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Get UK CAA SRG/1601 2009

AIC AD SB etc. directly relevant to occurrence and where appropriate compliance state of aircraft equipment or documentation. Form SRG/1601 CA 1673 October 2009 Page 1 of 2 GROUND STAFF REPORT A/C CONSTRUCTOR S NO. CAA Occurrence Number OCCURRENCE REPORT Safety Data Civil Aviation Authority Safety Regulation Group Aviation House Gatwick Airport South West Sussex RH6 0YR e-mail sdd caa*co. uk Fax 01293 573972 Tel 01293 573220 Please complete this form online print sign and send it to the above address. AIRCRAFT TYPE SERIES REGISTRATION If report is CONFIDENTIAL mark clearly at the top and provide contact address/Tel no. Your wish will be respected* Reporter s Ref DATE dd/mm/yyyy TIME OF EVENT DAY UTC OPERATOR NIGHT LOCATION/POSITION/RW TWILIGHT FLIGHT NO. ROUTE FROM ROUTE TO FL ALT/HT FT IAS KT TCAS RA IFR YES VFR NATURE OF FLIGHT ETOPS NO FLIGHT PHASE Please Select ENVIRONMENTAL DETAILS WIND DIRN* SPEED kt CLOUD TYPE PRECIPITATION HT ft OTHER METEOROLOGICAL CONDITIONS VISIBILITY KM ICING TURBULENCE RUNWAY STATE OAT C CATEGORY M BRIEF TITLE DESCRIPTION OF OCCURRENCE Any procedures manuals pubs. ENGINE TYPE/SERIES ETOPS APPROVED GROUND PHASE MAINTENANCE ORGANISATION GROUND HANDLING TEL* UNATTENDED COMPONENT/PART MANUFACTURER PART NO. REFERENCES - MANUAL/ATA/IPC SERIAL NO. COMPONENT OH/REPAIR ORGANISATION ORGANISATION AND APPROVAL REFERENCE NAME POSITION SIGNATURE If report is voluntary i*e* not subject to mandatory requirements can the information be published in the interests of safety Address and tel*no. if reporter wishes to be contacted privately. NOTE 1 If additional information as below is available please provide. NOTE 2 If the occurrence is related to a design or manufacturing deficiency the manufacturer should also be advised promptly. NOTE 3 Where applicable a report of this incident should be forwarded directly to other agencies involved e*g* Aerodrome Authority ATC agency. REPORTING ORGANISATION - REPORT ORGANISATION COMMENTS - ASSESSMENT/ACTION TAKEN/SUGGESTIONS TO PREVENT UTILISATION - AIRCRAFT TOTAL SINCE OH/REPAIR UTILISATION - ENGINE/COMPONENT SINCE INSPECTION HOURS CYCLES ADVISED LANDINGS REPORTER S REF REPORT NEW E-MAIL NIL CLOSED OPEN FDR DATA RETAINED FAX SUPPL REPORTER S INVESTIGATION. CAA Occurrence Number OCCURRENCE REPORT Safety Data Civil Aviation Authority Safety Regulation Group Aviation House Gatwick Airport South West Sussex RH6 0YR e-mail sdd caa*co. uk Fax 01293 573972 Tel 01293 573220 Please complete this form online print sign and send it to the above address. uk Fax 01293 573972 Tel 01293 573220 Please complete this form online print sign and send it to the above address. AIRCRAFT TYPE SERIES REGISTRATION If report is CONFIDENTIAL mark clearly at the top and provide contact address/Tel no. AIRCRAFT TYPE SERIES REGISTRATION If report is CONFIDENTIAL mark clearly at the top and provide contact address/Tel no. Your wish will be respected* Reporter s Ref DATE dd/mm/yyyy TIME OF EVENT DAY UTC OPERATOR NIGHT LOCATION/POSITION/RW TWILIGHT FLIGHT NO. .

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