Cabin Safety Report

Your Information:

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

Flight No		Date		Time
Route	-		Divert?	Location	Select Location Cockpit Cabin Galley Upper Deck Toilet Other, Specify: If other, Please Specify:
Gate		A/C Type	select type A-300 B-747-168 B-747-368 B-747-468 B-737 B-777 MD-90 Other	A/C Reg.

Flight Phase

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

Weather Conditions

Please select Weather Condition : Turbulance Select Condition Haze Clear Rain Other

Lighting Conditions

Please select Lighting Condition : Select Condition High Medium Low Other

Events

	Bomb Threat		Evacuation		Slide Deployment
	Hijacking		Dangerous Goods Exposure		Smoke Detector Activated or Vandalized
	Violation in Security Procedures		Intoxicated Passenger		Smoking Regulation Violation
	Communication System Failure		Jumpseat Defect		Cabin Smoke
	Death On Board		Galley/Lavatory Water Overflow		Demonstration Procedure Violation
	Decompression		Potential hazard to the crew or pax		Other
	Disruptive Pax (*)		Problem enforcing the regulation
	Emergency Equipment Failure		Sterile Cockpit Violation
	Emergency Landing		Weapons regulation violation	(*) Provide Concerned Report

Cabin Smoke Description

Smoke Type

Electrical

Smoke Color

Select Color White Black Orange Yellow Colorless

Smoke Material

Select Material Galley Contents Passengers Belongings Cagro Food Waste

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

Suggestions/Comments

Questions?

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