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Nature of Issue/Concern
Full Name
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Reference #
Select Type of Concern
select
Safety
Security
Quality
Compliance
Environmental
HR
Operational
Select Custom Report Type
select
Air Traffic Control
Airport Initial Safety
Bird / Other Wildlife Strike
Cabin Safety
Captain's Trip Report
Fatigue Report
Flight Safety
FRMS Report
General Safety
Hazard/Occurrence Form
Incident/Accident/Hazard/Near Miss
Interference With Crewmember
Maintenance
Passenger Accident / Incident
Request Document Change
Security Officer Report
Select Audit
select
Or Add New
Audit Name
:
Flight Safety Form
Reporter
select
--- --- ---
Captain
First Officer (pilot flying)
First Officer (pilot not flying)
Crewmember
Pilot Flying PF
Pilot Monitoring PM
Experience
years
Airspace
select
--- --- ---
Class A (PCA)
Class B (TCA)
Class C (ARSA)
Class D (Control Zone/ATA)
Class E (General Controlled)
Class G (Uncontrolled)
Special Air Space
Unknown
Weather
select
--- --- ---
Clear
Cloudy
Cyclonic
Dusty
Fog
Hail
Hazy
Ice
Indoor
Lightning
Mist
Overcast
Partly Cloudy
Rain
Sleet
Snow
Thunderstorm
Windy
Light
select
--- --- ---
N/A
Dawn
Day
Dusk
Indoor
Night
ATC Advisory
select
--- --- ---
Local
Ground
Arrival
Departure
Center
Flight Service Station
UNICOM
CTAF
Altitude
ft.
Miss Distance Horizontal (ft.)
ft.
Miss Distance Vertical (ft.)
ft.
Evasive Action Taken
TCAS Factor
GPWS Active
Air Traffic Control Form
Reporter
select
--- --- ---
Tower
Approach
Center
Flight Service Station
Experience
years
ATC Control Position
select
--- --- ---
Radar
Hand-off
Radar Associated
Local
Ground
Assistant
Arrival
Departure
Data
Clearance Delivery
Coordinator
Manual
Pre-flight
In-flight
Flight Watch
Supervisor
Monitor
Instruction Factor
select
--- --- ---
No
I was instructing
I was receiving training
Airspace
select
--- --- ---
Class A (PCA)
Class B (TCA)
Class C (ARSA)
Class D (Control Zone/ATA)
Class E (General Controlled)
Class G (Uncontrolled)
Special Air Space
Unknown
Weather
select
--- --- ---
Clear
Cloudy
Cyclonic
Dusty
Fog
Hail
Hazy
Ice
Indoor
Lightning
Mist
Overcast
Partly Cloudy
Rain
Sleet
Snow
Thunderstorm
Windy
Light
select
--- --- ---
N/A
Dawn
Day
Dusk
Indoor
Night
Altitude
ft.
Miss Distance Horizontal (ft.)
ft.
Miss Distance Vertical (ft.)
ft.
Evasive Action Taken
TCAS Factor
Conflict Alert Active
Maintenance Report Form
Reporter
select
--- --- ---
A&P
A
P
Repairman
Inspection Authority
FCC
Experience
years
Instruction Factor
select
--- --- ---
No
I was instructing
I was receiving training
Other Factors
select
--- --- ---
Lighting
Weather
Work Cards
Manuals
Briefing
N/A
Items Involved
select
--- --- ---
Inspection
Testing
Repair
Logbook Entry
Fault Isolation
Installation
Scheduled Maintenance
MEL
When Problem Detected
select
--- --- ---
Routine Inspection
In-flight
Taxi
While aircraft was in service at gate
Pre-flight
Deferred Maintenance
Outcome
select
--- --- ---
Flight delay
Flight cancellation
Gate return
In-flight shut down
Aircraft damage
Rework
Improper service
Air turn back
N/A
Airworthiness
select
--- --- ---
Aircraft released to service
Aircraft records completed
Aircraft required documents aboard
Not released for service
Unknown
Mission
select
--- --- ---
Passenger
Cargo
Business
Training
ATA Code
select
--- --- ---
6 - Dimensions and Areas
7 - Lifting and Shoring
8 - Leveling and Weighing
9 - Towing and Taxiing
10 - Parking and Mooring
11 - Placards
12 - Servicing
18 - Vibration Analysis
20 - Standard Practices
21 - Air Conditioning
22 - Auto Flight
23 - Communications
