Civil Aviation Department

Personal Details

Please fill in all the blanks. This section will be destroyed and no record kept. All identies contained in theis report will be removed to ensure complete reporter confidentiality.

Please read CAIR Leaflet before filling the form.

Name
Telephone Number
E-mail address
Postal Address

General

Event / Hazard Type
Date of Occurrence
Location
Time

Please select the appropriate section related to this event

Flight Operations / Cabin

Air Traffic Services

Engineering

Ground Hazard / Other

Operational Information

Crew Position
Crew Duty
Light / Visibility	Day Night Dawn Dusk
Type of Operation	Schedule Charter Corporate Other
Type of aircraft
Flight Phase	Taxi Take off Climb Cruise Descent Approach Missed Approach Landing GA
Weather (if applicable)	VMC IMC Rain Windshear Turbulance Marginal Storm Fog Mixed Other

Air Traffic Information

Type of Aircraft (Make/Model)
Flight Plan
Altitude (ft)
Distance and Radial from Airport
Type of Flight	VFR IFR SVFR None
Flight Phase	Taxi Take off Climb Cruise Descent Approach Missed Approach Landing
Visibility (m)
Cloud Ceiling (ft)
Name of ATC Facility
ATC Service Provided
Types of Airspace (Class A-G/Special)

Engineering Information

Aircaft / Engine Type
Aircraft Registration
System / Component Name
System / Component Part No.
System / Component Serial No.
Activity (Maintenance/Turnaround/refuelling etc.)
Maintenance Task Card No.

Detailed Account of the Event

Keeing in mind the topics shown below, discuss those that you feel are relavant and anything else you think is important. Include what you believe really caused the problem and what can be done to prevent a recurrence, or correct the situation

Chain of events: How the problem arose, How it was discovered, Contibuting factors, Corrective action

Human Performance considerations: Perceptions, judgements, decisons; Actions or Inactions; Factors affecting the qualities of human performance

 

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