INSTRUCTION/EVALUATION REPOR T

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Set araton i s ensure d

Safety alet s ar e provide d

Performs handoffs/pointout s

Required coordinations ar e performe d Good contro l judgement i s applie d pncrtty o f duties i s understoo d Positive contro l i s provide d

Effect ve traffi c flo w i s maintaine d

Aircraft identit y i s maintaine d

Strip posting i s complete correc t

Cleaiance del'ver y i s complete/correct an d timel y

LOrts/directives ar e adhere d to

Additional services ar e provide d

Rapidly recovers fro m equipmen t failure s an d emergencie s

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Effective workin g spee d i s maintaine d Equipment statu s informatio " i s maintaine d

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Page 7: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

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4 Emr . j /ees Comment s

T- s -eccrt has teen . , ci s-ussed with me (Signatuie) Date J P ± P l l _ U _ _ ~y~" fcation RecetificatiO" cedu'y that this employee meets qualification requirements and is capable of wooing under uene ral super.,sion

b T-a'u re of Ce"j'er Dat* \ \ > p i T | 2 f l ^ i^-'iv . S l | l . I N L ' l l U'l-'n ,

Page 8: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

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• No t Difficul t d Occasionall y Difficul t • Mostl y Difficul t D Ver y Difficul t

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6. Priorit y of duties i s understood .

7. Positiv e contro l i s provided.

8. Effectiv e traffi c flo w is maintained .

9. Aircraft identit y i s maintained .

10. Stri p posting is complete/correct .

11 Clearanc e deliver y i s complete/correct an d timel y

12. LOAs/directive s ar e adhered t o

13. Additiona l service s are provide d

14. Rapidl y recover s fro m equipment failure s and emergencies .

15. Scan s entire contro l environmen t

16. Effectiv e working spee d i s maintained.

17 Equipmen t statu s informatio n i s maintained.

18. Equipmen t capabilities ar e utilized/understoo d

19. Function s effectivel y a s a radar/towe r tea m membe r

20. Communicatio n i s clear and concise .

21 Use s prescribed phraseology .

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23. Use s appropriate communication s method .

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Page 9: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A Reference s

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13. Recommendation Q Certificatio n Skil l Check • Certificatio n ' D Continuatio n of OJT D Skil l Ehancement Training D Suspensio n of OJT

14 Employee' s Comments

This report has been discussed

S Pinto- S7/2/7'

15 Certification/Recertificatio n P I certify that this employee meets qualification requirements and is capable of working under general supervision.

Signature of Certifier Date.

FAA FOR M 3120-2 5 (5-98 ) Supprseclf s Previou s f-rt l io n NSN 0052-0 0 90 0 200 Z

Page 10: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

F*t)«-*i Aviation AamimiUai;J -

ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPOR T

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6. Complexit y • / J o t Difficul t 0 Occasionall y Difficul t • Mostl y Difficul t • Ver y Difficul t

9 Purpos e i n n I T n n i c H I Familiarizatio n r- i Instructiona l n Evaluatio n i_j U J I I_ J U J I - t_ j S c e n a r j 0 U S c e n a r j0 L J scenari o

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G. Othe r

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1. Separatio n i s ensured.

2 Safet y alert s are provided .

3. Perform s handoffs/pointouts .

4. Require d coordinations ar e performed .

5. Good contro l judgment i s applied.

6. Priorit y o f duties i s understoo d

7. Positiv e contro l i s provided.

8 Effectiv e traffi c flo w i s maintained .

9. Aircraft identit y i s maintained .

10. Stri p posting i s complete/correc t

11. Clearanc e deliver y i s complete/correct an d timely .

12. LOAs/directive s are adhered to .

13. Additional service s ar e provide d

14. Rapidl y recover s from equipmen t failure s an d emergencies .

15. Scan s entire contro l environmen t

16. Effectiv e workin g spee d i s maintaine d

17. Equipmen t statu s information i s maintained .

18. Equipmen t capabilitie s ar e utilized/understood .

19. Function s effectivel y a s a radar/towe r tea m member .

20. Communicatio n i s clear an d concise .

21 Use s prescribed phraseology .

22. Make s onl y necessar y transmission s

23. Use s appropriate communication s method .

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25. Visua l Separation i s applied correctly .

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Page 11: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A Reference s

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Signature: Date: ^r-5~v/ 13 Recommendatio n • Certificatio n Skil l Check •Certificatio n

• Continuatio n of OJT • Skil l Ehancement Training • Suspensio n of OJT

14. Employee's Comments:

This report has been discussedwith me 'Sinnature^ Date sysx

j -15 Certification/Recertificatio n

I certify that this employee meets qualification requirerffents and is capable of working under general supervision.

Signature of Certifier Date-

FAA FOR M 3120-2 5 5-98 ) SjpersoJe s Pr r \ o.» , Ed.li i NSN Q052-OQ-9CO-2CC 2

Page 12: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

© ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPORT

Nanv- z Liar e

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7 Positiv e contro l i s prov dec

8 Effectiv e traffic flo w is maintaine d 9 Aircraf t identit y i s maintaine d

10 Stn p posting , s complete/correc t

11 Clearanc e delivery . s compiete/correct ana timely 12 LOAs/directive s are adhere d to 13 Add* t cnal services are provide d 14 Rapidl y recover s fro m equipment failure s and emergencie s

15 Scan s entir e contro l environmen t 16 Effectiv e working spee d i s maintaine d 17 Equipmen t status informatio n i s maintained

18 Eq u pment capaDurties ar e utiiized/unoerstooa

19 Function s effectivel y a s a radarAower team membe r

20 Commumca t o-> is dear an d cone se

21 Use s preserved phraseolog y

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23 Use s appropnate communication s metho d

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Page 13: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s

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Signature

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12A Reference s

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• Certificatio n SkiB Check • Certificatio n O Continuatio n of OJT • Skil l Enhancement Training • Suspensio n of OJT

14 Employee' s Comments. This report has been discussed ^ y • y with me (Signature)

f imf tr i r I! ir Date 7j/tf

15 Certification/Recertification . I certify that this employee meets qualification requirements and is capable of wooing under general supervision

Signature erf Certifier Dat e

FAA FOR* J l »M f5-» ) Suparaad M Prawoui Edfewi NSN OOW CO900-2002

Page 14: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

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14 Rapidl y recover Hor n equipmeni failures rind <»iTierg~ncies

1*> Scan s entire contro l environment

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16 fcquipment capabilitie s ar e utilized/understoo d ll> r unctions etfeJi.el v a s a radar/tower tea m membe r

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Page 15: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

i : pn . i i -

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I I ( continuatio n > f 'J I f • Skil l Enhancemen t Trainin g I I Susp~n- ion o f OJ T

14 E 1" f. 1 •,—-•. ' n i n n - • ! l

I n repor t h i s hi-i-i i iiSi us^e d A'tl h i i v i i iq iu i tut . ) Date

15 ( enif ication/Kc i L-rtif i aliu n ! c c l i f v 'ha t Ihi' i M i i f i i oy i ^ mi-«=t ^ qualid ' alie n \< q u t f "nerts an d > • caputs' — o f work im j undt' r ni-n'-M i -upprvisio n

signature <>t < Mti ' i _ Dat ^

f W h u m ~ IZi i ( ii> i . i • l l l l ) i II i l l l l

Page 16: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

< £ > d < r a l A v i .

ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPOR T

tame Date - r /

_/ 4. f e a t h e r H VF R • MVF R D IF R PI Othe r

5. Vvorkioa d • > P t QPv lode ra te D Heav y

6 Complexit y n ^ l o r Difficul t k j Occasionall y Difficul t • Mostl y Difficul t • Ver y Difficul t

Scenaro Pos i t ion s i

I 7 H o i T r P ^ - T

' 6 ~ota ; Hco' S T r Py

OJF [ P Faniiiiari>:atio r Scenario

9. Purpos e Q O J I

P I Skil l Chec k f j Certificatio n O Recertif icatio n P ] Skil l Ei ' l ianceinen t C H Othe r

Instructional Scenario

Q Evaluatio n Scenario

Job Tas k Jon Suotas k

A Separatio n

B. Courdiriatic T

C Contro l Judgement

D. Method s and Procedures

1. Separatio n i s ensured.

2. Safet y alert s are provided

3. Perform s handoffs/pointout s

I 4 . Require d coordination s are performed. I 5 , Goo d contro l judgemen t i s applie d i 6 . Priorit y o f duties i s understood.

7. Positiv e contro l i s provide d 8. Effectiv e traffi c flo w i s maintaine d

9. Aircraf t identit y i s maintained .

10. Stri p postin g i s complete/correc t

11 Clearanc e deliver y i s complete/correct an d timely.

12. LOA s directive s ar e adhered to.

13. Additiona l sen/ice s are provided.

14 Rapidl y recover s fro m equipmen t failure s and emergencies.

E. Equipmen t

15. Scan s entir e contro l environment .

1C. Effectiv e workin g spee d i s maintained. 17. Equipmen t statu s informatio n i s maintained.

