Ground Incident / Accident / Damage / Safety Report

• Type of Report

  Select Safety report Damage report Accident report Incident report

  • Safety report
  • Damage report
  • Accident report
  • Incident report

• Subject

• Conducted on

  Date

• Lead investigator

• Prepared by

• Address
  Address

• Document No.

General information

• Airline :

• Aircraft Type And Registration :

• Configuration :

• Local Date And Time of Event :

  Date

• STA:

• STD :

• Location / Parking Bay :

• Type of Flight

  Select Charter flight Schedule flight Ambulance Military Cargo flight Ferry flight Night stop

  • Charter flight
  • Schedule flight
  • Ambulance
  • Military
  • Cargo flight
  • Ferry flight
  • Night stop

• Route :

• Passengers Onboard :

• Crew Onboard :

• The sole objective of this investigation is to prevent aircraft accidents , incidents and injuries to people . it isnot the purpose of this activity to apportion blame or liability

3.1 What Happened ?

• Detailed description of situation

3.2 Staff Involved :

• Name/s and Personal Number/s

3.3 Injuries to Person :

• Injuries to.Person ? If yes . describe the injuries and write details of injured person

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Name and Peraonal Number of Injured Person

• Describe the.Injuries

• Photos of Injuries ?

  Media

• Action Taken

3.4 Damage to Aircraft :

• Damage to Aircraft ? If yes , describe the damage

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Describe the damage

• Photos of Damage

  Media

• Action Taken

3.5 Ground Support Equipment Involved :

• Tyoe of Equipment

• Equipment Number

• Age of Equipment

• Manufacturing Company

• Last Overhaul

  Date

3.6 Damage to Equipment :

• Any Damage ? If yes , describe the damage

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Describe equipmwnt damage

• Photos of Damage

  Media

• Action Taken

3.7 Additional Information :

• Write below any other related information

• Attach Any other related photos

  Media

4.1 Analysis :

• Write the full anylsis to the mentioned case

• Media

  Media

4.2 Root Causes :

• Define the root casuses based on the anylsis of the mentioned case

Finding :

• List all Finding here :

Corrective Action / s :

• List all corrective action/s taken

Preventive Action :

• List all preventive action/s taken

Observations and Recommendations :