Occurrence Reporting

Bellow and on the next pages is an occurrence reporting form. Please fill in all required fields.


Occurrence reporting form



Occurrence title

Occurrence title:

Contact Information

Reported by:
Address:
Phone:
Email:

Aircraft Information

Aircraft type:
Aircraft model:
Other type / model:
Aircraft registration:
Aircraft serial No.:
Aircraft Flight Hours:
Aircraft Engine Hours:
Current location of the aircraft:

Occurrence Information


Occurrence Location (enter airfield with 4-letter ICAO code, if not applicable put "NA"):
Departure point:
Planned destination:
Date (local) of occurrence:
Time (local) of occurrence:
Landing on Alternate:
Flight phase:
Date (UTC) of occurrence:
Time (UTC) of occurrence:
Occurrence description (please anonymize the information):
Did the occurrence induce any of the following?
Number of injuries to persons on aircraft:
Minor:
Serious:
Fatal:
Number of injuries to persons on ground:
Minor:
Serious:
Fatal:
Aircraft Damage:
Damage to Property:
Was the occurrence reported to the local aviation authority/accident investigation branch?
Is the aircraft still in operation?
Explain why Restricted:
Did warning/safety systems function properly?
Failed part - if applicable (State or describe known technical occurrence to any aircraft system or structure - e.g.: fault, malfunction, defect, loss of part, leakage,..):

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