18. Equipmen t capabilitie s ar e utilized/understood.

F. Communicatio n 19. Function s effectivel y a s a radar towe r team membe r

20. Communicatio n i s clear and concise

21. Use s prescribe d phraseolog y

j 22 . Make s onl y necessar y transmission s

! 23 . Use s appropriat e communication s method .

24. Relie f briefing s ar e complete an d accurate.

G. Othe r 25. Visua l Separatio n i s applied correctly .

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Page 17: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

1 12 Comments .

y$!yOLK o/lA. /$e //rtiitA /?& c ^ ?7Ay//>*/)

12A Reference s

Sign ituie Date y? j /

13 Re i ommendation [ J Certif catior S k n Check [ j Certif u ation

CI Continuatio n of O IT [~] Skil l Enhancement Trainin q • Suspensio r o f OJT

14 L mj) 0'.°e - Comment s

THIS repon na s bee r diM ussed wit h m e (Signature / / Date 7 / -7/ '

15 (..-"i f catioiwRecertifioa'ion 1 rortif, tha t 'IT S employe e meet s qualification requirement? ' a'1 ' i s c apab'e of working unde r genera l supervisio r

Signature o f Certifier Date

r \ \ 1 in n ' ' ^ r ' 0 S i i \ , | U , | | u i r > n,

Page 18: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

)

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U * Da»*rt.-nM * ol trwutflAaen ' ^ ~ ^ FwSWkl Avtitfan Admlnlctfatlon

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A ATCT/ARTC C OJ T J INSTRUCTION/EVALUATIO N REPOR T

1. Name

4. Weather

0 VF R • MVF R • IF R • Othe r

5. Workload 0 Ligh t D Moderat e O Heav y

2. Date Jun 1 3 , 2 0 1 1

t ' - J \X

3. Scenario/Position(s ) RA66

6. Complexity E l No t Difficul t D Occasionall y Difficul t D Mostl y Difficul t D Ver y Difficul t

9. Purpose rj\ r, ,T n n i c H I Familiarizatio n r— i Instructiona l n Evaluatio n La U J I u UJ h L_ I S c e n a r i 0 L J S c e n a r i 0 L_ J S c e n a r i 0

D Skil l Check D Certificatio n • Recertificatio n • Skil l Enhancement D Othe r

11,

8

c re E o •c Q.

Job Task

A. Separatio n

B. Coordinatio n

C. Contro l Judgment

D. Method s and Procedures

E. Equipmen t

F. Communicatio n

G, Othe r

Job Subtas k

1. Separation is ensured.

2. Safety alert s are provided.

3. Performs handoffs/pointouts .

4. Require d coordinations are performed.

5. Good control judgment i s applied.

6. Priority of duties is understood.

7. Positive control is provided.

8. Effective traffi c flow is maintained.

9. Aircraft identity i s maintained.

10. Strip posting is complete/correct .

11. Clearanc e delivery i s complete/correct and timely .

12. LOAs/directives are adhered to.

13. Additional services are provided.

14. Rapidly recover s from equipment failures and emergencies .

15. Scans entire control environment .

16. Effective working speed is maintained.

17. Equipment status information i s maintained.

18. Equipment capabilities ar e utilized/understood .

19. Functions effectively as a radar/tower tea m member .

20. Communication i s clear and concise.

21. Use s prescribed phraseolog y

22. Makes only necessary transmissions .

23. Uses appropriate communications method .

24. Relie f briefings are complete and accurate.

25. Visual Separation is applied correctly .

"8 2 0) v>

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10. Routing

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Simulation Training

FAA FOR M 3120-2 5 (5-9S ) Supersede s Preview s Editio n NSN 0052-00-SOO-2J0 2

Page 19: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A. References

3. Perform s handoffs/pqintouts . AWB750 JTW^MMMJ a $o&V out to 68 abeam CAMRN on a westerly heading, even after conflict alert began to flash with their traffic, point out was not made. Trainer had to intervene.

Had to prompt to point out PHL prop to W51 desendmg to ACY. I n addition ACY approach Bhould be made aware that the aircraf t will be higher than normal due to an aircraft that was traffic proceedin g direct RBV at 70.

5. Good control judgment is applied. requested W51 assign N1129W 9 90 near AVALO 20 degrees right for an

aircraft southwest bound on V139 a 100 going to BHI. Whe n asked the reason for the vector, replied that the BWI aircraft must be delivered to next facility @ 80. Thi s was incorrect, review LOA's.

requested W51 issue 20 degrees right on SOO1900 DOV departure climbing to 170, for traffic Brigs 9 140. Thes e aircraft were not traffic. Additionally, if they were traffic, 20 Degrees right barely provided 5 miles lateral seperation.

I notified that a new restriction was placed on the status board-L4 53 closed. Sinc e that notification two ahipp departures departed with bad routing, no action was taken by trainee with either the It controller or the receiving sector.

SJA906 was assigned a great altitude FL230 northeast bound at BRIGS for an overflight direct SWL at FL220. Onfortunetel y the H controller compelled -fcy to make the decision on your own, after you told him to "watch those two guys".

Opon recognizing an overtake situation with two FHL jetB, decided that getting approval from W51 for one of the aircraft at 120 was a valid solution. Afte r discussing our requirement with W51 to provide PHL jets in trail, chose to initiate the handoffs without giving the R person the opportunity to aimjfh speeds and enter them in the forth line data and pass them via automation. No w we are required to pass the speeds manually. Us e automated procedures over manual procedures when possible.

10. Strip posting is complete/correct. N3Q1RJ had bad routing to ILQ, trainer had to prompt trainee to read the routes

18. Equipment capabilities are utilized/understood.

CONTINUED ON NEXT PAGE

7110.65: 5-4- 7

7110.65: 2-1-1 5 7110.65: 5-4- 7

7110.65: 2 -10 - 1

7110.65: 5-6- 2

7110.65: 2-10- 1

7110.65: 2 -10- 1

7110.65: 2-10- 1

FAA FOR M 3120-25 (5-98 ] Supersede s Proviojs Editio n NSN. 0052-00-900-200 2

Page 20: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A. Reference s

The data entry QB XXXX (beaco n code) on a correlated target does not diplay 7110.65 : 2-3-? the FOB we pull up for agceting point outs.

21. Uses prescribed phraseology. Military call signs must be spoken in single digit form, not group form. 7110.65 : 2-4-20 OPBC18- OPEC one eight vs OPEC eighteen.

Conducted . Dat e 6 /' l/'t ^a^v^ ^j

13 Recommendatio n \Q>O0if iea1io n Skil l Check D Certificatio n ontinuation of OJT D Skil l Ehancement Trainin g • Suspensio n of OJT

14. Employee's Comment s

This report has been discuss A - . / ^ / * with me (Signature) Date - '' J- t /

s

15 Certification/Recertificatio n I certify that this employee meets qualification requirements and is capable o f working unde r genera l supervisio n

Signature of Certifier . Dat e

FAA FOR M 3120-2 5 (5-98 1 Supersede s Pre/.OJ S E o -or NS N CC52-C0-90. . : " ;

Page 21: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

yjl</~ y/'/y

\ f j * f\(,, ATCT/ARTC C OJT i KiKsp^KS^TaiSffissaai- INSTRUCTION/EVALUATIO N REPOR T / Nam e

4. Weathe r D VF R QMVFR mIFR PI Othe r ^

5 Workloa d C U i g h t @ Moderat e • Heav y

2. Dat e '• 6/11/11 i

RA66

6. Complexit y Q /y lo t Difficul t ^Occas iona l l y Difficul t • Mostl y Difficul t • Ver y Difficul t

9 Purpos e fvfOJ T • OJ F D Familiarizatio n D Instructiona l D Evaluatio n Scenario Scenari o Scenari o

• Skil l Check • Certificatio n D Recertificatio n D Skil l Enhancement • Othe r 11

Job Task

A Separatio n

B Coordinatio n

C Contro l j Judgemen t i i

1 u c ra

D Method s and Procedures

Per

foni

E Equipmen t

F Communicatio n

G Othe r !

i

Job Subtas k

1 Separatio n is ensured. 2 Safet y alerts are provided. 3 Perform s handoffs/pointouts. 4. Require d coordinations are performed. 5 Goo d control judgement is applied 6. Priont y of duties is understood. 7 Positiv e control is provided 8 Effectiv e traffic flow is maintained 9. Aircraf t identity is maintained.

