Safety Event/Report Form
Reporting form used for reporting all safety events
Date
-
Day
-
Month
Year
Enter the date of reporting
Name
First Name
Last Name
Select the nature of the event
Observation
Incident
Accident
Risk Assessment
Select the nature of the event from the dropdown list
Enter the location of the event
E.g. Lydd airport, briefing room, simulator
Call sign
Enter the radio call sign used (if applicable)
Type of aircraft
E.g. TBM 900
Flight phase
Ground
Start up
Taxi
Take-off
Climb
Cruise
General Handling
Descent
Approach
Landing
N/A
Select the appropriate phase of flight when the event occurred or could occur
Describe what happened (or what could happen)
Please provide as much information regarding the event as possible
Hazard Category
Operational
Management & Manpower
Human Factors
Safety Culture
Environment
Flight Planning
What do you consider could be the worst possible consequence if this event did happen again?
1
2
3
4
5
1 = Negligible, 5 = Catastrophic
In your opinion, what is the likelihood of such an event or similar happening again?
1
2
3
4
5
1 = extremely improbable, 5 = frequent
Declaration (please select)
*
To the best of my knowledge all information supplied is true & correct
Can you suggest mitigation actions to prevent reoccurrence?
Please suggest actions to be taken to prevent reoccurrence, e.g. checklist, safety notice, etc.
Submit
Should be Empty: