FLIGHT OPERATIONS
HUMAN FACTORS & CRM
CONFIDENTIAL REPORTING SYSTEM
=> __ This report is confidential, Your name will not be revealed.
‘NUMBER:
Name: .. 3 Letter code :
WE MAY HAVE TO CONTACT YOU. PLEASE PROVIDE YOUR NAME AND CONTACT
Date Time
‘AIC REG:
f , Local
UTC
DAY
nicat |]
BE KEPT.
THE ABOVE INFORMATION IS CONFIDENTIAL. IT WILL BE REMOVED FROM THE.
REPORTING FORM AND RETURNED TO YOU. NO RECORD OF YOUR IDENTITY WILL
Rout:
. Div/To ....
~-No. of —
ASR Raised
CREW
PAX
YES_] NOL]
WHAT HAPPENED? (Briefly describe the event, along with any contributing factors e.g. weather, technical problems)
IN YOUR OPINION, WHY DID IT HAPPEN?
DID YOU DO ANYTHING TO RESOLVE THE PROBLEM? IF YES, WHAT?
SAFTY RECOMMENDATION : (Teil us what can be done to prevent a similar event in the future)
Rev0t : 268ep2010