Air Safety Report

Your Information:

Name				Position		PRN
If you need feedback, Please provide :
Mail Box		Fax		E-mail

Date		Time	UTC	Flight No
Route	-		Divert?	Location
Gate		A/C Reg.		A/C Type	select type A-300 B-747-168 B-747-368 B-747-468 B-737 B-777 MD-90 Other

Flight Phase

Please Select FLIGHT phase : Select Phase Parked Push-back Taxi-out Take Off Climb Cruise Decent Holding Approach Landing Taxi-in Paked in Other

Events

	Aircraft Damage		Exceedence (sys \ limit)		SOPs		TCAS/ Near Air Miss ®
	ATC Communication		Excursion TWY/RWY		Overweight Landing		Use of Reserve Fuel
	Bird / Lightning Strike		Incursion TWY/RWY		PAX Illness /DR. Kit		Weight and Balance
	Communication Deficiency		Fire or Smoke Warning		RFI Report		Wind Shear
	Dangerous Goods		FOD damage/ concern		Ramp safety		(P)  Wind shear
	Diversion		GPWS/ EGPWS (TERR)		Return From Flight		Braking malfunction
	Disruptive Passenger (PAX)*		Ground Support Deficiency		Safety Equipmen		Other Safety Concerns
	Emergency		Taxi Concern		Security Breach	(*)	in addition PIC/FAIC has to fill the required form
	Engine Shutdown/Failure		Handling Difficulties		Severe Turbulence	®	See Item 22
			Navigational concern		Tail Strike

Factual description of event with any relative factors (weather, airport facility, cabin equipment, etc.)

Suggestions/Comments

Questions?

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