t8 b2 new york tracon briefing guide folder- interview statements with personnel statements-...

8/14/2019 T8 B2 New York TRACON Briefing Guide Folder- Interview Statements With Personnel Statements- Vollaro- Wiley- Ji

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- D E C . 1 5 . 2 0 0 3 3 : 5 6 P M 9 - 1 1 C O M M I S S I O N N O . 0 5 9 6 P . 6

Interview StatementTh e aifonuadoa givenby yon wfli become part ofibe records in U w Privcy Act SystemThe FAA's authority 10 obraln the intomatian iscontained in 49 U.S.C. Section 1344, 49 U.S.C.Scctian 134$^ and 5 U-S.C Section 3Q LProviding of this mformarion is mandatory. Th epriftripal use Of tbc bfonnaiion provided is to

determine trcnd/ctusts and rccaauamu} ATCsyitcm Jzaprovtmeni, fafonnaiian pjnvidcd willbe disclosed u a ncronne use in accord with U icsystem dcscriptioa of O?MA3OV*T-1. Underthis imhoriiy, disdoawes any be made ro unionrrprcieniatives 2nd to the NTSB. Ftilure toprovide the Infonnnion requested will rtsult inscricin tin


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D E C . 1 5 . 2 0 0 3 3 : 5 6 P M 9 - 1 1 C O M M I S S I O N 0 N O . 0 5 9 6 P . 5rrjvSONNEL STATEMENTFEDERAL AVIATION ADMINISTRATE^NEW YORK TRACON1515 Stewart Ave., Westbury, NY 11 590BACKGROUND; Much of the information concerning the circumstances of this accident/incident can be retrievedvia recorded data sources. However, some of the facts concerning " W h a t you saw an d what you did may not havebeen completely captured. Th e purpose of this statemen t is to provide any frets within yo'ur person al knowledge thatyou believe will provide a more complete understanding of the circumstances surrounding this accident/moident.Therefore, speculations, hearsay, opinions* conclusions, and/or other extraneous data are not to be included in thisgcaicraent This statement may be released to flie publ ic through FOIA or Litigation activities including pretrialdiscovery, depositions, an d actual court testimony.INSTRUCTIONS: This statement is to be printed an d signed by you and your signature below certifies its accuracy.It wil] neither b e edited nor typed and, once signed, wil] constitute your original statement

in--* f ) t\d*^_ athis statemen t concerns theIncidcat/Accldent involvingi Mc/C"" O (aittrtflO(s))[ . m : < ^ V > UTC. My oame is hnre .PWM Vn

(tiiae)


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D E C . 1 5 . 2 0 0 3 3 : 5 6 P M 9 - 1 1 C O M M I S S I O N A N O . 0 5 9 6

Interview Statement^infen^tipt.givcr.byyDiiwiUbecomcpanof detennini irend/owes tod ncnmmcad ATCOwJooVTl" ** ?liV1Cy ACt SyttCni> system improvcmoiL Infatmwteo provided will~ * be disclosed uB routine usa in accord with IheThe FAA's authority to obrain i h f t informiriM is syn;m description of OfM/GOVT-1. Unicrmottined in 49 U.S.Q Section 1344, 49 U.S,C *is twhoriiy. ductosures may be made to Unionjeaion 1348, aad 5 UJS.C. Sc^tin 301. represenarivts id to the NTSB. Faflure 10Frovidtag of ihis infamurioD is mandamr/. "Hit provide ihc Woraadon rtqocsd win result inprincipal use of the information provided is to disciplinary action under FAA regnlxiioiis.

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D E C . 1 5 . 2 0 0 3 3 : 5 6 P M 9 - 1 1 C O M M I S S I O N A N O . 0 5 9 6PERSONNEL STATEMENTFEDERAL A V1ATIOH ADMINISTRATION

NEW YORK TRACON1515 Stewart Ave.. Wcsibuty. NY 11590BACKGROLMD: Much of the information concern ing th e circumstances of this accident/incident can be retrievedvia recorded dad sourctt. However, some of the facts coDcEnnng what you saw mid what you did m ay not riavebeen completely captured. The purpose of this statement is to provide any racrs within your personal know/ledge thatyou believe will provide a more complete understanding of th e circumstances surrounding this accident/incident.Therefore, speculations, hearsay, opinions, conclusions, and/ar other extraneous data arc not to be included in thisstatement. This statement may be released to th e publ ic through FOlA or iitigatior> activities including prttrialdiscovery, depositions, an d actual conn testimony.INSTRUCTIONS: This statement is to be printed end signed by you and your signature beiuw c ertifies its accuracy,h will neither be edited nor typed and, once signed, will constitute your original statement.This statement concerns th e Incident/Accident i nvo lv ing , _a t .. ______

3 s ~ > laircrart ] D < J ) ) l l o c a t i o n iHi-fi I .at (priUbb UTC. Myname is


