事件/事故/不安全状况/质量报告表Incident/Accident/Unsafe Situation/Quality Report Form

• 姓名 Name:

• 部门/单位 Department/Unit

• 日期 Date

  Date

SECTION I

• 事件类别 Event Category

  事故 AccidentGood

  事件 Incident

  未遂事件 Near Miss

  不安全状况 Unsafe Condition

  质量 Quality

• 事故种类 Accident Type

  Select 航空器与航空器 Aircraft with Aircraft 航空器与车辆 Aircraft with Vehicle 航空器与设施设备 Aircraft with Facility 航空器与人员 Aircraft with Personnel 车辆与车辆 Vehicle with Vehicle 车辆与设施设备 Vehicle with Facility 车辆与人员 Vehicle with Personnel 其他 Other

  • 航空器与航空器 Aircraft with Aircraft
  • 航空器与车辆 Aircraft with Vehicle
  • 航空器与设施设备 Aircraft with Facility
  • 航空器与人员 Aircraft with Personnel
  • 车辆与车辆 Vehicle with Vehicle
  • 车辆与设施设备 Vehicle with Facility
  • 车辆与人员 Vehicle with Personnel
  • 其他 Other

• 地点 (事件发生地点，如 xxx机位,xxx附近等） Location (The place where the event occurred, such as Parking Stand xxx, near xxx, etc.)

• 是否损坏航空器？<br>Is there damage to the aircraft?

  是 Yes

  否 No

• 是否影响运行？<br>Does it affect operation?

  是 Yes

  否 No

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 事件类型 Event Type

  Select 鸟类/野生动物状况 Bird/Wildlife Sighting Report 航空器设施、机械故障或损坏 Aircraft equipment, mechanical failure or damage 航空器油料泄露 Aircraft Oil Spillage 机场设施、设备、道面等损坏 Damage to airport facilities, equipment, pavement, etc. FOD 风险 FOD Risk 安保事件，人身安全，消防事件 ​​ Security incidents, personal safety, Fire Incidents 违规事件 Violations 管理/服务相关投诉 Management/Service Related Complaints 其他 Other

  • 鸟类/野生动物状况 Bird/Wildlife Sighting Report
  • 航空器设施、机械故障或损坏 Aircraft equipment, mechanical failure or damage
  • 航空器油料泄露 Aircraft Oil Spillage
  • 机场设施、设备、道面等损坏 Damage to airport facilities, equipment, pavement, etc.
  • FOD 风险 FOD Risk
  • 安保事件，人身安全，消防事件 ​​ Security incidents, personal safety, Fire Incidents
  • 违规事件 Violations
  • 管理/服务相关投诉 Management/Service Related Complaints
  • 其他 Other

• 航班号/机型 Flight Number / Aircraft Type

• 航空器注册号 Aircraft Registration

• 地点 (事件发生地点，如 xxx机位,xxx附近等） Location (The place where the event occurred, such as Parking Stand xxx, near xxx, etc.)

• 飞行阶段 Phase of Flight

  Select 入位后 Parked 滑行 Taxi 航途中 En route 下降 Descent 进近 Approach 着陆滑行 Land Roll 其他 Other

  • 入位后 Parked
  • 滑行 Taxi
  • 航途中 En route
  • 下降 Descent
  • 进近 Approach
  • 着陆滑行 Land Roll
  • 其他 Other

• 鸟类/野生动物范围 Size of Wildlife/Bird

  小 Small

  中 Medium

  大 Large

  未知 Unknown

• 位置 Place

  Select 雷达罩 Radome 挡风玻璃 Windshield 1号发动机 Engine No. 1 2 号发动机 Engine No. 2 3号发动机 Engine No. 3 4号发动机 Engine No. 4 螺旋桨 Propeller 机翼 Wing/Rotor 机身 Fuselage 起落架 Landing Gear 机尾 Tail 灯 Lights 其他 Other

