Name:

Telephone:

Time of day to call:

Date of Occurrence:

Location of Occurrence:

Aircraft Type:

Aircraft Registration:

Flight No:

Aircraft Operator:

Occupation:

Total Pilot Hours:

Non-Pilot Aviation Experience:

Phase of Flight: Aircraft StandingTaxiingTake-offEn routeManoeuvringApproachLandingOthers

Altitude:

Weather Conditions:

Visibility:

Wind:

Cloud:

Please fully describe the occurrence (including your suggestions to prevent similar occurrences):