Professional Documents
Culture Documents
Part 1. DAMAGE BY
AIRPORT
Other Aircraft Ramp Equipment Vehicle Foreign Object Jet Blast Unknown (Previously Unreported) Other (specify) Part 2. DETAILS OF DAMAGE
Date Time of Occurrence Phase of Operation Area (Stand, etc.) Aircraft Reg. Aircraft Type Flight Nr. Scheduled Ground Time Flight Delay hrs. min. Flight Cancelled YES/NO (delete as appropriate) Part 3. NUMBER OF CASUALTIES Fatalities Employees Passengers Others Non Fatal
Part 4. VEHICLE/RAMP EQUIPMENT DETAILS AND CONDITION REPORT Serviceable () Faulty () Serial Fleet Nr. Type Owner Area (Stand, etc.) Age of Vehicle/Ramp Eq. Last Overhaul
Tyres Brakes Steering Lights Wipers Protection Warning Devices Stabilisers Tow Hitch Field of vision from driving position
Remarks Remarks
Part 5. DETAILS OF PERSONNEL INVOLVED 1 Name Job Title Company Staff Nr. Licence Part 6. CONDITIONS Weather Use of official met. report Visibility Wind/gust Temperature m km / If kts c rain snow sleet hail fog
Name Job Title Company Staff Nr. Licence Lighting Good Poor Day Night Twilight
Part 7. CONTRIBUTORY FACTORS Identify by code from the checklist factors which in your opinion contributed to the incident/accident by major factor Other factors (specify) Which of these contributory factors are normal practice?
Part 8. SKETCH
Part 9. NARRATIVE Give a description of what happened. Include details of relevant contributory factors identified.
TOTAL NUMBER OF FLIGHT DEPARTURES IN REFERENCE PERIOD: WIDE BODY A/C CONV. A/C TOTAL
Category / Type of Equipment Involved WIDE BODY A/C 1. PASSENGER HANDLING EQUIPMENT Air jetties (passenger bridges) Passenger stairs/steps Mobile lounges (elevating) Invalid handling vehicle Passenger coaches/buses Others Sub total 2. AIRCRAFT LOADING EQUIPMENT Ramp tractors Baggage/cargo carts/dollies Container/pallet loaders Forklifts Belt conveyors Catering/cleaning trucks (elev.) Others Sub total 3. AIRCRAFT SERVICING EQUIPMENT Toilet /water vehicles Fuelling trucks/services Aircraft tow tractors/tow bars Air start/ground power units Engineering access equipment High lift equipment/De-icers Others Sub total 4. MISCELLANEOUS Motor vehicles Others Sub total 5. FOREIGN OBJECT DAMAGE Subtotal 6. JET BLAST DAMAGE Subtotal 7. PREVIOUSLY UNREPORTED DAMAGE Subtotal TOTAL
CONV. A/C
TOTAL
CONV A/C
TOTAL