1. Type of Notification
Notes:
- Routine Change conducted in accordance with change procedures approved by the CA (notification minimum 10 working days in advance of the change)
- Non-complex Change to the management or safety management system or the Functional System (minimum 35 working days in advance of the change)
- Complex Change to the management or safety management system or Functional System (minimum 90 working days in advance of the change)
- Unplanned Change conducted in accordance with change procedures approved by the CA (notification is submitted as per SP CA approved procedures)
A CA review may take place for any of the above changes. The SP will be notified.
2. Reference and Version Number of this Notification
* All Textbox fields within this form are limited to 255 characters.
Please provide your organisation's unique reference number for this change.
Also add a version number i.e. Version 01, as it may be necessary to amend the change later.
Should the information in a change notification change, a new change notification form must be submitted with the same reference number and the version number increased by one.
3. Organisation Details
PLEASE SPECIFY - DTBU, CTBU, STBU, SENR, EIDL, EIKN, EIKY, EISG, EIWF, EIWT, MET or OTHER
4. Primary Contact Person for this Notification
Person with overall responsibility for the implementation of the change.
5. Secondary Contact
6. Proposed Change
7. Service Impacted by the Change
Tick the box to indicate which services are affected by the change. If not listed tick ‘Other’ and provide details.
8. Functional System Changes
Tick the appropriate box or boxes.
9. Describe the Impact of the Change
Tick the appropriate box and describe other potential impacts not listed.
10. Safety Acceptability of a Change to the Functional System
ATS.OR.210 Safety Criteria
- An air traffic services provider shall determine the safety acceptability of a change to a functional system, based on the analysis of the risks posed by the introduction of the change, differentiated on basis of types of operations and stakeholder
classes, as appropriate.
- The safety acceptability of a change shall be assessed by using specific and verifiable safety criteria, where each criterion is expressed in terms of an explicit, quantitative level of safety risk or another measure that relates to safety risk.
10.(1) Quantitative Measure (Level) of Safety Risk (Pre-Mitigation)
Based on the analysis of the risks posed by the introduction of the change where each criterion (i.e. specific and verifiable safety criteria) is expressed in terms of an explicit quantitative level of safety risk.
10.(2) Other Measures (Proxies) Related to Safety Risk (Pre-Mitigation)
Based on the analysis of the risks posed by the introduction of the change where each criterion (i.e. specific and verifiable safety criteria) is expressed in terms of another measure (i.e. a proxy) that relates to safety risk.
AMC2 ATS.OR.210(a) Safety Criteria - Other Measures Related to Safety Risks - Proxies
List the proxy or proxies used related only to the highest risk(s) (i.e. where the proxy is measurable, quantitatively or qualitatively, to an adequate degree of certainty).
11. Other Service Providers or aviation undertaking affected by the change?
12. Name of entity which oversees or is responsible for the assurance case
If applicable, insert name of entity(s) below:
13. Attachments to this Notification
If yes, list titles and version numbers hereunder and attach to the submission.
50 character limit on file name attachments. For files over 2MB in size, please email these to
ansdinfo@iaa.ie and ensure to include the reference number used in this notification form.
Attachment 1 (50 character name max)
This field is required
Max file size 2MB
Attachment 2 (50 character name max)
This field is required
Max file size 2MB
Attachment 3 (50 character name max)
This field is required
Max file size 2MB
Attachment 4 (50 character name max)
This field is required
Max file size 2MB
14. Declaration
I declare that I have the legal capacity to submit this Notification to the competent authority and that all information provided in this Notification form is correct and complete.
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Please use the SUBMIT button below to send in your form. The sender will receive an automated email with the information they provided. Please retain this email as part of
your change records regarding the notification of change to the CA.
Data Protection
Personal data included in this application is processed by the IAA pursuant to European and National Regulations on the protection of individuals with regard to the processing of personal data. It will be processed solely for the purposes of the performance,
management and follow up by SRD of the IAA, without prejudice to possible transmission to internal audit services. The applicant shall have the right of access to his/her personal data and the right to rectify any such data that is inaccurate or incomplete.
Should the applicant have any queries concerning the processing of his/her personal data, he/she shall address them to the IAA at the following address:
ansdinfo@iaa.ie.