Privacy Impact Assessment

PRIVACY IMPACT ASSESSMENT (PIA)
PRESCRIBING AUTHORITY: DoD Instruction 5400.16, "DoD Privacy Impact Assessment (PIA) Guidance". Complete this form for Department of Defense
(DoD) information systems or electronic collections of information (referred to as an "electronic collection" for the purpose of this form) that collect, maintain, use,
and/or disseminate personally identifiable information (PII) about members of the public, Federal employees, contractors, or foreign nationals employed at U.S.
military facilities internationally. In the case where no PII is collected, the PIA will serve as a conclusive determination that privacy requirements do not apply to
system.
1. DOD INFORMATION SYSTEM/ELECTRONIC COLLECTION NAME:

Air Force Safety Automated System (AFSAS)
3. PIA APPROVAL DATE:

2. DOD COMPONENT NAME:

United States Air Force

SECTION 1: PII DESCRIPTION SUMMARY (FOR PUBLIC RELEASE)
a. The PII is: (Check one. Note: foreign nationals are included in general public.)
From members of the general public

From Federal employees and/or Federal contractors

From both members of the general public and Federal employees and/or
Federal contractors

Not Collected (if checked proceed to Section 4)

b. The PII is in a: (Check one)
New DoD Information System

New Electronic Collection

Existing DoD Information System

Existing Electronic Collection

Significantly Modified DoD Information System
c. Describe the purpose of this DoD information system or electronic collection and describe the types of personal information about individuals
collected in the system.

The Air Force Safety Center's (AFSEC) world-wide mishap prevention program provides senior leaders, both in the field and at
Headquarters Air Force, rapid access to information necessary to make informed decisions regarding safety improvements to weapons
systems and mission operations. The AFSEC Enclave is designed to securely and cost-effectively host systems in support of that mission.
In support of that mission and effort, AFSEC developed the web-based Air Force Safety Automated System (AFSAS), which is a proven
system that provides mission-essential capabilities to investigators and safety professionals from initial reporting through final hazard
mitigation disposition across all safety disciplines (Flight, Ground, Weapons, and Space). AFSAS will reside within the AFSEC Enclave as
a constituent system and will be used by the AF and Navy personnel.
Information is collected from those involved in mishaps and witnesses (potentially members of the general public) to include Name, DoD
Identification number (DoD ID), grade, gender, age, assigned organization base, employment information, to include official email, and
medical information such as type of injury for Military (Active Duty, Guard and Reserve), DoD civilians, and DoD contractors.
The system will collect Name, Address and a contact phone number, for non-DoD civilian personnel designated as witnesses to a mishap.
d. Why is the PII collected and/or what is the intended use of the PII? (e.g., verification, identification, authentication, data matching, mission-related use,
administrative use)

PII is collected for mission-related and administrative use. The information is collected to compare Air Force Safety mishap reports with
injury reports logged at USAF Clinics. AFI 91-204 and DoDI 6055.7 both require that all injuries and illnesses reported at AF Clinics must
be reported and used for mishap prevention and analysis purposes.
The USAF Safety Center requires collection of PII for mishap prevention and safety purposes as part of mission-related use.
e. Do individuals have the opportunity to object to the collection of their PII?

Yes

No

(1) If "Yes," describe the method by which individuals can object to the collection of PII.
(2) If "No," state the reason why individuals cannot object to the collection of PII.

All DoD Personnel must provide their information. Other personnel, including contractors, are required to consent to collection prior to
providing the information. Files related to accidents will not be routinely retrieved by name or personal identifier. While a person's name
and injury type is maintained by the system, these will not be the primary means of retrieving files related to accidents.
f. Do individuals have the opportunity to consent to the specific uses of their PII?

Yes

No

(1) If "Yes," describe the method by which individuals can give or withhold their consent.

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(2) If "No," state the reason why individuals cannot give or withhold their consent.

During a mishap investigation, a privacy case flag is set in AFSAS by the investigator when interviewing an injured person involved in a
mishap. This prevents privacy data from being viewed by persons not involved in the investigation and prevents it from being reported in
the OSHA 300 Log report to Department of Labor. However, once the preliminary message has been released in the AFSAS system, and
during the course of a mishap investigation, the investigation board can see privacy information. Once the investigation is closed, privacy
information cannot be viewed. The one exception is that HQ AFSEC personnel (approximately four individuals) with the quality control
role granted to their accounts can see privacy information at any time.
g. When an individual is asked to provide PII, a Privacy Act Statement (PAS) and/or a Privacy Advisory must be provided. (Check as appropriate and
provide the actual wording.)
Privacy Act Statement

