Civil Aviation Daily Occurrence Reporting System (CADORS) Manual - TP 4044

Table of Contents

1.0 Introduction

1.1 Purpose

The purpose of the CADORS Manual is to outline the criteria and reporting procedures for aviation occurrences to aid the holder of an Air Traffic Service (ATS) Operations Certificate to fulfill the requirements of Section 807.01 of the Canadian Aviation Regulations (CARs).

1.2 Applicability

This document is applicable to the holder of an ATS operations certificate.

1.3 Description of Changes

This document includes updated information concerning criteria and reporting procedures that the holder of an ATS operations certificate should use in order to comply with Section 807.01 of the CARs.

2.0 References and Requirements

2.1 Reference Documents

It is intended that the following reference materials be used in conjunction with this document:

  1. (a) Aeronautics Act
  2. (b) Canadian Aviation Regulations
  3. (c) Canadian Transportation Accident Investigation and Safety Board Act
  4. (d) Transportation Safety Board Regulations

2.2 Cancelled Documents

This document replaces the CADORS Manual (TP 4044, Fourth Edition, February 1995) and subsequent amendments.

Upon coming into force of the fifth edition of the CADORS Manual, the exemption NCR 04-2008 “Exemption from Standards Specified in the CADORS Manual made pursuant to Section 807.01 of the Canadian Aviation Regulations" will cease to be in effect.

2.3 Definitions and Abbreviations

The following definitions are used in this document:

  1. (a) Aircraft is defined as any machine, including a rocket, capable of deriving support in the atmosphere from reactions of the air.
  2. (b) Approach aid can include, but is not limited to, Localizer Performance with Vertical Guidance (LPV), Lateral Navigation (LNAV), Vertical Navigation (VNAV), and Required Navigation Performance (RNP).
  3. (c) Collision is defined in the Transportation Safety Board Regulations as an impact, other than an impact associated with normal operating circumstances, between aircraft or between an aircraft and another object or terrain.
  4. (d) Communication system can include, but is not limited to, Surveillance Fusion System (FUSION), Automatic Dependent Surveillance – Broadcast (ADS-B), and Aircraft Communications Addressing and Reporting System (ACARS).
  5. (e) Navigational aid is defined as any visual or electronic device, airborne, space-based or on the surface of the earth, that provides point-to-point guidance information or position data to aircraft in flight, including, but not limited to, Global Navigation Satellite System (GNSS), Satellite-based Augmentation System (SBAS), Ground-based Augmentation System (GBAS), Aircraft-based Augmentation System (ABAS), and Flight Management System (FMS).
  6. (f) Risk of collision is defined in the Transportation Safety Board Regulations as a situation in which an aircraft comes so close to being involved in a collision that a threat to the safety of any person, property or the environment exists.

The following abbreviations are used in this document:

  1. (a) ABAS: Aircraft-based Augmentation System
  2. (b) ACARS: Aircraft Communications Addressing and Reporting System
  3. (c) ADS-B: Automatic Dependent Surveillance – Broadcast
  4. (d) ATS: Air Traffic Service
  5. (e) CADORS: Civil Aviation Daily Occurrence Reporting System
  6. (f) CARs: Canadian Aviation Regulations
  7. (g) ELT: Emergency Locator Transmitter
  8. (h) FMS: Flight Management System
  9. (i) FUSION: Surveillance Fusion System
  10. (j) GBAS: Ground-based Augmentation System
  11. (k) GNSS: Global Navigation Satellite System
  12. (l) JRCC: Joint Rescue Coordination Centre
  13. (m) LNAV: Lateral Navigation
  14. (n) LPV: Localizer Performance with Vertical Guidance
  15. (o) RNP: Required Navigation Performance
  16. (p) SBAS: Satellite-based Augmentation System
  17. (q) TCAS: Traffic Alert and Collision Avoidance System
  18. (r) TSB: Transportation Safety Board of Canada
  19. (s) VNAV: Vertical Navigation

3.0 Background

Section 2(1) of the Transportation Safety Board Regulations requires that all accidents; or incidents involving an aircraft having a maximum certificated take-off weight greater than 2 250 kg, or of an aircraft being operated under an air operator certificate issued under Part 7 of the CARs, be reported to the Transportation Safety Board of Canada (TSB) if they result directly from the operation of an aircraft. The TSB is the official source of aviation accident and incident data in Canada and collects aviation occurrence information for the purpose of advancing safety.