24 - Electrical Power
25 - Equipment/Furnishings
26 - Fire Protection
27 - Flight Controls
28 - Fuel
29 - Hydraulic Power
30 - Ice & Rain Protection
31 - Instruments
32 - Landing Gear
33 - Lights
34 - Navigation/Pitot Static
35 - Oxygen
36 - Pneumatics
37 - Vacuum
38 - Water/Waste
43 - Command Control & Communications
44 - Nuclear Hardness Components & Devices
49 - APU
51 - Structures
52 - Doors
53 - Fuselage
54 - Nacelles/Pylons
55 - Stabilizers
56 - Windows
57 - Wings
60 - Propellers Standard Practices
61 - Propellers
62 - Main Rotor
63 - Main Rotor Drive
64 - Tail Rotor
65 - Tail Rotor Drive
65 - Rotor (C Model only)
66 - Powertrain
70 - Power Plant Standard Practices
71 - Power Plant General
72 - Engine Reciprocating
72 - Engine Reciprocating
73 - Engine Fuel & Control
74 - Engine Ignition
75 - Engine Air
76 - Engine Controls
77 - Engine Indicating
78 - Engine Exhaust
79 - Engine Oil
80 - Engine Starting
81 - Turbines
82 - Engine Water Injection
83 - Accessory Gearboxes
91 - Charts
Cabin Safety Form
Reporter
select
--- --- ---
Flight Attendant (FA)
FA in charge
Extra FA
Trainee
Off-duty FA
Experience
years
Weather
select
--- --- ---
Clear
Cloudy
Cyclonic
Dusty
Fog
Hail
Hazy
Ice
Indoor
Lightning
Mist
Overcast
Partly Cloudy
Rain
Sleet
Snow
Thunderstorm
Windy
Light
select
--- --- ---
N/A
Dawn
Day
Dusk
Indoor
Night
Flight Phase
select
--- --- ---
Predeparture
Taxi
Takeoff
Climb
Cruise
Descent
Approach
Landing
Gate Arrival
Tail #
Flight #
Flight Date
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Cabin Activity
select
--- --- ---
Boarding
Deplaning
Safety related duties
Beverage service
Meal service
Cart service
Tray service
Movie
Passenger Involved
Injury
Fire/Smoke
Evacuation
Bird Strike Reporting Form
Operator
Aircraft Make/Model
Engine Make/Model
Aircraft Registration
Time of Day
select
--- --- ---
Dawn
Day
Dusk
Night
Airport Name
Runway Used
Location
Height AGL (ft)
Speed (IAS) (kt)
Flight Phase
select
--- --- ---
Parked
Taxi
Take-off Run
Climb
Enroute
Descent
Approach
Landing Roll
Birdstrike Status
Confirmed
Unconfirmed
Near Miss
Radome
Struck
Damaged
No
Windshield
Struck
Damaged
No
Nose (excluding above)
Struck
Damaged
No
Engine #1
Struck
Damaged
No
Engine #2
Struck
Damaged
No
Engine #3
Struck
Damaged
No
Engine #4
Struck
Damaged
No
Propeller
Struck
Damaged
No
Wing/Rotor
Struck
Damaged
No
Fuselage
Struck
Damaged
No
Landing Gear
Struck
Damaged
No
Tail
Struck
Damaged
No
Lights
Struck
Damaged
No
Other (specify)
Struck
Damaged
No
Effect on Flight
select
--- --- ---
None
Aborted Take-off
Precautionary Landing
Engines Shut Down
Other (specify)
Sky Condition
select
--- --- ---
Clear
Partly Cloudy
Overcast
Precipitation
select
--- --- ---
Fog
Rain
Snow
Bird Species
Number of birds seen
select
--- --- ---
--- ---- ----
1
2-10
11-100
more
Number of Birds Struck
select
--- --- ---
--- ---- ----
1
2-10
11-100
more
Size of Birds
select
--- --- ---
Small
Medium
Large
Pilot Warned of Birds
Yes
No
Person Preparing Report
Reporter Title
Department
Captain's Trip Report
Flight Date
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Aircraft
Flight #
Crew
Flight Type
Freighter
Passenger
Charter
Ferry
Irregularities
Yes
No
Description
Captain's Name
Chief Pilot's Name
Interference With a Crewmember
Flight #
Aircraft Type
Aircraft Registration
Date of Occurrence
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Time of Occurrence
Location
Phase of Flight
Standing
Pushback/Towing
Taxi
Takeoff
Initial Climb
En Route
Maneuvering
Approach
Landing
Emergency Descent
Uncontrolled Descent
Post-Impact
Unknown
Crewmember Names
Captain