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Privacy Advisory

Not Applicable

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Authority: 10 U.S.C. 9013, Secretary of the Air Force; 10 U.S.C. 3013, Secretary of the Army; 10 U.S.C. 5013, Secretary of the Navy; E.O.
12196, Occupational Safety and Health Administration’s reporting requirements, Occupational safety and health programs for Federal
employees; 29 CFR 1960, Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters;
Department of Defense Directive 5134.01, Under Secretary of Defense for Acquisition, Technology, and Logistics (USD(AT&L));
Department of Defense Instruction 6055.07, Mishap Notification, Investigation, Reporting, and Record Keeping; Air Force Policy Directive
91-2, Safety Programs; Air Force Instruction 91-204, Safety Investigation and Reports; Air Force Instruction 91-207, and The U.S. Air Force
Traffic Safety Program.
Purpose: Information is collected for trending and analysis of Air Force Mishaps, to meet the Air Force Safety mission goals to prevent
mishaps and preserve combat capability.
Routine Use:
In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, the records contained
herein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows:
To the appropriate Federal, State, local, territorial, tribal, foreign, or international law enforcement authority or other appropriate entity
where a record, either alone or in conjunction with other information, indicates a violation or potential violation of law, whether criminal,
civil, or regulatory in nature.
To any component of the Department of Justice for the purpose of representing the DoD, or its components, officers, employees, or members
in pending or potential litigation to which the record is pertinent.
In an appropriate proceeding before a court, grand jury, or administrative or adjudicative body or official, when the DoD or other Agency
representing the DoD determines that the records are relevant and necessary to the proceeding; or in an appropriate proceeding before an
administrative or adjudicative body when the adjudicator determines the records to be relevant to the proceeding.
To the National Archives and Records Administration for the purpose of records management inspections conducted under the authority of
44 U.S.C. §§ 2904 and 2906.
To a Member of Congress or staff acting upon the Member’s behalf when the Member or staff requests the information on behalf of, and at
the request of, the individual who is the subject of the record.
To appropriate agencies, entities, and persons when (1) the DoD suspects or has confirmed that there has been a breach of the system of
records; (2) the DoD has determined that as a result of the suspected or confirmed breach there is a risk of harm to individuals, the DoD
(including its information systems, programs, and operations), the Federal Government, or national security; and (3) the disclosure made to
such agencies, entities, and persons is reasonably necessary to assist in connection with the DoD’s efforts to respond to the suspected or
confirmed breach or to prevent, minimize, or remedy such harm.
To another Federal agency or Federal entity, when the DoD determines that information from this system of records is reasonably necessary
to assist the recipient agency or entity in (1) responding to a suspected or confirmed breach or (2) preventing, minimizing, or remedying the
risk of harm to individuals, the recipient agency or entity (including its information systems, programs and operations), the Federal
Government, or national security, resulting from a suspected or confirmed breach.
Used to (a) Establish the severity of injury/illness and to ensure proper reporting accountability within the Department of the Air Force; (b)
Identify causes of illness/injuries so supervisors and functional managers can take appropriate action to eliminate or control unsafe and
unhealthy conditions; (c) Prepare statistical and historical reports as required by Executive Order 12196 and Department of Defense; (d)
Provide documentation for cumulative summation of treatment causes.
Disclosures: Mandatory; Accounts are created and accessible only by approved individuals who must read and agree to a Privacy Act
Statement, Consent to Monitoring Statement, FOUO Clause, and Notification of Safety Privilege Information Protection requirement.
Link to SORN: Pending (AFSAS is the same system that the Navy uses for managing safety investigations. Navy is publishing a new SORN,
which will cover AFSAS and their use of this same system. This may also become a DoD-wide SORN)
h. With whom will the PII be shared through data exchange, both within your DoD Component and outside your Component? (Check all that apply)
Within the DoD Component

Specify.

Other DoD Components

Specify.

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DoD Safety Offices and Medical Clinics

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Other Federal Agencies

Specify.

State and Local Agencies

Specify.

Contractor (Name of contractor and describe the language in
the contract that safeguards PII. Include whether FAR privacy
clauses, i.e., 52.224-1, Privacy Act Notification, 52.224-2,
Privacy Act, and FAR 39.105 are included in the contract.)

Specify.

Other (e.g., commercial providers, colleges).

Specify.

USCG Safety Offices and Medical Clinics

i. Source of the PII collected is: (Check all that apply and list all information systems if applicable)
Individuals

Databases

Existing DoD Information Systems

Commercial Systems

Other Federal Information Systems

j. How will the information be collected? (Check all that apply and list all Official Form Numbers if applicable)
E-mail

Official Form (Enter Form Number(s) in the box below)

Face-to-Face Contact

Paper

Fax

Telephone Interview

Information Sharing - System to System

Website/E-Form

Other (If Other, enter the information in the box below)

AF Form 978, Supervisor Mishap/Incident report
k. Does this DoD Information system or electronic collection require a Privacy Act System of Records Notice (SORN)?
A Privacy Act SORN is required if the information system or electronic collection contains information about U.S. citizens or lawful permanent U.S. residents that
is retrieved by name or other unique identifier. PIA and Privacy Act SORN information must be consistent.
Yes

No

If "Yes," enter SORN System Identifier

SORN is Pending by Navy

SORN Identifier, not the Federal Register (FR) Citation. Consult the DoD Component Privacy Office for additional information or http://dpcld.defense.gov/
Privacy/SORNs/
or
If a SORN has not yet been published in the Federal Register, enter date of submission for approval to Defense Privacy, Civil Liberties, and Transparency
Division (DPCLTD). Consult the DoD Component Privacy Office for this date
If "No," explain why the SORN is not required in accordance with DoD Regulation 5400.11-R: Department of Defense Privacy Program.