10. Stri p posting is complete/correct. 11 Clearanc e delivery is complete/correct and timely 12 LOAs/directive s are adhered to 13 Additiona l services are provided. 14 Rapidl y recovers from equipment failures and emergencies. 15 Scan s entire control environment 16. Effectiv e working speed is maintained. 17 Equipmen t status information is maintained 18 Equipmen t capabilities are utilized/understood 19 Function s effectively as a radar/tower team member 20 Communicatio n is clear and concise

21 Use s prescribed phraseology. 22. Make s only necessary transmissions. 23 Use s appropriate communications method.

24 Relie f briefings are complete and accurate 25 Visua l Separation is applied correctly

4)

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Page 22: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12. Comment s

F20: Communication: Advers e weather today. lapsed into some sloppy communications which led to confusion at the sector. Ha d there been less experienced R-controllers on the position, the confusion could have been infectious and detrimental to the operation.

Once again, made some good decisions in assigning headings, and had some solid instances of displaying a firm grasp of the situation at hand. However , these instances were overshadowed by the fumbled communications, some examples of which hereby follow:

N500TJ, an over-flight on V139 at 12,000, had J174 routing. Th e flight was issued V139 routing instead. Th e flight read back the routing, but then asked if he could have his original routing of BR1GS-JAMIE-CLT. Kevi n misunderstood this request , and coordinated a change in destination to CLT instead. Instructo r intervened . 1931Z .

called HTO sector requesting direct ACK for N695MM. Th e HTO controller tol d o issue DEEPO ACK to the flight. nterpreted this to mean: go deep, and

then direct ACK. Thi s would have resulted in an airspace violation, and furthermore, Kevin should make an effort to clarify instructions that sound confusing. H e needs to develop the confidence to question things which sound odd to him. 1931Z .

SIE sector was pointing out AAL530, a HOGGS-CAMRN arrival which needed to deviate east of BRIGS for weather. Kevi n said "You're watching the philly traffic comin g down?" Th e SIE controller said she was. AWI393 8 was descending from F200 to 14,000, flashing at CASINO sector. RPA310 9 was still level at F200 and not flashing at CASINO sector. Thi s communication is totally unacceptable and quite dangerous. N o call signs or codes were exchanged in the communication. 2151Z .

JFK departures called for higher on DAL1779. I n response, Kevin authorized 16,000. then told the R-controller that AAL66 would be climbing to 16,000. Thi s was

completely incorrect , as was borne out once the pilot's checked on.

B4: Required coordination:

PDT 4507, five miles east of CAMRN at 13,000 requested direct RICED for weather . need to be prompted to coordinate with N90. 1953Z .

needs to display more focus and determination in order to be successful at this position.

Signature:

12A. Reference s

XL Date:

13. Recommend/atio n • Certificatio n Skill Check • Certificatio n / • Continuatio n of OJT • Skil l Enhancement Training Q Suspensio n of OJT

14. Employee' s Comments:

This report has been discussed with me (Signature) , -

y

Date: P/P/ 15. Certification/Recertificatio n

I certify that this employee meets qualification requirements and is capable of working under general supervision.

Signature of Certifier: Date: FAA For m 3120-25 (5-98) Supersedes Previous Edition (Electronic ) NSN:0O52-OO-900-20O2

Page 23: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

, ' . < - -

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ATCT/ARTCC OJ T INSTRUCTION/EVALUATION REPOR T

Date , / 3 Scenari o Posi t or(s i //> HHJ,

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9 Purpos e E50J T • OJ F Q Familiarizatio n Q Instructiona l • Evaluatio n Scenario Scenari o Scenau o

D Skil l Check D Certificatio n Q Recertificatio n • Skil l Enhancement • Othe r

10 Routin g

Job Task

A Separatio n

B Coordinatio n

C Contro l Judgement

L) Method s and Procedures

E Equipmen t

f Communicatio n

G Othe r

Job Subtask

1 Separatio n is ensured 2 Safet y alerts are provided 3 Perform s handoffs/pointouts 4 Require d coordinations are performed 5 Goo d control judgement is applied 6 Pnont y of duties is understood 7 Positiv e control is provided 8 Effectiv e traffi c flow is maintained 9 Aircraf t identity is maintained

10 Stri p posting is complete/correct | 1 1 Clearanc e delivery is eomplete'coTect and timely

12 LOA s directives are adhered to 13 Additiona l services are provided 14 Rapidl y recovers from equipment failures and emergencies 15 Scan s pntire control environment 16 Effectiv e working speed is maintained 17 Equipmen t status information is maintained 18 Equipmen t capabilities are utilized/ understood 19 Function s effectively as a radar/tower team member 20 Communicatio n is clear and concise

21 Use s prescribed phraseology 22 Make s only necessary transmissions 23 Use s appropriate communications method 24 Relie f briefings are complete and accurate 25 Visua l Separation is applied correctly

P ^

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F \ \ I om i M2< i 2 > (" v <S ) sup I M U f i i !• > I litir- n ( l l u i n n K )

Page 24: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s

fl * P P^ 6 At t M > fl-^ 1 >^ ^

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12A Reference s

P

Signature _2£L Date 6/^7// 13 Recommen/3ptio n / O Certificatio n Skil l Check O Certificatio n

• Continuatio n o f OJT • Skil l Enhancemen t Trainin g • Suspensio n o f OJ T

14 Employee s Comment s

This repor t ha s bee n discussed wit h me (Signature )

-4-Date

15 Certification/Recertificatio n I certify tha t thi s employee meet s qualification requirement s an d is capable o f working under genera l supervisio n

Signature o f Certifie r Date

V\\ I .inn ^ I 20-2-s P - 9 S ) supeisede- . FKVIKUN Ldm .> , (Fleet i leetloiiR I - \ \ 00' - ) l 2 0 i

Page 25: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

/_

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6 Complexit y JEk-Not Difficul t O Occasionall y Difficu l • Mostl y Difficul t • Ver y Difficul t

)JF •Famil iar izat io n • Instructona l O Evaluatio n Scenario Scenari o Scenari o

ation • Recertificatio n [ J Skil l Enhancemen t • Othe r

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1 Separatio n is ensured 2 Safet y alerts are provided 3 Perform s handoffs/pointouts 4 Require d coordinations are perfoi 5 Goo d control judgement is applie

med j

6 Pnont y of duties is understood 7 Positiv e control is provided 8 Effectiv e traffic flow is maintained 9 Aircraf t identity is maintained

10 Stn p posting is complete/correct 11 Clearanc e delivery is complete/co 12 LOAs/directive s are adhered to 13 Additiona l services are provided 14 Rapidl y recovers from equipment 15 Scan s entire t ontrol environment

rrect and timely

ailures and emergencies

16 Effectiv e working speed is maintained 17 Equipmen t status information is maintained 18 Equipmen t capabilities are utilizer 19 Function s effectively as a radar/to 20 Communicatio n is clear and conci

[/understood wer team member

se 21 Use s prescribed phraseology 22 Make s onlvJ necessary transmissions

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Page 26: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Lcrrmu-nt s

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14 Employe e s Comments '

This repor t ha s b^e n discussed wit h me (Signature ] Date ti_ - y- / /

1 h Certification . Recertifiration T I certify tha t thi s employee meet s qualificatio n requirement s an a i s capable o f workin g under qenera l supervisio n

Signature o f Cprb t er Dat e

\ \ I ' n i l ? ) 2 f l - J S ( s i A | s i , p is,. d h . mu~l . l i ' . i I l k i i m n K i ^ (11 1 H J

Page 27: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

ffe.6- /p i .) 43Jts:~t?«o ATCT/ARTCC OJT

INSJRJJCTIQN/EVALUATiqN REPORT 2 Date/ ,

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Safety alert s are provide d

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Required coordinations ar e performe d

Good contro l judgement i s applie d

Priority o f duties i s understoo d

Positive contro l is provide d

Effective traffi c flow i s maintaine d

Aircraft identit y i s maintaine d

Strip posting i s complete/correc t

Clearance deliver y i s complete/correct an d timel y

LOAs/directives ar e adhered t o

Additional service s ar e provide d

Rapidly recover s fro m equipment failure s and emergencie s

Scans entir e contro l environmen t

r

Effective workin g spee d is maintaine d

Equipment statu s informatio n i s maintaine d

Equipment capabilitie s ar e utilized/understoo d

Functions effectivel y a s a radar/tower tea m membe r

Communication i s clear and concis e

Uses prescnbed phraseolog y

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r

Simulat ion Tra in ing

I \ \ For m ' 1 2 0 - ^ ( s " M s upfi-..u> P', i > . i am » ( I lo-tion u I

Page 28: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

n

12 Comment s

fip&L- $- &yyy> Cy L^ i\,,ri+ {Zrn?ti

ft Witt" (* (IffetfL f(2&( y>it ^yfjj, pAcfrL-A^cluf f?\a>L~>ir\7Z£> &>t<?m 1~ip L, ^^y s>c^^