Flight Attendant 1
First Officer
Flight Attendant 2
Level Category
select
Level 1
Level 2
Level 3
Level 4
Description of the Interference Event
Suspected Factors That May Have Caused the Interference Event
Nature of Obvious Injuries to Passenger(s) Onboard
Nature of Obvious Injuries to Crewmember(s) Onboard
Actions Taken by Captain and Crewmembers
Name of Law Enforcement Agency Contacted
Passenger identity (if known)
Crew Suggestions or Opinions
Additional Information
Bird / Other Wildlife Strike Report
1. Name of Operator:
2. Aircraft Make/Model
3. Engine Make/Model
4. Aircraft Registration
5. Local Date/Time of Incident
Date/Time Occurred
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6. Time of Incident
select
--- ---- ----
Dawn (A)
Day (B)
Dusk (C)
Night (D)
7. Airport Name
8. Runway Used
9. Location if Enroute
(Nearest Town/Reference & State)
10. Height AGL (ft)
11. Speed (IAS) (kt)
12. Phase of Flight
select
--- ---- ----
A. Parked
B. Taxi
C. Take-off Run
D. Climb
E. Enroute
F. Descent
G. Approach
H. Landing Roll
13. Part(s) of Aircraft Struck or Damaged
Struck
Damaged
A. Radome
B. Windshield
C. Nose (excluding above)
D. Engine No. 1
E. Engine No. 2
F. Engine No. 3
G. Engine No. 4
Struck
Damaged
H. Propeller
I. Wing/Rotor
J. Fuselage
K. Landing Gear
L. Tail
M. Lights
N. Other (specify)
What other part?
14. Effect on Flight
select
--- ---- ----
None
Aborted Take-off
Precautionary Landing
Engines Shut Down
Other (Specify)
15. Sky Condition
select
--- ---- ----
No Cloud (A)
Some Cloud (B)
Overcast (C)
16. Precipitation
select
--- ---- ----
Fog
Rain
Snow
None
17. Bird Species
18. # birds seen and/or struck
Seen
select
--- ---- ----
1
2-10
11-100
more than 100
Struck
select
--- ---- ----
1
2-10
11-100
more than 100
19. Size of bird
select
--- ---- ----
Small (S)
Medium (M)
Large (L)
20. Pilot warned of birds
Yes
No
21. Remarks
(Describe damage, injuries, and other pertinent information)
DAMAGE / COST INFORMATION
22. Aircraft time out of service:
Hours
23. Estimated cost of repairs (U.S. $):
$
24. Estimated other Cost
(U.S. $)(e.g. loss of revenue, fuel, hotels):
$
Reported by (Optional)
Title
Date
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SAFETY MANAGEMENT SYSTEM (SMS)
INCIDENT/ACCIDENT/HAZARD/NEAR-MISS REPORT
This SMS Report is for reporting airside incidents / accidents / hazards or near-misses that may result, or have resulted in damage to Authority equipment / property or personal injury or third party vehicle / property damage.
Date of Report:
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Person Reporting:
Check Type of Reports:
Injury/Illness
Property Damage
Equipment
Hazard
Violence
Fuel Spill
Near-Miss
Vehicle
Aircraft
Other
Occurrence date:
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(if different from report date):
Time:
Hours
01
02
03
04
05
06
07
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09
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12
Minutes
00
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02
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59
AM
PM
General Area:
Specific Location:
Employee Report
Name:
Occupation:
Description of Incident / Accident / Hazard / Near-miss / Workplace Violence:
PPE Available?
Used?
Description of direct (root) cause(s):
Description of indirect (root) cause(s):
Description of injury / illness:
Object / Equipment / Substance causing Incident / Accident / Injury / Illness:
Employee WCB Report completed?
Yes
No
Date reviewed:
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Employee WCB Report forwarded to supervisor?