This is the same system that the Navy uses for managing safety investigations. Navy is publishing a new SORN, which will cover AFSAS
and their use of this same system, which might become a DoD-wide SORN.
l. What is the National Archives and Records Administration (NARA) approved, pending or general records schedule (GRS) disposition authority for
the system or for the records maintained in the system?
(1) NARA Job Number or General Records Schedule Authority.

N1-AFU-90-03

(2) If pending, provide the date the SF-115 was submitted to NARA.

(3) Retention Instructions.

T91-03 R01.00 Nuclear Weapon Accident/Incident Deficiency Analyses and Summaries with Accident/Incident Deficiency Report Air
Force Safety Automated System IT System Approved: Destroy with related reports
T91-03 R03.00 Nuclear Weapon Accident/Incident Deficiency Report Air Force Safety Automated System IT System Approved: Destroy
after microfilm or automated data is determined adequate substitute
T91-05 R01.00 Aircraft, Space, Missile, Explosives & Nuclear Mishap Reports AF Safety Automated System IT System Approved:
Unscheduled
T91-05 R04.00 Ground Mishap Reports at HQ AFSA Air Force Safety Automated System IT System Approved: Destroy after 5 years
T91-05 R07.00 Automated Mishap Data Air Force Safety Automated System IT System Approved: Destroy when no longer needed
T91-05 R08.00 Mishap Logs and Inventories Air Force Safety Automated System IT System Approved: Destroy when no longer needed
T91-05 R09.00 Mishap/Incident Reference Sheets at HQ AFSA AF Safety Automated System IT System Approved: Destroy after 2 years
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T91-05
R12.00
Occupational
Force Safety
Automated
System IT System Approved: Destroy
after 5 years
DD
FORM
2930,
JUN 2017 Injuries and Illnesses Air
PREVIOUS
EDITION
IS OBSOLETE.
Note: Among the disposition(s) cited in this field, the one with the longest retention time will be used on the system’s records data.

m. What is the authority to collect information? A Federal law or Executive Order must authorize the collection and maintenance of a system of
records. For PII not collected or maintained in a system of records, the collection or maintenance of the PII must be necessary to discharge the
requirements of a statue or Executive Order.
(1) If this system has a Privacy Act SORN, the authorities in this PIA and the existing Privacy Act SORN should be similar.
(2) If a SORN does not apply, cite the authority for this DoD information system or electronic collection to collect, use, maintain and/or disseminate PII.
(If multiple authorities are cited, provide all that apply).
(a) Cite the specific provisions of the statute and/or EO that authorizes the operation of the system and the collection of PII.
(b) If direct statutory authority or an Executive Order does not exist, indirect statutory authority may be cited if the authority requires the
operation or administration of a program, the execution of which will require the collection and maintenance of a system of records.
(c) If direct or indirect authority does not exist, DoD Components can use their general statutory grants of authority (“internal housekeeping”) as
the primary authority. The requirement, directive, or instruction implementing the statute within the DoD Component must be identified.

5 U.S.C. 41 4101-4118, the Government Employees Training Act of 1958; 5 U.S.C. §301, Departmental Regulations; 10 U.S.C. 3013,
Secretary of the Army; 10 U.S.C. 5013, Secretary of the Navy; E.O. 12196, Occupational Safety and Health Administration’s reporting
requirements, Occupational safety and health programs for Federal employees; 29 CFR 1960, Basic Program Elements for Federal Employee
Occupational Safety and Health Programs and Related Matters; Department of Defense Directive 5134.01, Under Secretary of Defense for
Acquisition, Technology, and Logistics (USD(AT&L)); Department of Defense Instruction 6055.07, Mishap Notification, Investigation,
Reporting, and Record Keeping; Air Force Policy Directive 91-2, Safety Programs; OPNAVINST 5102.1(Series)/MCO P5102.1(Series),
Navy & Marine Corps Mishap and Safety Investigation, Reporting, and Record Keeping Manual; OPNAVINST 3750.6(Series), Naval
Aviation Safety Management System; Air Force Instruction 91-204, Safety Investigation and Reports; Air Force Instruction 91-207, and The
U.S. Air Force Traffic Safety Program.
n. Does this DoD information system or electronic collection have an active and approved Office of Management and Budget (OMB) Control
Number?
Contact the Component Information Management Control Officer or DoD Clearance Officer for this information. This number indicates OMB approval to
collect data from 10 or more members of the public in a 12-month period regardless of form or format.
Yes

No

Pending

(1) If "Yes," list all applicable OMB Control Numbers, collection titles, and expiration dates.
(2) If "No," explain why OMB approval is not required in accordance with DoD Manual 8910.01, Volume 2, " DoD Information Collections Manual:
Procedures for DoD Public Information Collections.”
(3) If "Pending," provide the date for the 60 and/or 30 day notice and the Federal Register citation.

AFSAS 30 day notice submitted for publication. AFSAS OMB package with WHS pending review

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