SCENIC AIR INCIDENT - ACCIDENT - HAZARD - OCCURRENCE - REPORT FORM

• Type of report

  Incident

  Accident

  Hazard

  Occurrence

  Maintenance

• Has a Technical log entry been made

  Yes

  No

• Has the SNAG been discussed with Person Responsible for Maintenance - PRAM

  Yes

  No

• Technical Log number

• Has a MANDATORY report been filed with NCAA? If 'YES' please attach file or screen shot of report

  Yes

  No

• Prepared by

• Reporter / Pilot

• Date of event

  Date

• Time of event

  Date

• Location

• Site conducted

  Select

undefined

• Aircraft Registration

  Select V5-EGL V5-MFZ V5-TEN V5-KON V5-SAA V5-WAF V5-MUA V5-KPR V5-KKR V5-KDK V5-WAL

  • V5-EGL
  • V5-MFZ
  • V5-TEN
  • V5-KON
  • V5-SAA
  • V5-WAF
  • V5-MUA
  • V5-KPR
  • V5-KKR
  • V5-KDK
  • V5-WAL

• Aircraft Type

  C210

  C208

  Kodiak

  Other

• If not aircraft, please elaborate

• Wind Conditions

  Calm

  Moderate

  Strong

  Cross Wind

• Temperature

• Flight Report number

• 5 “M” Model - Which Category your Event Falls Into, more than one may be selected

  Man

  Machine

  Mission

  Medium

  Management

Phase of flight (if applicable)

• Select most relevant

  Select A/C Standing Taxi Take-off Climb Cruise Descent Approach Landing Manoeuvring Other or N/A

  • A/C Standing
  • Taxi
  • Take-off
  • Climb
  • Cruise
  • Descent
  • Approach
  • Landing
  • Manoeuvring
  • Other or N/A

• Describe the Event and make available as much details as possible

• What can be done to stop/Prevent this event Occurring again

Actioned by

• please ✔️ who needs to be notified

  Select Accountable Manager Safety Manager Flight Operations Manager PRAM Branch Manager - Windhoek AMO/AME NCAA Incidents DAAII

  • Accountable Manager
  • Safety Manager
  • Flight Operations Manager
  • PRAM
  • Branch Manager - Windhoek
  • AMO/AME
  • NCAA Incidents
  • DAAII