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Interview StatementThe information given by you will become partO fthe records in tbc Privacy Act Sysism,OPM/OOVT-1.Th e FAA's autfioriiy to obtain th e information I Bcooained in 49 U.S.C Section 1344, 49 U.S.C.Section 1348, and 5 U-S.C. Section 3 D I -Providing of this Information is mandatory, Theprincipal use of ihc information provided is I D

determine tread/causes ad recommend AX Csystem improvemen:. iBfonnariDQ providedwillb 'e disclosed as a routine osc in accord with Uj tsysicm descripdon of OPM/GOVT-l, UnJ=ribis Liithoricy, disciosurca may bo made to unionrepresentatives ind to the NTSB. FaDure toprovide ihc infonnadon requested will result ir >disciplinary action under K AA

Date


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D E C . 1 5 . 2 0 0 3 3 : 5 6 P M 9 - 1 N O . 0 5 9 6 P . 9O M M I S S I O NPERSONNEL STATEMENTFEDERAL AVLAHON ADMINISTRATIONN\ YORK TRACON

1 5 1 5 Stewart Ave.. WestUiry, NY 1 1 590Mu ch of the information con cerning the circumstances of this accident/incident can be retrievedvia recorded data sources. However, some of th e facts concernin g what you saw and what you did may not havebeen completely caprmd. Th e purpose of this stareiDcm is to pro vide any facts within your personal knowledge thatyou believe -will provide a more complete understanding of the circumstances surrounding this accident/incident.

Therefore, speculations, hearsay, opinions, conclusions, and/or other extraneous data are not to be included in thisstatement. This statement may be released to th e public through FOlA or litigation activities inc luding pietrialdiscovery, depositions, and actual court testimony.INSTRUCTIONS: This statement is To be printed an d signed by you and your signature below certifies its accuracy.I t will neither be edited nor typed and. on ce signed, will cojjstiiutc y ou r originalThis statement concerns th e At ,U?ovd


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D E C , 1 5 . 2 0 0 3 3 : 5 5 P M 9 - 1 1 C O M M I S S I O N N O . 0 5 9 6

laterYiew StatementThe information givenby ym i willbecome part efthe records in the ftiviey Act SystemOPM/GOVT-l.Tb FAA1* authority to obtain ih e inromurion iseoouiaed in 49 US.C. Scoion 1144, 49 U.S.CSwtion IMS. and 5 US.C. Section 3Q Lrnjvidmg of tins infonniriDn is ffluidatDty, Theprincipal use of ihe infomwrion provided is to

determine trmd'eaujes ituJ reeemmcnd ATCsystem impmvcnlEm. Information provided willbo disclosed as a ronaQo ttsc in accord wiib thesysnan description pf OPM/GOVT-1. Underthii authority, disdosotca m & y be nude to unionreprescntairvcs and to the N"TSB. Failure toprovide the inforniMirin rcqoesied will result indisciplinary letjon under FAA regulations.

Sign*,cure


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D E C . 1 5 . 2 0 0 3 3 : 5 5 P M 9 - 1 1 C O M M I S S I O N N O 0 5 9 6 F 2PERSONNEL STATEMENT ' FEDERAL AVIATION ADMINISTRATENE"WYORK.TRACON1515 Siewart Ave., Westbury. NY 11 590B ACKgROUND; Much of the information concerning th e cirrmnsiflnces of this accident/incident can be retrievedvia recorded data sources. However- some of the facts concerning what you saw and What you did may not havebeen completely captured. The purpose af This statement is to provide any facts within your personal knowledge thatyou believe will provide a. more complete understanding of the circumstancw surrounding this a.ccidenl/iiicidcm.Therefore, speculations. bearsoy, opinions, conclusions, and/or other extraneous data are nor lo be included in thisstatement. This statement m ay bt rfrkastd to th e public through F01A or litigation activities including preo-ialdiscovery, depositions, and actual court testimon y.INSTRUCTIONS: This statement U to be printed and signed by you and your signature below certifies iis accuracv,Ii will neither be edited nor typed and. once stenecL ^vill constitute your original statement.This statement concern* the Incident/Accident involving y v < > P C_ at

l- ur C*ll (tcraftro(j ( locmioriQ\.at /cAV3 tJTC. Myn a m e is O>~K ^ ^Ctu.\ CSg-> 1amemp l o y e di . .( O p i f j j t ) p_ - . - < *y Ty On f e 'P t t U T f 0 * ?Jt

/ i r - i l i~i iposraon* 1)'position from / /- ^ / UTC to J / UTC.

Complete this section ONLY fo r accidents: Operational equipment configuration was: Radar C h an n e l ; (A) or (B ) .Beacon Channel: (l)or(2). MTlsetat ^miles . Polarization m use: (LPWr (CPV

.. Video Map jo ysc: (] ) (2) (5) W (51or QEquipment configuration unknown.Text of siatemcnt (continue on reverse if needed):

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t8 b2 new york tracon briefing guide folder- interview statements with personnel statements-...

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