Air Accident / Serious Incident Report Form - Bureau Of Air Accident Investigation
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6AIR ACCIDENT / SERIOUS INCIDENT REPORT FORM
The following information is required for a BAAI investigation and will be treated in confidence unless required for the compilation of an accident report in
accordance with ICAO Annex 13,Regulation (EU) No.996/2010 and Legal Notice 16 of 2013.. Please return completed form to:
Chief Inspector of Air Accidents, Bureau of Air Accident Investigation, 233, Republic Street, Valletta VLT1116 Malta.
Mobile: +356 99382725
1. AIRCRAFT
2. FLIGHT DETAILS
1.1 Aircraft Details
2.1 The Flight
Registration:
Build year:
Purpose of flight:
Type & Series:
Departure airfield:
Engine model:
Departure time:
(UTC)
Planned destination:
1.2 Weights (Kg
Lbs
) & CG
Basic:
Max T/O:
Max Ldg:
CG:
2.2 Loading ( use same units as in 1.2)
1.3 Checks
Load details:
Weight:
C of A Category:
Date:
No. of Crew:
Last check type:
Date:
No. of Passengers:
Total airframe hours:
Fuel type:
Baggage/Freight:
1.4 Maintenance Organisation
Company:
3. OPERATOR
Address:
Company:
Address:
Tel:
Fax:
Tel:
Fax:
4. FLIGHT CREW
4.1 Commander
4.2 Second Pilot / Flight Engineer
Name:
D of Birth:
Name:
D of Birth:
Licence Type & No:
Licence Type & No:
State of issue:
State of issue:
Limitations:
Limitations:
Handling pilot:
YES
NO
Handling pilot:
YES
NO
F/E
Date last renewed
Date last renewed
Instrument Rating: ___________________________
Instrument Rating:
IMC Rating: ___________________________
IMC Rating:
Night Rating: ___________________________
Night Rating:
A/Instructor Rating: ___________________________
A/Instructor Rating:
Certificate of test / revalidation: ___________________________
Certificate of test / revalidation:
Medical Certificate: (Class/Date) ____________________________________ Medical Certificate: (Class/Date) ____________________________________
Medical limitations: ____________________________________
Medical limitations: ____________________________________
Total flying hours on type:
Total flying hours on type:
Total flying hours on type, PIC:
Total flying hours on type, PIC:
Total flying hours all types:
Total flying hours all types:
Total flying hours all types, PIC:
Total flying hours all types, PIC:
Total hours last 90 days:
Total hours last 90 days:
Total hours last 28 days:
Total hours last 28 days:
Total hours last 24 hours:
Total hours last 24 hours:
Public Transport flights only
Public Transport flights only
Duty period to time of occurrence:
hours
Duty period to time of occurrence:
hours
Rest period prior to duty:
hours
Rest period prior to duty:
hours
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PLEASE USE REVERSE OF FORM AS CONTINUATION SHEET
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