Transport Canada collects aviation occurrence information through the Civil Aviation Daily Occurrence Reporting System (CADORS) to provide initial information on occurrences involving any Canadian-registered aircraft as well as events that occur at Canadian airports, in Canadian sovereign airspace, or international airspace for which Canada has accepted responsibility that includes events involving foreign-registered aircraft. Information from CADORS is used in the early identification of potential hazards and system deficiencies, and to assist in the assessment of associated risks.

The CADORS Manual is incorporated by reference into Section 807.01 of the CARs.

4.0 Criteria for Reporting

The holder of an ATS operations certificate shall report to the Minister any aviation occurrence that meets, or appears likely to have met, the criteria of an aircraft accident as described in Subsection 4.1, or an aircraft incident as described in Subsection 4.2.

4.1 Aircraft Accident

An aircraft accident is any aviation occurrence resulting directly from the operation of an aircraft where:

  1. 1) A person, other than a stowaway, sustains a serious injury or fatal injury, that is not self-inflicted or inflicted by another person or caused by natural causes, as a result of that person:
    1. a) Being in the aircraft;
    2. b) Coming into direct contact with any part of the aircraft, including any part that may have become detached from the aircraft; or
    3. c) Being directly exposed to the jet blast or propeller wash of the aircraft.
  2. 2) The aircraft sustains damage or structural failure adversely affecting the structural strength, performance or flight characteristics of the aircraft normally requiring major repair or replacement of any affected component part, other than damage or failure that is limited to:
    1. a) The engine, its cowlings, or its accessories;
    2. b) The propellers, wing tips, antennae, tires, brakes, or fairings; or
    3. c) Small dents or puncture holes in the aircraft skin.
  3. 3) The aircraft is missing or is completely inaccessible.

4.2 Aircraft Incident

An aircraft incident is defined as:

  1. (1) Any occurrence involving an aircraft where:
    1. a) An engine fails or is shut down as a precautionary measure;
    2. b) Smoke or fire occurs, other than an engine fire that is contained within the engine and does not result in engine failure or damage to other component parts of the aircraft;
    3. c) Difficulties in controlling the aircraft in flight are encountered due to any aircraft system malfunction, weather phenomena, wake turbulence, operations outside the approved flight envelope or uncontrolled vibrations;
    4. d) The aircraft fails to remain within the landing or takeoff area, lands with one or more landing gear retracted or drags a wing tip or engine pod;
    5. e) Any crew member is unable to perform their flight duties as a result of incapacitation;
    6. f) Decompression, explosive or otherwise, occurs that necessitates an emergency descent;
    7. g) A fuel shortage occurs that necessitates a diversion or requires approach and landing priority at the destination of the aircraft;
    8. h) The aircraft is refuelled with the incorrect type of fuel or contaminated fuel;
    9. i) A collision or risk of collision with any other aircraft or with any vehicle, terrain or obstacle occurs, including a collision or risk of collision that may be related to air traffic control procedures or equipment failures;
    10. j) The aircraft receives a Traffic Alert and Collision Avoidance System (TCAS) Resolution Advisory;
    11. k) A flight crew member declares an emergency (such as medical), or indicates any degree of emergency that requires priority handling by an air traffic control unit or the standing by of crash, firefighting, or rescue services;
    12. l) Toxic gases or corrosive materials leak from any area aboard the aircraft;
    13. m) A transmission gearbox malfunction occurs; or
    14. n) A slung load is released unintentionally or as a precautionary or emergency measure from the aircraft.
  2. 2) Unauthorized incursion or operating irregularities involving vehicles, pedestrians, or animals.
  3. 3) Failure or interference of a navigational aid, approach aid, communications system, airport lighting, power failure, or any other system breakdown which has an adverse effect on flight safety, or a major impact on operations.
  4. 4) Criminal action, such as a hijacking, bomb threat, riot, sabotage, or a breach of aviation or airport security.
  5. 5) Unavailability of a runway due to snow, ice, flood, obstruction or foreign object that results in a major impact on airport operations.
  6. 6) Bird strikes, which result in aircraft damage or other operational impact.
  7. 7) Missing aircraft reports, Search and Rescue action (i.e. Joint Rescue Coordination Centre [JRCC], emergency locator transmitter [ELT] activations, or communications searches).
  8. 8) Significant building and equipment fire or other major damage on airport property or Transport Canada remote sites.
  9. 9) Labour action affecting operational capability.
  10. 10) Item dropped from aircraft.
  11. 11) Regulatory infractions.
  12. 12) Environment emergencies such as significant fuel spill, hazardous chemical or radioactive spill on an airport property.
  13. 13) Accidental death or serious injury to employees or members of the public while on airport or Transport Canada property.
  14. 14) Operating irregularities.
  15. 15) Any occurrence that may generate a high degree of public interest or could be of direct interest to specific foreign air authorities.
  16. 16) Missing weather observations or other weather information.

