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Bird/Wildlife Strike Report

Bird/Wildlife Strike Report

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Bird/Wildlife Strike Report

Privacy Notice for the Collection of Personal Information
Provision of the information requested on this form is voluntary. The information is being collected for the purpose of responding to your query/comments. Personal information that you provide is protected under the provisions of the Privacy Act. The Act provides you with a right of access to your information.

Note: If field is unknown please select unknown from the pick list, but if field is unreported please leave blank.

* indicates required field

Please enter your Name:

Telephone Number:

Type of Report:
*

Reporting Source:
*

Operator:

Date (yyyy/mm/dd):

*

Height (AGL, feet):

Local Time (hhmm) (24 hour time):

Time Zone:

Speed (IAS, Knots):

Aircraft Information

Model:

Make:

Engine Type:

Engine Make:

Registration:

Flight No.:

Airport Information

Airport Name:
*

Phase of Operation:

Province:

Region:

Runway:

if En Route, distance from airport:

Parts Struck/Damaged

Radome:

Windshield:

Nose:

Engine 1:

Engine 2:

Engine 3:

Engine 4:

Propeller:

Wings:

Rotor:

Fuselage:

Landing Gear:

Tail:

Lights:

Pitot Static:

Tail Rotor:

Other:

Effects on Aircraft/Flight

None

Aborted Takeoff

Precautionary Landing

Engine(s) Shut Down

Forced Landing

Fire

Penetration of Airframe

Vision Obscured

Engine Ingestion

Engine Uncontained Failure

Other

Light Condition:

Sky Condition:

Precipitation:

Bird/Mammal Information

Note: if bird species or mammal is unidentifiable please select ‘Unknown bird’ or ‘Unknown mammal’; however, if bird or mammal species is unreported, please leave blank.

Species Common Name:

Size of Bird:

Number of Birds Seen:

Number of Birds Struck:

Bird Remains Submitted for Identification?

Pilot warned of Birds?

Additional Information

Cost Information

Aircraft Time out of Service:
Hours

Estimated Cost of Repairs or Replacement:
CDN $ in thousands

Damage Category (DND)

Estimated Other Costs (loss of revenue, hotels):
CDN $ in thousands