Occurrence form

Occurrence Information

Headline*

Short description of the event. Example of a headline: “Total loss of power during takeoff”

Occurrence description*

Please provide more extensive description of the event.

Manufacturer’s Part Number affected (if any)

Identification of possible affected/failed part(s) or appliances on the aircraft. Please write the part number in accordance with Pipistrel’s IPC. If you cannot identify the part number, or are unsure which part number is correct, please write the description of the part(s) affected.

Occurrence date (UTC)*

Occurrence time (UTC)

Occurrence time (Local)

State/location of occurrence*

Where the actual occurrence happened.

Last point of departure*

Where the aircraft departed from.

Planned destination*

The planned final point of the flight.

Weather conditions

What were the weather conditions in the area of the occurrence?

Weather relevant?

Did weather affect the operation of the aircraft. Was the occurrence caused by weather conditions?

Injuries and damage data

Number of aircraft occupants*

The number of people in the aircraft at the time of occurrence.

Injuries*

Were there any injuries sustained by the crew on board the aircraft or by other parties on the ground?

Highest injury level*

What was the highest injury level recorded?

Number of occupants, who suffered the highest injury level*

How many of the occupants have suffered the highest injury level?

Highest aircraft damage*

Highest damage reported on the aircraft.

Other damage (if any)

Other damage to property, other aircraft, etc. Leave empty if none.

Aircraft data

Aircraft serial number*

Serial number of the aircraft affected in the occurrence. Can be found on a metal plate near the tail of the aircraft.

Aircraft registration*

Registration code of the aircraft involved in the occurrence.

Aircraft flight hours*

Total number of flight hours accumulated by the aircraft at the time of the occurrence.

Engine hours*

Total number of engine hours accumulated by the aircraft at the time of the occurrence.

Aircraft still in operation?*

Is the aircraft still in operation?

Current position of the aircraft*

Where the aircraft is currently situated.

Datalogs available?*

If your aircraft is equipped with a datalogging system, have you saved the datalogs from the occurrence flight? Please ensure the datalogs are provided to our Support team.

Reporter data

Reporter’s phone number

Phone number of the person reporting the occurrence.

Important note: this information will only be used in order to contact the reporter and request further information on the event. It will not be included in the follow-up occurrence reports and will not be stored by the organisation in accordance with applicable European regulation.

Reporter’s email address*

Email address of the person reporting the occurrence.

Important note: this information will only be used in order to contact the reporter and request further information on the event. It will not be included in the follow-up occurrence reports and will not be stored by the organisation in accordance with applicable European regulation.

Has the occurrence been reported to the local aviation authority/investigation unit?

Please note that every incident or accident should be reported to your local investigation unit.

Have there recently been any similar occurrences on this or other aircraft you operate?

If you have experienced the same or similar issue recently on this or other aircraft serial numbers, please write the details in this field. Include at least the following data:
- Date of issue
- Date of filing OCR report to Pipistrel
- Aircraft serial number
- What corrective actions have you implemented to rectify the issue?

Other comments

Provision for additional comments from the reporter.

* I hereby certify that the above statements are true and correct to the best of my knowledge

Attachments

Multiple files can be uploaded. Allowed file types: PDF, JPG, PNG, MOV, MP4, WEBM and GIF. Maximum size: 500MB.

Occurrence Reporting

Below and on the next pages is an occurrence reporting form. Please fill in all required fields marked with *.

Occurrence Information

Injuries and damage data

Aircraft data

Reporter data

Attachments

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