'-ft'u^l/^iM- u vP . T^~<>1&IN4<-V / ^ ' - ^ ^ ^ ^ K

^ A r t K ^ W ^ ' A ' ^r C * ^ ^ } ' 1 « r / ^

/e$Oy i » r~^

xy Signature

12A Reference s

Date 'U 13 Recommendatio n / • Certificatio n Skil l Check •Cer t i f i ca t io n

O Continuatio n o f OJ T • Skil l Enhancemen t Trainin g • Suspensio n o f OJ T

14 Emp'oyee s Comment s

This repor t ha s bee n discussed with me (Signature ) Date

15 Certification/Recertificatio n I certify tha t thi s employee meet s qualificatio n requirement s an d i s capable o f working under genera l supervisio n

Signature o f Certifie r Date

f \ \ I o nn "U2 W l> ( 5 " M s T Pi l I I , ' I I l u t r i i )

Page 29: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

rfy^u ^'"~ ^ -

/ N a m e

4 Weathe r • VF R • MVF R • IF R • Othe r

O ATCT/ARTC C OJT

INSTRUCTION/EVALUATION REPORT \ " ~"~ 2 Dat e jj :

kloa d ' 6 Complexi t y • Ligh t • No t Difficul t • Moderat e I • Occasional l y Difficul t • Heav y • Mostl y Difficul t

• Ver y Difficul t

9 Purpos e • OJ T • OJ F • F a m i l i a r i z a t i o n • i n s t r u c t i o n a l • E v a l u a t i o n Scenar io Scenari o Scena i i o

• Skil l Chec k • Certificatio n • Recert i f icatio n • Skil l Enhancemen t • Othe r

Scenano/Posit ion(s)

1 7 Hour s

l~8 Tota l Hour s Thi s Positio n

' 1 0 Rout in g

11

Job Tas k

A Separatio n

B Coordinatio n

C Contro l Judgement

D Method s an d Procedures

Job Subtas k

Separation i s ensure d

Safety alert s ar e provide d

Performs handoffs/pointout s

Required coordinations ar e performe d

Good contro l judgement i s applie d

Priority o f duties i s understoo d

Positive contro l i s provide d

8 Effectiv e traffi c flo w i s maintaine d

E Equipmen t

F Communicatio n

G Othe r

9

I 1 0 t —

! 1 1

' 1 2

' 1 3

i 1 4 I —

15 i 1 6

'17 1

riy ' 2 0

I 21

r

22

j 2 3

24 125"

Aircraft identit y i s maintaine d

Strip posting i s complete/correc t

Clearance deliver y i s complete/correct an d timel y

LOAs/directives are adhere d to

Additional service s ar e provide d

Rapidly recover s fro m equipmen t failure s and emergencie s

Scans entir e contro l environmen t

Effective working speed is maintaine d

Equipment statu s informatio n i s maintaine d

8 Equipmen t capabilitie s ar e utilized/understoo d Functions effectivel y a s a radar/tower team membe r

Communication i s clear an d concis e

Uses prescnbed phraseolog y

Makes only necessar y transmissicn s

Uses appropriate communication s metho d

Relief briefings ar e complete an d accurat e

Visual Separation i s applied correctl y

Vi c

Simulat ion Tr- i ininy

F \ \ 1 oni l 1120-2 S ( s 9S ) Supersed e Pre> i«n- Film n 1 1 I t U l o n a )

Page 30: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Commen' s nneii's p . ,

-774;^ 0h> 4 ^ 7 ^ , rr^^

„ 0 T y lfth<L - " - • » » - . /- • -

5 « ? S , *v > \

z.)

12A Reference s

Signature A

13 Recommendatio n • Geptfficatio n Skil l C heck •Cert i f icat io n

[Si Continuatio n of OJT • Shi l Enhancemen t Training • Suspensio n o f OJ T

14 E n oiovee s Comment s y

T us repor t ha s bee n discussed wit h m e (Signature ) Date ysszy •y

S C^r t ficahon/Recertificatioi ' I ertif y tha t thi s employee nicet c qualificatio n rea u ren ents inc l i s capable o f working under genera l supervisio n

Sianatiire of Certi f er Date

I \ A I orm > P f l ' s p > M s,i| u P i u I I n i 1 1 k, l i I i

Page 31: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

\ p ! -- -*' (. - ' -

l l .S. 0*-p.i»i, i . . .n» o f l i . i i ^ i v n m i . . ! , Fociwr* ) A v i a t i o n A d m i n i s t r a t i o n

ATCT/ARTCC OJ T + u?

INSTRUCTION/EVALUATION REPOR T i . N

4. Weathe r ' • VF R • MVF R GhFR n Othe r 9. Purpos e EfOJ T • c

• Skil l Chec k • Certifie s 11.

)

c

Job Tas k

A. Separatio n

B. Coordinatio n

C. Contro l Judgement

D. Method s an d Procedures

E

o

E. Equipmen t

F. Communicatio n

I

\

G Othe r

/ \

j 5 . ' Work loa d • J-igh t \SS Moderat e

I • Heav y

5JF • F a m i l i a r i z a t i o n • Instruc t Scenario Scena r

it ion • Recert]ficatjq_ n • SkillJE n

Job Subta s

2. Dat e

6 / C b m p l e x i t y E f N o t Difficul t • Occasional l y Difficu l • Most l y Diff icul ! • Ver y Difficul t

_.7\

3 Scenario/Posi t ionis ) '?it Cei c _

t

onal • Evaluat io n o Scenar i o nancement • Othe r

<.

1. Separatio n i s ensured.

2. Safet y alert s ar e provided .

3. Perform s handoffs/pointouts .

4. Require d coordination s ar e performed.

5. Goo d contro l judgement i s applied. 6. Priorit y o f duties i s understoo d 7. Positiv e contro l i s provided . 8. Effectiv e traffi c flo w i s maintaine c

9. Aircraf t identit y i s maintained.

10. Stri p posting i s complete/correct .

11. Clearanc e deliver y i s complete/correct an d timel y

12. LOAs/directive s ar e adhered to .

13. Additiona l service s ar e provided.

14. Rapidl y recover s fro m equipment 'ailure s and emergencies .

15 Scan s entir e contro l environment .

16. Effectiv e workin g spee d i s maintained.

17 Equipmen t statu s informatio n i s maintained

18. Equipmen t capabilitie s ar e utilized/understood .

19. Function s effectivel y a s a radar/tower tea m member .

20 Communicatio n i s clear an d conc i

21 Use s prescribed phraseology .

3S.

22. Make s only necessar y transmissions .

23. Use s appropriate communication s method .

24 Relie f briefing s ar e complet e an d accurate .

25 Visua l Separation i s applied corr e ctly.

y • c

| ; | £ : 5 c o

y i y'

-y\

y ! y

/ y

y

/

y

/ 4 .y \

y

/I ;

y\

y' '

y

i

7 Hour s

8. Tota l Hour s Thi s Positio n 1 J •. . - > • \ •

10 t o u t i n g

— • 5

\ ---'-

;

. . — . —

— r ' r- r

Simulat ion Training

FAA Fen n 3 I 20-25 o- ' JS i Supa,cd, > I V M .U - Kiiii. m i hlect.mnic)

Page 32: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s

1 X f I t ^ 4 . v_ _ L vi ~ ; v > ^ . v \ <. J'- I

(. LV v £, . t ^ C v . \ , c ' , v v t P ^ \ ^

O t P P C ,A . U ^ c „ \ c k V,CW L

A A \

\ \ < IV.C I N f f i I K

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C \2 » 0 - \ x ' A - ^

< — r - s e,~~tPV \ r '-c\ C P > V . ( ^ v J c . V \ V> t -VY^ P

i\ a i v 6^ nd o r < • c4 c W 'f >SiC 5 r ^

-V C . ^ O P

~\(J

^ SS t ^ ° '"N P t oJ>< -1 \ ~ -

X~xS\\

12A Reference s

Signature Date u'y /»' 13 Recommendatio n • Certificatio n Skil l Check • Certificitio n

• Continuatio n o f OJT • Skil l Enhancemen t Training • Suspensio n o f OJ T

14 Employee s Comment s

This repor t ha s bee n discussed with me (Signatur eThis repor t ha s bee n /

Date W>(. LL 15 Certification'Recertificatio n

I certify tha t thi s employee meet s qualification require i ient s and ^ capab' e o f workin g unde r genera l supervisio n

Signature o f Certifie r Date I A \ I mm "M20-2 5 {^ 'IS ) Supei^t d P u mi l I I n < 1 lev. home I

Page 33: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

,A,W(W„c t>r r. , , pt.. , < t w e d « « l Aviatio n Admtnldrat io n

=>afher ' 5

ATCT/ARTCC OJT I^TR^CTJON/^ALAJATION^EPORT

Qate

-Pt-

4 Weathe r • VF R • MVF R B IF R • Othe r

5 Workloa d • Ligh t Q l M o d e r a t e • Heav y

• No t Difficul t E J Occasional l y Difficul t • Mostl y Difficul t • Ver y Difficul t

9 Purpos e \^OJT • OJ F • Famil iarizatio n • Instructiona l • Evaluatio n Scenario Scenari o Scenari o

• Skil l Chec k • Certif icatio n • Recertif icatio n • Skil l Enhancemen t • Othe r

-,~^. 3 Scenari o Pos i t i ons )

UM/lL L JmiiL Complexi ty 7 Hour s

~- K.

