European Aviation Safety Agency
Form
Operational Occurrence Report
Refer to Completion instructions for details
1. REFERENCE INFORMATION
1.1 Reporting Organisation*
1.4 Name of submitter
1.2 Country*
1.3 EASA Approval Ref.
1.5 Email address
1.6 Telephone number
1.7 Internal Reference Number* 1.8 Issue Number
1.9 Date of report
1.10 Report type
1.11 Report status
Initial Report Date
1.12 Parties informed
2. OCCURRENCE
2.1 Date of occurrence (UTC)
2.5 Last departure point
2.2. Time (UTC)
2.3 Flight number
2.6 Planned destination
2.4 ETOPS (Yes/No)
2.7 Diverted to
2.8 Aircraft Type (Make/model/master series/series)**
-
-
-
2.9 Aircraft registration
2.10 Aircraft serial number
2.11 Year built
2.12 Aircraft altitude
2.13 Aircraft flight level
2.14 Speed
2.15 Aircraft weight
2.16 Technical Log number
2.17 Flight phase
2.18 Location of occ
2.19 Latitude of occ
2.20 Longitude of occ
** - If there is another aircraft involved, fill out information in the end of the form
FO.IORS.00046-002© European Aviation Safety Agency. All rights reserved.
Proprietary document. Copies are not controlled. Confirm revision status through the EASA-Internet/Intranet.
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European Aviation Safety Agency
2.21 Occurrence related to
Operational Occurrence Report Form
2.22 Injury level
2.23 Aircraft Damage
3.1 Weather conditions
3.2 Wind direction
3.3 Wind speed
3.4 Wind gusts
3.5 Cloud amount
3.6 Height of cloud base
3.7 Air temperature
3.8 Dew point
3.9 QNH
2.24 Occurrence class
3. METEO
4. RUNWAY
4.1 Runway identifier
4.2 Runway condition
5. AIRCRAFT CONFIGURATION
5.1 Autopilot
5.2 Auto throttle
5.3 Gear position
5.5 Spoilers position
5.6 Weather radar
5.4 Flaps position
6. DETAILS
6.1 Headline
6.2 Narrative
FO.IORS.00046-002© European Aviation Safety Agency. All rights reserved.
Proprietary document. Copies are not controlled. Confirm revision status through the EASA-Internet/Intranet.
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European Aviation Safety Agency
Operational Occurrence Report Form
6.3 Description of Occurrence Investigation
6.4 Risk Assessment
6.5 Corrective Actions
6.5 Conclusion
7. AIRPROX/NEARMISS
7.1 General
7.1.1 Horizontal rel mvmt
7.1.2 Rate of closure
7.1.3 Distance in time
7.1.5 Min horiz sep recorded
7.1.6 Vertical sep recorded
7.2.2 Traffic info type
7.2.3 RA Geometry
7.2.4 RA Type
7.2.5 Heading
7.2.6 Pilot response to RA
7.2.7 Cleared flight level
7.2.8 Cleared altitude
7.2.9 RA Classification
7.1.4 Military a/c involved
7.1.7 Risk severity
7.2 Aircraft 1
7.2.1 A/c avoiding action
7.2.10 Other aircraft seen
FO.IORS.00046-002© European Aviation Safety Agency. All rights reserved.
Proprietary document. Copies are not controlled. Confirm revision status through the EASA-Internet/Intranet.
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European Aviation Safety Agency
7.3 Aircraft 2
7.3.1 A/c avoiding action
Operational Occurrence Report Form
7.3.2 Traffic info type
7.3.3 RA Geometry
7.3.4 RA Type
7.3.5 Pilot response to RA
7.3.6 Cleared flight level
7.3.7 Cleared altitude
7.3.8 RA Classification
7.3.9 Other aircraft seen
8.2 Birds struck
8.3 Bird size
8.5 Parts damaged
8.6 Pilot advised
9.2 Color of ash cloud
9.3 Density of ash cloud
8. BIRD STRIKE
8.1 Birds seen
8.4 Parts struck
9. VOLCANIC ASH
9.1 Ash cloud visible
9.4 Est. duration of cloud encounter
9.5 Severity of cloud encounter
10.1 Fuel type used
10.2 Recommended fuel type
10.3 Fuel mass on board
11.2 Microburst
11.3 Windshear
11.5 W/Shear alert installed
11.6 Headwind loss
12.2 Turbulence intensity
12.3 Mountain wave intensity
10. FUEL
10.4 Fuel volume on board
11. WIND AT TAKE_OFF/LANDING
11.1 Relative wind direction
11.4 Crosswind component
12. TURBULENCE
12.1 Turbulence type
FO.IORS.00046-002© European Aviation Safety Agency. All rights reserved.
Proprietary document. Copies are not controlled. Confirm revision status through the EASA-Internet/Intranet.
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European Aviation Safety Agency
Operational Occurrence Report Form
13. AIRCRAFT 2 (if another aircraft was involved)
13.1 2nd Aircraft Type (Make/model/master series/series)
-
13.2 2nd Aircraft registration
-
-
13.3 2nd Aircraft serial number
14. ATTACHMENTS
Attachment 1
Attachment 2
Attachment 3
Attachment 4
Attachment 5
FO.IORS.00046-002© European Aviation Safety Agency. All rights reserved.
Proprietary document. Copies are not controlled. Confirm revision status through the EASA-Internet/Intranet.
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