Yes
No
Note: Employee WCB report must be submitted within 72 hours
Airport Initial Safety Report
Report company
Airport
Name
Date:
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Incident / Accident title
Occurrence airport
Airport
Occurrence time
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Incident / Accident type:
Aircraft FODs damage
Aircraft towing
Bird Strike
Cargo, luggage transport
Continuous service during construction
Crew maintenance service
Equipment, facilities failure
Fire
Hazardous goods transport
Human injured
Navigation, Communication, airport management assurance
Operation area incursion
Passenger assurance
Runway incursion
Vehicle and equipment collision with aircraft
Vehicle, equipment collision with vehicle
Others
Cause:
Crew
Crew maintenance
Ground service
Incident
Others
# of Persons Injured
Death
Serious injured
Slightly injured
Brief Description:
Determine responsibility:
Airport's responsibility
Not airport's responsibility
To be confirmed
Incident level:
Accident
Potential accident
Other insecure incident
To be confirmed
Hazard/Occurrence Form
Date/Time Unknown
* Required
Date/Time Occurred
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UTC
Local
Leave date blank if unknown
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Flight Details
Flight no
Met Conditions
select
N/A
VMC
IMC
A/C Registration
required when Flight No is entered
select
N/A
11384
Turbulence
select
None
Light
Moderate
Severe
Departure Airport
Flight Phase
select
N/A
Parked
Pushback
Taxi
Take Off
Climb
Cruise
Descent
Approach
Landing
Missed Approach
Destination Airport
Type of approach
select
N/A
Visual
ILS (CATI)
ILS (CATII)
ILS (CATIII)
Non-Precision Approach (NPA)
Circling
GBAS Landing System (GLS)
Diverted Airport
Runway
Pilot Flying
select
N/A
LP
RP
Speed
kts
Location
A/C Mass
kg
FL
Alt
ft
A/C Technical Log no
Configuration
Auto Pilot
select
N/A
On
Off
Gear
select
N/A
Up
Down
Flaps/Slats
select
N/A
Up
1
5
7
8
15
20
25
29
30
45
Spoiler
select
N/A
Deployed
Aerodrome Information
Wind
e.g. 09015, VRB05, 25015G30
Temp
e.g. 25-02
Visibility
e.g. 3500, CAVOK
Dew Point
e.g. 25-02
Weather
select
N/A
Fog
Haze
Drizzle
Rain
Rain Shower
Freezing Drizzle/Rain
Rain and Snow
Small hail/Snow Pellets
Hail
Snow
Snow Shower
Snow Grains
Thunderstorm
QNH
3 or 4 digits
Cloud 1
select
N/A
Few
Scattered
Broken
Overcast
Sky Obscured
Cloud 2
select
N/A
Few
Scattered
Broken
Overcast
Sky Obscured
Cloud height ft.
Cloud 3
select
N/A
Few
Scattered
Broken
Overcast
Sky Obscured
Additional information (RWY cond, BA, ILS U/S, DME U/S, etc)
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
Security Officer Report
Reporter Name
Internal ID#
Incident Report ID
Incident Summary
Remaining Characters
:
1000
Who, What, When, etc.
Remaining Characters
:
2000
Incident Location
Incident Type
If Other, What Type
Officer Details / Comments
Remaining Characters
:
3000
This report type is not setup, use OLD ISSUE REPORTER
This report type is not setup, use OLD ISSUE REPORTER
Personnel Fatigue Report
* Required
Name:
Telephone:
Reason for Report:
Related Company Report ref:
Called in fatigued for an assigned duty
Fatigue associated with a safety-related event
General Fatigue concern
Event Date:
Event Time:
Base:
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
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Flight No:
Destination:
Check-In Time:
Check-Out Time:
Employee Type
Pilot
Cabin Crew
Maintenance
Dispatch/Ops personnel
Other
Contributory factors
Contributory factors:
Timing of most recent sleep period:
Timing of second most recent sleep period:
Start (reference time)
End (reference time)
Start (reference time)
End (reference time)
Contributory factors:
Last Duty Period
Duty Period - Start:
Flight Duty Period - Start:
Flight Duty Period - End
Duty Period - End
Previous Duty Period
Duty Period - Start:
Flight Duty Period - Start:
Flight Duty Period - End
Duty Period - End
Contributory factors:
Multiple consecutive duties
Start Time
Hotel rest (noisy / temp / other)
Insufficient rest time
Finish time
Change of Standby / Reserve period
Re-assignment / Irregular Ops
Workload - Overload
Long duty day
Duty in WOCL (Window of Circadian Low 0200 - 0600)
Multiple flying legs
Home issues
Health
Night Duty
Long-term fatigue
Other (detail below)
AM / PM / Redeye mixing
Other:
Physical Symptoms:
NO PHYSICAL SYMPTOMS NOTED