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Initial Incident Report №
1.Aircraft Data
Model / Serial:
Flight No:
Operator/Owner:
Reg. No:
2.Flight Data
Date :
Flight No:
Occur/time:
Depart/Destination point:
Occur/station:
Captain:
3.Injured Persons on board
Yes
No
4.Nature of Condition (Check one more)
Engine
Any failure of one or more engine
Failure in a propeller control system
Fuel flow drop/fuel leak
Fire outbreak Flight/Ground
Engine stoppage
Leak inflammable liquid
Oil leak
Warning indication
Engine power loss
Breakdown systems, that didn't stop the flight
Difficulty in operating L/G
Electrical power loss
Tyre outburst
Bird Strike
Loss of breaking strength
Fluid Loss
Overtemperature
Multifailures
Bird Strike Warning indication
Loss of system of indication vital for airworthiness and safety
Flight control system
Pressurisation and air condition system
Pitch and heading indicator system
Speed & Altitude system, indicators
Escape slide faulty operation
De-icing system
Flame/Smoke
5.Stage (check one)
Maintenance
Landing
Take-Off
Cruise
Approach
Towing/Taxi
Climb
Others
Descend
EngStart
6.Please fully describe the incident and the extent of damage to the aircraft asis known.
Reported by :
Organization name :
Date :
Phone number:
E-mail:
Address:
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