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Occurrence Reporting

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

Occurrence reporting form

Occurrence title

Occurrence title *

Contact Information

Reported by *
Address *
Phone *
Email *
Distributor 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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