8 Tota l Hour s Thi s Posit '

l l P Jt ">

10 Routin g

Job Tas k

A Separatio n

B Coordinatio n

C Contro l Judgement

Job Subtas k

1 Separatio n i s ensure d

2 Safet y alert s are provided

D Method s and Procedures

E Equipmen t

F Communicatio n

3

4

~5

~6 ~f

iS

~9

10

11

12

13

14

15

16

17

18

To

20

21

22

Performs handoff s pointout s

Required coordinations ar e performer!

G Othe r

23

24

25

Good control judgement i s applied

Priority o f duties i s understoo d

Positive contro l i s prov-ded

Effective traffi c flo w is maintaine d

Aircraft identit y i s maintaine d

Strip posting i s complete/correc t

Clearance delivery i s complete correc t and timely

LOAs/directives are adhered to

Additional service s are provided

Rapidly recover s fro m equipmen t failure s and emergencies

Scans entir e contro l environmen t

Effective working spee d i s mainta.ned

Equipment statu s informatio n i s maintained

Equipment capabilitie s are utilized/understood

Functions effect i /ely a s a radar/tcwer tea m membe r

Communication i s clear and concs e

Uses prescribed phraseolog y

Makes onl y necessar y transmission s

Uses appropriate communication s metho d

Relief bnefings are complete an d accurate

Visual Separatio n i s applied correctl y

y

y !

y/

y\ y y__

y • •

L y_

y

y^

y I

y\ y\ / r

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y

-4 - -

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Simulat ion Training

1 \A I orm ^12(1-2 ^ (^-4s i Sup. , i . - f u i u I dm m iFku ion i u

Page 34: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s

c / ^ r x a t V c C e r c 4 S < S S , a n y ^ V ^ c ^ ^ - > ^

12A Reference s

o £ \\-fcV _ cic4ic , 5/"\V

c k s c - V r \ ^ 4 | H 0 - X X x ^ V ^ ^ ^ A ^ H / 1

^ V N AesaA , o A o c \ur rs s P • • • -

^ ^ w n ^ r , - - ^ ^

V*e, •+• ,To- 1

b lue v ~ ^ - ^ < - c ^ ( p

/ J i t ! r - o v — • v p- '~^

r-e-C \M"?G > ^ P ^ " ^

U o _ . ^ - H ^ "H O ^ - ^ ^ft* I J "

( ^ Y W ~ S

ISO) ^ C C ^ V ^ ^ > S *. C W i ^ ' - A - ^ S D O ^

5oC^»^ u- t A \~r e o S

- 5i C A -J 0 C ! T T

•?>B) y \ i D v S ^ t - vxP- \ W J Y W T U o a feu - ( p t \ i ^ « ^ O^ - A ~n > / A £

Signature - Date 6 ^ i \

13 Recommendatio n • Certificatio n Skil l Check •Cert i f icat io n

• Continuatio n o f OJT • Skil l Enhancemen t Trainin g • Suspensio n o f OJ T

14 Fnplovoe s Comment s

This repor t ha s bee n u n w u o J ^ - U W i l l ! i i i ^ ( J i y n c i U l i C I

15 Certification'Recertificai.o n I certify tha t thi s employee meet s qualificatio n requirement s an d i s capable o f workin g under genera l supervisio n

Sianat ir e o f Certifie r Date

I \ \ I orm I P " 2 ^ O ' is i - , v , - d P . I I . 1,1 m i i l L t l i o m i

Page 35: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

i

V

1 U ' O n m i l r m n l o t r i i . i , ! . . tt / Ft td«tr* I A v U i i o n A d m l n i i t r a i l o n

1 Nam e

4 Weathe• VF R • MVF R • " I F R • Otne r

9 P u

• S k i i

/«?/- yyi

ATCT/ARTCC OJT 1 INSTRUCTION/EVALUATION REPOR T

2 Dat e , 3 Scenari o Position(s )

i nr Ligw 1 • Moderat e

• Heav y

rpose Qt ! ) J T • OJ F •Famil iar izat io n • Instruc t Scenario Scena r

ill Check • Certificatio n • Recertificatio n • Skil l En

Job Task Jo b Subta s

A Separatio n

B Coordinatio n i

I C Contro l j Judgemen t

) D Method s and i i Procedure s

i

= c

Per

E Equipmen t

F Communicatio n i i

1 G Othe r

I

)

l

1 Separatio n is ensured ? Safet y alerts are provided

6 Complexit y 7 Hour s -p • . '?* / • No t Difficul t I l~~*">y •^Occasional ly Difficul t [ 8 Tota l Hours Tins Position • Mostl y Difficul t ( • Ver y Difficul t J

onal • Evaluatio n o Scenan o hancement • Othe r

k

3 Perform s handoffs/pointouts 4 Require d coordinations are perfor 5 Goo d control judgement is applie 6 Priont y of duties is understood

med j

7 Positiv e control is provided 8 Effectiv e traffic (low is maintained 9 Aircraf t identity is maintained

10 Stn p posting is complete/correct 11 Clearanc e delivery is complete/co 12 LOAs/directive s are adhered to 13 Additiona l services are provided 14 Rapidl y recovers from equipment 15 Scan s entire control environment 16 Effectiv e working speed is mainta 17 Equipmen t status information is in

rrect and timely

'ailures and emergencies

ned amtained

18 Equipmen t capabilities are utilized/understood 19 Function s effectively as a radar/tower team member 20 Communicatio n is clear and concise

21 Use s prescribed phraseology 22 Make s only necessary transmissic 23 Use s appropriate communications

>ns method

24 Relie f briefings are complete and accurate 25 Visua l Separation is applied corre ctly

c > <*•

i I E X! O O O

y

y

y y

, i

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i

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1 \ \ I i»tm 3 l 2 u "' s j - , . a S j S u . , ?u , _ , M i l | , iHui i II K I

Page 36: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A Reference s

^J^pA-53/b o^r W -\ \ . clu>ovt ^c^y MX)

b? \j 0 1 p Ci \\t(j[ \\, v"i a f *

W ^ C W H OPC! - ^ - P . c \ c P P P o-f -

I 0 O R V ^ C ' C r C T H > W i L ^ 4^vVhjrv\ L d « rfCP

P-C4L u * ~ > W A - 1,6 . V 0

Signature Date y\do\\ 13 Recommendatio n • Certificatio n Skil l Check •Cert i f icat io n

• Continuatio n o f OJ T • Skil l Enhancemen t Trainin g • Suspensio n o f OJ T

14 Employee s Comment s

1 his repor t ha s bee n f\fdiscussed wit h me (Signature ) j Date "Vc^/l

15 Certification/Recertificatio n ' I certif y tha t thi s employee meet s qualification requirement s an d i s capable o f working under genera l supervisio n

Signature o f Certifie r Date

V \ 1 o rm ^ 1 20 -25 (5-QS ) Stipe s dt«P, t i,m s Ldmr i (Ficctroniv. )

Page 37: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

1 1

4 • i | 3 'J H

<S ^•.^ie.-at A * i .

N i d t V

e.Titl '- l . f K f 1 I K P(-

11

— ' , _ ) • - ,* •

^ j o c ' <

3 . l l M I

• I U , t ' • M ; kr it .