  • 雷达罩 Radome
  • 挡风玻璃 Windshield
  • 1号发动机 Engine No. 1
  • 2 号发动机 Engine No. 2
  • 3号发动机 Engine No. 3
  • 4号发动机 Engine No. 4
  • 螺旋桨 Propeller
  • 机翼 Wing/Rotor
  • 机身 Fuselage
  • 起落架 Landing Gear
  • 机尾 Tail
  • 灯 Lights
  • 其他 Other

• 信息来源 Information Report By

  Select 飞行员 Pilot warned of Bird/Wildlife 塔台 ATC-TWR Informed 机务人员 Engineering Informed GHD LAMECO Green Town 其他 Other

  • 飞行员 Pilot warned of Bird/Wildlife
  • 塔台 ATC-TWR Informed
  • 机务人员 Engineering Informed
  • GHD
  • LAMECO
  • Green Town
  • 其他 Other

• 是否损坏航空器？<br>Is there damage to the aircraft?

  是 Yes

  否 No

• 是否影响运行？<br>Does it affect operation?

  是 Yes

  否 No

• 是否发现FOD?<br>Was FOD found?

  是 Yes

  否 No

• 其他特殊情况描述（如有） Description of other special circumstances (if any)

• 相关照片/依据 Related photos/evidence

  Media

• 航班号/机型 Flight Number / Aircraft Type

• 航空器注册号 Aircraft Registration

• 位置 (该损坏或故障所在位置如 xx办公室，xx机位附近等） Location (the location of the damage or failure, such as xx office, near Parking Stand xxx, etc.)

• 航空器不正常状况位置（如舱门、xx面板等） Location of aircraft abnormal condition (such as cabin door, xx panel, etc.)

• 是否损坏航空器？<br>Is there damage to the aircraft?

  是 Yes

  否 No

• 是否影响运行？<br>Does it affect operation?

  是 Yes

  否 No

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 航班号/机型 Flight Number / Aircraft Type

• 航空器注册号 Aircraft Registration

• 油料类别 Type of Oil

  一号喷气燃油 JetA1 (fuel)

  液压 Hydraulic

  机油 Engine oil

  其他 Other

• 泄漏范围 Size Leakage

  Select 小 Small 中（1-3平方米） Medium (1-3 square meters) 大 （3平方米以上） Large (over 3 square meters)

  • 小 Small
  • 中（1-3平方米） Medium (1-3 square meters)
  • 大 （3平方米以上） Large (over 3 square meters)

• 是否影响运行？<br>Does it affect operation?

  是 Yes

  否 No

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 地点 (事件发生地点，如 xxx机位,xxx附近等） Location (The place where the event occurred, such as Parking Stand xxx, near xxx, etc.)

• 是否影响运行？<br>Does it affect operation?

  是 Yes

  否 No

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 地点 (发现FOD风险位置如 xx办公室，xx机位附近等） Location (the location of the damage or failure, such as xx office, near Parking Stand xxx, etc.)

• FOD 等级 FOD Level

  低危 Low Risk

  中危 Medium Risk

  高危 Hight Risk

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 地点 (事发地点如 航站楼xx区域，xx机位附近等） Location (the location of the incident, such as the xx area of ​​the terminal, near the Parking Stand xxx, etc.)

• 是否影响运行？<br>Does it affect operation?

  是 Yes

  否 No

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 违规人员姓名 Violator Name:

• 部门/单位 Department/Unit:

• 职位 Position:

• 证件号 license number：

• 联系方式 Contact information：

• 车辆/设施设备信息（车辆种类，牌号等详细信息） Vehicle/facility equipment information (vehicle type, license plate number, etc.)

• 地点 (事发地点如 航站楼xx区域，xx机位附近等） Location (the location of the incident, such as the xx area of ​​the terminal, near the Parking Stand xxx, etc.)

• 是否损坏航空器？<br>Is there damage to the aircraft?

  是 Yes

  否 No

• 是否影响运行？<br>Does it affect operation?

  是 Yes

  否 No

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 投诉人员/部门/单位/服务名称 Name of complainant/department/unit/service

• 投诉内容（请提供尽可能多的详细信息） Complaints detail (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media

• 情况描述（请提供尽可能多的详细信息） Description of situation (please provide as much detail as possible)

• 相关照片/依据 Related photos/evidence

  Media