5.0 Reporting Procedures

Transport Canada endeavours to ensure the accuracy and integrity of the data contained with CADORS, however, the information within should be treated as preliminary, unsubstantiated, and subject to change.

The TSB is the official source of aviation accident and incident data in Canada.

An aviation occurrence that meets, or appears likely to meet, the criteria of an aircraft accident or an aircraft incident, as described in Subsections 4.1 and 4.2, shall be reported in the CADORS.

Holders of an ATS Operations Certificate will report accidents, incidents, and other occurrences through an occurrence reporting process. They will strive to include the aviation occurrence information listed in Section 6.0, where it is available and applicable to the specific occurrence. When a flight crew reports an occurrence to ATS that meets reportable criteria, holders of an ATS Operations Certificate will also report that occurrence through the same reporting process.

An aviation incident can also be reported by filing an “Aviation Incident Report Form” from Transport Canada’s website Footnote 1.

6.0 Aviation Occurrence Information

Reports shall include the aviation occurrence information described in Subsections 6.1, 6.2 and 6.3, where available and applicable to the specific occurrence. Any additional information relevant to the aircraft accident or incident can also be included in the report.

6.1 Occurrence Information

Where available and applicable, the report should include the following information:

  • Report identifier
  • Occurrence date
  • Occurrence time (in Coordinated Universal Time [UTC])
  • Occurrence location
  • Number of fatalities resulting from the occurrence
  • Number of injuries resulting from the occurrence

6.2 Aircraft Information

Where available and applicable, the report should include the following aircraft information:

  • Aircraft registration mark
  • Flight number
  • Aircraft make and model
  • Owner and/or operator name(s)
  • Aircraft origin and destination
  • Phase of flight
  • Type of flight rule the aircraft was operating under at the time of the occurrence
  • In the case of a diversion, indicate the aerodrome where the aircraft diverted
  • Any damage sustained to the aircraft

6.3 Occurrence Summary

An occurrence summary can be provided to describe the occurrence and sequence of events. Personal information and identifiers will not be included in the published CADORS record’s narrative.

6.4 Update(s) to an Existing CADORS Record

If additional information becomes available, it can be submitted as an update to the original report. This can be done through the same reporting mechanism or by sending an e-mail to the CADORS Administrator.

If an existing CADORS record requires a correction, this information can also be submitted through the same reporting mechanism or by sending an e-mail to the CADORS Administrator.

7.0 Contact

For more information, please contact the CADORS Administrator at:

  • CADORS-SCREAQ@tc.gc.ca; or
  • CADORS Administrator
    Transport Canada
    Aviation Intelligence and Risk branch (AARI)
    Place de Ville, Tower C
    330 Sparks Street
    Ottawa, ON K1A 0N8
    Canada
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