ATCT/ARTCC OJ T INSTRUCTION'EVALUATION REPOR T

Hit, f / .JO , i

O I lilllp' t <! ' • No t Diffuul l • O r uistu Diff u i • Mo-t l / l; i *i , ' i • P r . Di' t

P

i-

yy

t ) L _ i = " . c i A 1 ^ . ~r <

i t - 1 E t c - i i i

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l t n

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1 s ^ i ! it i i t n i

S f t ' . i > i ' i I - r T r " - i * i , > J -

i p , , i i n - ( f , - ! >.rn

^ _ ' i l u • i 1 1 i t s -if r !-" •

l - - ' r I, ' 1 1 u n v r v J < F - c - iit r I K , I ' I

•* f-ric i • ,r t df i i l ' i i ' un' i .ne : 0 ' i r i =ifi i! i,tit , i s i,i wit-wit u

1 1 0 Stri f ^ustiiii ] i s i ornplt t « i uvr t I — -

I 1 1 C' e ^ i n i ) i h i r, i ( i nip F t Cvir n t m I Inn I

iz L C - - 'i n t i i ir , i Jn ' 1 •

i - i i ' i i l r i • i i [ ' '

14 F J , I S r , n i -l J ' j r . s i n ! , _ 5 - i ' I i

i l " I V ' l K i i n l , s , i i s intalf u . b i | i m r

f f uiiini u ii i t m

17 Fqui ( ni l n i ltus inform-jti c i i s maintaine d

18 tqui f ni l n ' i ) ilnli i S i i ' u! i <>.y\ und^fito o I 19 Fi n cnon^ • Ik < t u 4 y as a radar'to.ver team II K m l > r

20 C jmnu i n ilio i i s t l e i r i n t i k b i

/ 1 s < - , - , u n I | 11 1

ir I r i s i , s b , - -

' • " ( i M J r s p i i l ,

11 > . '~fr -

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i i i '

i j Ot l i

) I I \ ' - f i - i - 1

" , i i l i i , , i n v t

y

y

Page 38: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12. Comment s 12A Reference s

i r x ^ M ^ t * s V u c ^ ipV \ M \ C U J f --A y %cy\ nc-yy^ o r x t v ^ M i w / ^

o c W PV c Po ' s - ^ tf o n CA^y\

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oo r

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C o m i ' ^ l o ^c.-v x 21 ' ^ ^ J " C ^ ^ ^ v F

A w t P P - P*« - o u ^ o X ^O C ^ ~ »1

v t n - » ^ *° -^ ^—^s:^" \\ no r ^-«.<- P +^,^ V 010 ' K^.'oi j

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yi*n re^^

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f r , ^ M ^ C * -^ 0 rv U > '^ p

; ,*>© fb o< ^ r * -. ^ ^ ^ b J S u " > ^

re J Dat e _ _ £ M . " 13 Recommendatio n • Certificatio n Skil l Check •Certificatio n

• Continuatio n of OJT • Skil l Enhancement Training • Suspensio n of OJT

14 Employee s Comments

(Signature) ' Uu ,This report has been discussed with me -I

-h l Date 5JX"l ( i

15 Certification/Recertificatio n I certify that this employee meets qualification requirements and is capable of working under general supervisio n

Signature o f Certifier Date F \ \ Form "M2C-2 S (5-'/X) sur. i u i i u m i ui u . i f k-utcni i )

Page 39: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

<a>. _ ' Sd'Ti e

. . . '

ATCT/ARTCC OJT I INSTRUCTION/EVALUATION REPORT

4 vVpathe r ' • VF R D MVF K D F R LZ] utne r

D L'qn t • l .b A at -n ne!. ,

2 Dat e

y±y

-* - J* J ' \

3 Scena r c,Pos'tion(s

'-Act 6 Complexit y • No t Difficul t ETOccasional y Din cult • Mostly D.ffi c " • Ver y Difficul t

G Purpos e r Y o i t n n i p f~ l Familiarizatio n r- i Irstmctiona l r~ l Evaluatio n u j u 1 1 i_ i cu r i_ j S c e n a n o i- J scenari o t - J Scenari o

• Skil l ChecK D Certificatio n Q Recertificatio n • Skil l Enhancement • Othe r

c g 6 •c

JQD Tas '

A Separatio n

B Coordna ' O P

C Contro l Judgment

D Method s an d Procedures

E Eau'prr e '

F Communicatio n

G Otne r

OP S mask

1 Separatio n s ensured

2 Safet > alert s are provide d

3 Perfo rms nandoffs pointojt s

4 Require d coordinations are performed

5 Goo d control judgment i s applied

6 p nomv o f duties i s understoo d

7 Positiv e contro1 is provided

8 Effectiv e traffi c flo w " s maintained

9. Aircraft identit y i s maintaine d

10 Stri p posting i s complete/correc t

11 Clearanc e dehver y is complete'correct and timely

12 LOA s directives are adhered to

13 Additiona l services are provide d

14 Rapidl y recover s from equipment failures and emergencies

15 Scan s entire contro l environmen t

16 Effectiv e wording speed is maintained

17 Equipmen t statu s informatio n i s maintained

18 Equipmen i capabilities ar e utilized/understoo d

19 Function s effectively a s a radar/tower team member

20 Communicatio n i s clear an d concise

21 Use s prescribe d phraseo'og y

22 Make s only necessar y transmission s

23 Use s appropriate communications metho d

24 Relie f briefings are complete and accurate

25 Visua 1 Separation i s applied correctl y

> o

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1-AA FORM 3120-25 3 f nrsede-s Pet .

Page 40: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A Reference s

& 7T-/c ,

"] ) -jfic &ct<yy c , U*J/ £ cv i ^U^St i , n -z o

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XPc P<tA T i l t < ^ R L i : r - W V ^ P—^ (

1 ^ AM/ > o k ^ k( ( C e ^ r ' ^ "" * W"f J

Signature. Date: f - 5 - 2o ( ( 13 Recommendatio n Q Certificatio n Skill Check D Certificatio n

• Continuatio n of OJT • Skil l Ehancement Training Q Suspensio n of OJT 14 Employee' s Comments:

This report has been discussed with me (Signature) Date: P ~ 5 - t\

15 Certification/Recertificatio n - ^ I certify that this employee meets qualification requirements and is capable of working under general supervision

Signature of Certifier. Date:

FAA FOR M 3120-2 5 (5-98 ) Sjpersede s Previou s Editio n NSN 0052-00-90 0 200 2

Page 41: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

M LL

"NO h\ecyy ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPOR T y

1 Na m

4Weather CS VFR • MVF R • IF R • Othe r

ier l 5 V

| 2 Dat e (

_ _ _L _ 5/Ja/' 1— — 6 Cortlplexit v

S D i N o t Difficul t [ y Occasionall y Difficul t • Mostl y Difficul t • Ver y Difficul t

9 Purpos e Q ' O J t • OJ F • Familiarizatio n • Instructiona l • Evaluatio n Scenario Scenari o Scenari o

• Skil l Check • Certificatio n • Recertificatio n • Skil l Enhancemen t • Othe r

5 Workloa d • Ligh t • Moderat e S ^ Heav y

3 Scenano'Positionfs )

, 7 Hour s P i ;

8 i otai Hours This Poai'iun

a^t s^ 10 Routin g

O j ) 11

Job Tas k

A Separatio n

B Coordinatio n

C Contro l Judgement

D Method s and Procedures

E Equipmen t

F Communicatio n

G Othe r

Job Subtas *

1 Separatio n is ensured 2 Safet y alerts are providea 3 Perform s handoffs/pointouts 4 Require d coordinations are performed 5 Goo d control judgement is applied 6 Pnont y of duties is understood 7 Positiv e control is provided 8 Effectiv e traffic flow is maintained 9 Aircraf t identity is maintained

10 Stri p posting is complete/correct 11 Clearanc e delivery is complete/correct and timely 12 LOAs/directive s are adhered to

13 Additiona l services are provided 14 Rapidl y recovers from equipment failures and emergencies 15 Scan s entire control environment 16 Effectiv e working speed is maintained 17 Equipmen t status information is maintained 18 Equipmen t capabilities are utilized/understood 19 Function s effectively as a radar/tower team member 20 Communicatio n is clear and concise

21 Use s presc nbed phraseology 22 Make s only necessary transmissions

23 Use s appropnate communications method 24 Relie f briefings are complete and accurate 25 Visua l Separation is applied correctly

6 8

y

v/

l u V .

7= e 3 i s

l —

-t-

S mulation Training

F \ \ I onii 112 0 2 s ( i Q\) su,* isi.de I' K \ i im m iF I a m n i o

Page 42: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s J T T I ^ I ' M . W's S v ^ "J^J^

v> tk-U^ -<k-c ;U P'- M - M \

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Signature

12A Reference s

Date _ J i i _ l j j L -13 Recommendatio n • Certificatio n Skill Check • Certificatio n

• Continuatio n of OJT • Skil l Enhancement Training • Suspensio n of OJT

14 Employe e s Comments

(Signature) This repon has been discussed with me Date 5M//7

15 Certification/Recertificatio n I certify tha t this employee meets Qualification requirements and is capable of .vorkin g under general supervision

Signature of Certifier Date I \A . I orm " 120-2S (5- l 'S) supu^< l I'-OM.U H L.lm i 1 1 leumiik i

Page 43: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

1 Narr e ," \

ATCT/ARTCC OJ T INSTRUCTION/EVALUATION REPOR T

I

4 Weathe r D VF R D MVF R Q IF R • Othe i

5 Wo'kc a : Qkght E I f.'oleral t CD riea.y

2 Dat e ' Sfend'i u 3 os

6 Complexit y • No t Difficul t D Occasional!! , D ffu ul ' £3-Mostly Dift u u ' O Ver y Difncu r

9 Purpos e 0 , - j , ^ f T Q I C ["" I Fjmnia r zat l p i Inst'uctiona l r- i ic.aluat.O' -

D SU M Civ ' D Cervica l or D Re < e'U a ' u D S * Einancem e . ' D O r e '

