Report Identification Report identification Reporting entity Country Type of organisation Other (specify) Name of organisation If you identify your organisation and your report using the two following fields you can submit a follow-up report at a later stage using the same references. When and where Latitude of occ North South Longitude of occ East West UTC Date - Time - - Local Date - Time (YYYY/MM/DD) (HH:MM) World region State/area Location of occurrence (DD.mmmm) Aerodrome Location on aerodrome Aerodrome status Aerodrome type Elevation above MSL ft Aerodrome longitude East West Runway Runway identifier Surface type Helicopter landing area Landing area type Surface type Area configuration Aerodrome latitude North South Location indicator (of aerodrome) Country ICAO code Other (specify) (DD.mmmm) What Headline Narrative language Narrative Mandatory Occurrence Reporting Aerodromes and Ground Handling Please complete the report on-screen and click the Email to CAA button on the last page to submit. OCCURRENCE GENERAL INFORMATION Form SRG1600 Issue 01, March 2019 Page 1 of 6
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Report Identification
Report identification
Reporting entity
Country Type of organisation Other (specify) Name of organisation
If you identify your organisation and your report using the two following fields you can submit a follow-up report at a later stage using the same references.
When and where
Latitude of occ North South
Longitude of occ East West
UTC Date - Time -
-Local Date - Time
(YYYY/MM/DD) (HH:MM)
World region
State/area Location of occurrence
(DD.mmmm)
Aerodrome
Location on aerodrome
Aerodrome status
Aerodrome type
Elevation above MSL ft
Aerodrome longitude East West
Runway Runway identifier Surface type
Helicopter landingarea
Landing area type Surface type
Area configuration
Aerodrome latitude North South
Location indicator
(of aerodrome) Country ICAO code Other (specify)
(DD.mmmm)
What
Headline
Narrative language
Narrative
Mandatory Occurrence ReportingAerodromes and Ground Handling
Please complete the report on-screen and click the Email to CAA button on the last page to submit.
OCCURRENCE GENERAL INFORMATION
Form SRG1600 Issue 01, March 2019 Page 1 of 6
AIRCRAFT INVOLVED
Aircraft identification
Aircraft registration
State of registry
Year built
Serial number
Manufacturer
Model
Series
Other (specify)
Aircraft description
Mass group
Wake turb. category
Propulsion type
Number of engines
Maximum t/o mass kg
Rotorcraft mass group
Aircraft category
Landing gear type
Flight details
Call sign
Flight number
Persons on board
Other (specifiy)
Occ. on groundFlight phase
Country ICAO code
Country Operator name Other (specify)
Operator
Operation type
Planned destination
Last departure point
Aircraft information 2
Aircraft registration
State of registry
Serial number
Year built
Manufacturer
Model
Series
Other (specify)
Aircraft category
Form SRG1600 Issue 01, March 2019 Page 2 of 6
Mandatory Occurrence ReportingAerodromes and Ground Handling
Please complete the report on-screen and click the Email to CAA button on the last page to submit.
ENVIRONMENT AND EXTERNAL CONDITIONS
Air navigation service
ATM contribution Effect on ATM serviceATS Unit name
Sector name
RTF frequency kHz
Services provided
Airspace
FIR/UIR name
Airspace typeAirspace name Airspace class
Special activities
Conditions and visibility
Weather relevant
Weather conditions
Light conditions
Cloud amount
Height of cloud base ft
Air temperature C
Dew point C
Visibility m
Visibility restrictions
Winds
Wind speed kt
Speed measured at
Wind gusts
Maximum gust kt
Wind direction Degree(s)
Rel wind direction
Turbulence intensity
Precipitation / phenomena
Phenomenon type
Phenomenon intensity
Weather report
Weather report
Form SRG1600 Issue 01, March 2019 Page 3 of 6
Mandatory Occurrence ReportingAerodromes and Ground Handling
Please complete the report on-screen and click the Email to CAA button on the last page to submit.
4
ADDITIONAL INFORMATION FOR SPECIFIC TYPES OF OCCURRENCE
Runway incursion
Entity involved Type of vehicle Vehicle controlled
Other (specify)
Bird/wildlife strike information
Parts struck Parts damaged
Bird size
Pilot advised of birds
Birds/wildlife seen Birds/wildlife struck
Species description
Other (specify)
Dangerous goods
Dang goods involved Dangerous good
Other (specify)
(Class number)
(UN number)
Subsidiary risk
Type of inner packaging
Origin of goods
Shipper name
Air Waybill/
Packaging
Total number of
Number of inner
Quantity per inner pack.
Type of outer
Packing group/ Class 7
Form SRG1600 Issue 01, March 2019 Page 4 of 6
Mandatory Occurrence ReportingAerodromes and Ground Handling
Please complete the report on-screen and click the Email to CAA button on the last page to submit.
CLASSIFICATION AND RISK
Damage
Damage not to a/c
Third party damageObject damaged
(to aircraft)
Highest damage
Injuries
Injury level
On aircraft 1
Fatal Serious Minor
On ground
Reason for incapacity
Person 1
Reason for incapacity
Person 2
Reason for incapacity
Person 3
Incapacitation
On aircraft 2
Classification
Occurrence class
Detection phase
Occurrence category
Event 1
Phase 1
Event 2
Phase 2
Event 3
Phase 3
Event types and phases of flight
(Use Ctrl to select more thanone type of occurrence)
(severity)
Risk
Risk classification
Risk methodology
Risk assessment
Form SRG1600 Issue 01, March 2019 Page 5 of 6
Mandatory Occurrence ReportingAerodromes and Ground Handling
Please complete the report on-screen and click the Email to CAA button on the last page to submit.
ANALYSIS AND FOLLOW-UP
Assessment
Corrective actions
Conclusions
Analysis / follow up
Report Management
Report status Report version
Parties informed
Tracking sheet number
Other reportinformation
Form SRG1600 Issue 01, March 2019 Page 6 of 6
Mandatory Occurrence ReportingAerodromes and Ground Handling
Please complete the report on-screen and click the Email to CAA button on the last page to submit.
Please remember to save the completed form for your records before clicking the Email to CAA button.
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