11

01 o c us E o

t ID

Q.

l,t ), •

A Sepaialio n

B Coori'natn i

i" Cont n lu Jgr t-r r

D Method s ana Procedures

E Equipme T

F Communicatio n

G Othe r

J >i auoiasi -

1 Separatio n i s ensure d

2 Safet y aied s are provide d

3 Perform- , handoffs pomtout s

4 Require d coordinations ar e perfeme c

5 Goc c contra 1 judgment i s apol ec

6 PnoT > o f dunes is understood

7 Positiv e contro l i s provide d

8 Effecti. e traffi c fio. v i s maintained

9 Aircraf t identit y i s maintaine d

10 Stri p posting i s complete/correc t

11 Clearanc e deliver y i s complete'correct and timely

12 LOAs'directive s are adhered to

13 Additiona l services ar e provide d

14 Raoidi y recover s from equipment fa i ures and emergencie s

15 Scan s entire contro l environmen t

16 Effectiv e workin g speed i s ma ntained

17 Equipmen t status information , s mainta ned

18 Equipmen t capabilitie s ar e utilized'understood

19 Function s effectively a s a radar/tower team membe i

20 Communicatio n i s clear and concis e

21 Use s p'esenhed phraseolog y

22 Make s only necessar y transmission s

23 Use s appropriate communications metho d

24 Re l e; briefings are complete ana accurate

25 Visua ' Separation i s applied correctl /

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FAA FORM 3120-25

Page 44: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A Reference s

, \ O L J / ! ^ < < A^y^y \y^y y- ^ Sur f

f-iA) Tel l r^tdw ^ ^ M ^ U * - y^ ^

< ^ v ' A - T ' ^ n i . A u Hoc s y d yi , V l f ^ I . . PlFp^

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\t l c LJAP c.~y

J* c- O A • ,Mn e ^ k t ^ - k M / C P n c ^ v U j T ^ 1 ' - 9 -->iP> Nf

Signature

/ « 7>C / L i ty t a

u> 4 3 )fc> ^

Date: JLZ.

P i 3( £

13 Recommendatio n Q Certificatio n Skill Check D Certificatio n ^Continuation of OJT • Skil l Ehancement Training • Suspensio n of OJT

14 Employee' s Comments

This report has been discussed with me (Signature) . Dat^k^P/''/

y ~ 15 Certification/Recertificatio n

I certify that this employee meets qualification requirements and is capable of working under general supervision Signature of Certifier Date.

FAA FORM 3120-2 5 ( 5 98) Supers^" . Picious Edition MSN 005 2 0C-QO 0 2002

Page 45: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

kkQ VA'(j ATCT/ARTC C OJT

SMCa-flSSSa; " INSTRUCTION/EVALUATIO N REPORT 1 Nam e p

, 4. Weathe r J2-VFR D MVF R D IF R • Othe r

5 Workloa d

D Ligh t ^-QTSoderate

D Heav y

2. Date / 3 Scenano/Posjtion(s )

k 3 ^ / V ? SSI 6. Complexity

D No t Difficul t .^^Occasional ly Difficul t

D Mostl y Difficul t • Ver y Difficul t

9 Purpose p r k k f l o i r . I~ l Familiarization r-\ Instructiona l n Evaluatio n ya UJ I i_ j UJI - i_ | S c e n a r i 0 U S c e n a r j 0 L J Scenari o

D Skil l Check • Certificatio n • Recertificatio n D Skil l Enhancement • Othe r

11

S

c 19 § Q-

Job Task

A. Separatio n

B. Coordinatio n

C. Contro l Judgment

D. Method s and Procedures

E. Equipmen t

F. Communicatio n

G Othe r

Job Subtas k

1. Separation is ensured.

2. Safety alerts are provided.

3. Performs handoffs/pointouts .

4. Require d coordinations are performed

5. Good control judgment i s applied.

6. Priority of duties is understood.

7. Positive control is provided.

8. Effective traffic flow is maintained.

9. Aircraft identity is maintained.

10. Strip posting is complete/correct .

11. Clearanc e delivery i s complete/correct and timely.

12. LOAs/directives are adhered to.

13. Additional services are provided.

14. Rapidl y recovers from equipment failures and emergencies.

15. Scans entire control environment .

16. Effective working speed is maintained.

17. Equipment status information is maintained.

18. Equipment capabilities are utilized/understood.

19. Functions effectively as a radar/tower team member .

20. Communication i s clear and concise.

21. Use s prescribed phraseology .

22. Makes only necessary transmissions .

23. Uses appropriate communications method.

24. Relie f briefings are complete and accurate.

25. Visual Separation is applied correctly

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Simulation Training

FAA FORM 3120-25 (5-93 ) Supersede s Previous Edition NSN 0052-00-900-201 ;

Page 46: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A. References

F<c,y $y&y- tMab^CAi^y yo/-^y-y C -?Y" ^

-I>ICPTL-V AiA^,>ue ? -tssm^ y ^ L^M •

— -, ,/~^r// - D o -ur r ,\y\\<y

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Signature

wta

(7Mt- k g / ' ? /

(q&'?o& c "s<e y^2~\

Date: C k / / f r / / /

13. Recefhmendation Q Certificatio n Skill Check • Certificatio n • Continuatio n of OJT D Skil l Ehancement Training • Suspensio n of OJT

14. Employee's Comments:

This report has been discussed Pwith me (Signature) d.

c. yyyy/ Date: < P r / k T

15. Certification/Recertification I certify that this employee meets qualification requirements and is capable of working under general supervision. Signature of Certifier: Date :

FAA FORM 3120-25 (5-98 ) Supersede s Previous Edition NSN 0052-00-900-200 2

Page 47: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

) 1

)

yj i "

V t, D»pirtm#fii of ItWfMMto* F«d«riri AvtMlon ArtrJnUmdo- .

1 Nam e

«_i ~ -_ -. - ' ATCT/ARTCC OJ T

INSTRUCTION/EVALUATION REPORT 5< D 7 £ ^

4 Weathe r

D VF R CLMVFR EJlFR D Othe r

5. Workload • Ugh t Bk todera te • Heav y

2. Date 6 / 5 / l »

3 Scenano/Po s

6. Complexity D No t Difficul t § $ Occasionall y Difficul t D Mostl y Difficul t D Ver y Difficul t

9 Purpos e rak , T r i n i c n Familiarizatio n r- i Instructiona l r- i Evaluatio n US U J i i_ J U J I - i_ j S c e n a r i 0 L- l scenari o L J Scenan o

D Skil l Check D Certificatio n D Recertificatio n • Skil l Enhancement D Othe r

11

8

c m § O.

Job Task

A Separatio n

B Coordinatio n

C. Contro l Judgment

D. Method s and Procedures

E. Equipmen t

F. Communicatio n

G. Othe r

Job Subtask

1. Separation is ensured.

2. Safety alerts are provided

3. Performs handoffs/pointouts .

4. Required coordinations are performed.

5. Good control judgment is applied.

6. Priority of duties is understood.

7. Positive control is provided. 8. Effective traffic flow is maintained.

9. Aircraft identity is maintained

10. Strip posting is complete/correct.

11. Clearance delivery is complete/correct and timely.

12. LOAs/directives are adhered to.

13. Additional services are provided.

14. Rapidly recovers from equipment failures and emergencies.

15. Scans entire control environment.

16. Effective working speed is maintained.

17. Equipment status information is maintained.

18. Equipment capabilities are utilized/understood.

19. Functions effectively as a radar/tower team member.

20. Communication is clear and concise.

21. Use s prescribed phraseology .

22. Makes only necessary transmission s

23. Uses appropriate communications method.

24. Relief briefings are complete and accurate.

25. Visual Separation is applied correctly.

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Simulation Training

L~$

FAA FOR M 3120-2 5 (5-98 ) Supersede s Previous Editio n NSN. 0052-00-900-2002

Page 48: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s 12A Reference s

C^ Vtpkr , '\Si<,t€y <7,<y ! *syw ^ r - . ^ u ASAC 5

6CS k 7 0 S O c\- s p\< k -j e O f S - t o - c K d i c k A ^ A k r o ^ \ LV£

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-* i

Signature y_

I ) ~h1- J W

/y/> / y ^ i ky / ^ ^

Date. tfsli

IT

13 Recommendatio n Q_Certificatio n Skill Check D Certificatio n Continuation of OJT • Skil l Ehancement Training Q Suspensio n of OJT jgcc

14 Employee' s Comment s

This report has been discussed with me (Signature) ,

6 - - k Date- _k / ' ' 15 Certification/Recertificatio n

I certify tha t this employee meets qualification requirement s and is capable of working under general supervisio n

Signature o f Certifier . Date-

FAA FOR M 3120-2 5 ( 5 98 ) Supen,eJ<> s Previous fcdilion NSN 005 2 0 C O00-2002

Page 49: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

I USD . rpaRnwnt ed Trm tportUoft

a

ATCT/ARTCC OJ T INSTRUCTION/EVALUATION REPOR T

4 Weathe r D VF R DMVFR B I F R D Othe r

5. Workload D Ligh t O Moderat e ETHeavy

2 Dat e ; 5 £&»//{

3. Scenano/Position(s)

6. Complexity D No t Difficult O Occasionall y Difficul t EchMostiy Difficult • Ver y Difficult

9 Purpos e n i x k i T I~ 1 n ip n Familiarizatio n i— i instructional r- i Evaluatio n u r U J I L_ | OJ F u scenari o u Scenari o U Scenari o

D Skil l Check • Certificatio n D Recertificatio n D Skil l Enhancement • Othe r

11

^ /

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I )

I

Job Task

A Separatio n

B. Coordinatio n

C Contro l Judgment

D Method s and Procedures

E. Equipmen t

F. Communicatio n

G. Other

Job Subtask

1. Separation is ensured. 2. Safety alerts are provided. 3. Performs handoffs/pointouts. 4. Required coordinations are performed. 5. Good control judgment is applied. 6. Priority of duties is understood 7. Positive control is provided. 8. Effective traffic flow is maintained. 9. Aircraft identity is maintained.

10. Strip posting is complete/correct. 11 Clearanc e delivery is complete/correct and timely. 12. LOAs/directives are adhered to. 13. Additional services are provided. 14. Rapidly recovers from equipment failures and emergencies. 15. Scans entire control environment. 16. Effective working speed is maintained. 17. Equipment status information is maintained. 18. Equipment capabilities are utilized/understood. 19, Functions effectively as a radar/tower team member. 20. Communication is clear and concise. 21 Use s prescribed phraseology. 22. Makes only necessary transmissions. 23. Uses appropriate communications method 24. Relief briefings are complete and accurate 25. Visual Separation is applied correctly.

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/^ip'^koyo)

Page 50: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s

,_->l,Vp/ / J CLO$U^ \SU*'*> fy^Uy k.C(cL /

A t ^ a /*-t . / - I s, j v-'^'<At>

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Signature:

; /

12A. References

Date: 3~/d<//f

13 Recommendatio n D Certificatio n Skill Check • Certificatio n • Continuatio n of OJT • Skil l Ehancement Training • Suspensio n of OJT

14. Employee' s Comments:

This report has been discussed I^f I X- (~\ U C ^ W ^ f / k k i Date- ids 5Mil

1 15 Certification/Recertificatio n 1 certify that this employee meets qualification requirements and is capable of working under general supervision. Signature of Certifier:

Date: FAA FOR M 3120-25 f5-98 . Supersede s Previous E*u

NSN. OOS2-C0-M0-200 2

Page 51: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

)

I 1 )

K,

HO W/*Wyi-<A

© U.8 Oaparenwi i o< rrenapontfon Fvdanf Aviatio n Administratio n

LName

ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPORT

4. Weather , ( ^ V F R D MVF R D IF R • Othe r

5. Workload 3TLi9ht

n Moderat e D Heav y

2. Date

shshi 3. Scenario/Position(s)

^3<? 6. Complexity • No t Difficult

•OvOccasionally Difficul t • Mostl y Difficult • Ver y Difficult

9. Purpose n n u n n i c l"~ l Familiarization i— i Instructional n Evaluatio n l_l U J i i_ i UJr - u S c e n a r i 0 L I Scenari o L J Scenari o

D Skil l Check • Certificatio n D Recertificatio n • Skil l Enhancement • Othe r

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)

Job Task

A. Separatio n

B. Coordinatio n

C. Contro l Judgment

D. Method s and Procedures

E. Equipmen t

F. Communicatio n

G. Other

Job Subtask

1. Separation is ensured. 2. Safety alerts are provided. 3. Performs handoffs/pointouts. 4. Required coordinations are performed. 5. Good control judgment is applied. 6. Priority of duties is understood. 7. Positive control is provided. 8. Effective traffic flow is maintained. 9. Aircraft identity is maintained.

10. Strip posting is complete/correct. 11. Clearance delivery is complete/correct and timely. 12. LOAs/directives are adhered to. 13. Additional services are provided. 14. Rapidly recovers from equipment failures and emergencies. 15. Scans entire control environment. 16. Effective working speed is maintained. 17. Equipment status information is maintained. 18. Equipment capabilities are utilized/understood. 19. Functions effectively as a radar/tower team member. 20. Communication is clear and concise. 21. Use s prescribed phraseology. 22. Makes only necessary transmissions. 23. Uses appropriate communications method. 24. Relief briefings are complete and accurate. 25. Visual Separation is applied correctly.

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FAA FORM 3120-25 (5-98 ) Supersede s Previous Edition NSN: 0052-00-900-2002

Page 52: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12. Comments 12A. References

/93S'£Q/6^ 0*W

@ ,4f k O K t - PP«MT - T f h ^ M * P ^ & ^ T k r l 5 i ^ ) £ j f c

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Signature: ^

Date: ^Z-T-H 13. Recommenda Certification Skill Check • Certificatio n

Continuation of OJT • Skil l Ehancement Training • Suspensio n of OJT

14. Employee's Comments:

This report has been discussedwith me (Signature) Date: 5/tthi

lb. certification/Kecertification I certify that this employee meets qualification requirements and is capable of working under general supervision.

Signature of Certifier: Date:

FAA FORM 3120-25 (5-98 ) Supersede s Previous Edition NSN: 0052-00-900-2002

OS CC\. ~(\£€^ (\^d £0H^lW$£r &1

Page 53: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

L.

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9 ATCT/ARTCC OJT INSTRUCTION/EVALUATION REPORT

a A f 4. Weather D VF R D M V F R S I F R D Othe r

5. Workload • Ligh t D Moderat e ETHeavy

2. Date / 3 Scenario/Position^ }

ayit> 6 Complexit y D No t Difficult D Occasionall y Difficul t Efrvlostly Difficul t D Ver y Difficult

9. Purpose p\y I T n n I F f~ 1 Familiarization r- i Instructiona l r- i Evaluatio n UT UJ i I_ J ojf - u S c e n a f j 0 U S c e n a r i o U S c e n a r 1 o

D Skil l Check D Certificatio n D Recertificatio n Q Skil l Enhancement • Othe r

11.

1

8

%

)

Job Task

A Separatio n

B. Coordinatio n

C Contro l Judgment

D. Method s and Procedures

E Equipmen t

F Communicatio n

G Othe r

, , - , • - ,

Job Subtask

1. Separation is ensured. 2. Safety alerts are provided. 3. Performs handoffs/pointouts. 4. Required coordinations are performed 5. Good control judgment is applied. 6. Priority of duties is understood. 7 Positiv e control is provided. 8. Effective traffic flow is maintained. 9. Aircraft identity is maintained

10. Strip posting is complete/correct. 11. Clearance delivery is complete/correct and timely. 12. LOAs/directives are adhered to 13. Additional services are provided. 14. Rapidly recovers from equipment failures and emergencies. 15 Scan s entire control environment 16. Effective working speed is maintained. 17 Equipmen t status information is maintained 18 Equipmen t capabilities are utilized/understood. 19 Function s effectively as a radar-tower toam member 20. Communication is clear ana concise 21 Use s prescribed phraseology 22 Make s only necessary transmissions 23 Use s appropriate communications method 24 Relie f briefings are complete and accurate 25 Visua l Separation is applied correctly

I

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y y y y y y y y

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7, Hours

M yes 8 Tota l Hours Tnis Position

10. Routing \ ty) 2-o T> a tn to W

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2~ o u <£ 5 sz 3

L-i—L-

Simulation Training

l. « , , , !V-- ' .-0.tMG-20'0

FAA FORM 312Q-25 (5-<?8> S.cf-»«^F-e,«0LS sEi fc -

11 .' _ ib- r- i

Page 54: APPENDIX G - United States Office of Special Counsel G.5 Seeley OSC.pdf · APPENDIX G.5

12 Comment s

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Signature

12A Reference s

Date: yy-i /<y 13 Recommendatio n D Certificatio n Skil l Check D Certificatio n

• Continuatio n of OJT • Skil l Ehancement Trainin g D Suspension o f OJT

14 Employee' s Comments :

This repor t has been discussed >> / ; . L t l U O - t ' biy ur £ "Uaie

Pfoc y« / 15 Certification/Recertificatio n / /

i certify tha t thi s employee meet s qualification requirement s and is capable of working unde r genera l super vi&ion

Signature o f Certifier "~ — — ; — Dat e

FAA FOR M 312D-2S tC '-" 5 ,; e! - e j . , :

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