1. Name of Operator/Carrier ![Enter the airline, name of business or if private pilot, the pilot’s name. (Example: Southwest Air or SWA; Wal-Mart; Ted King)](images/question.gif)
Type in a few letters contained within the Operator name or OperatorID. Add more if/as req'd. If found ,click that Operator Name from the listing so that appear in the entry box. If not found, type in the Operator Name and if known, the 3/4 letter Operator ID.
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2. Aircraft Make/Model![Be as complete as you can. Some abbreviations are okay. (Example: B737-300 instead of 737)](images/question.gif)
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3. Engine Make/Model![This is especially important if engine was struck. (Example: P&W JT-8D)](images/question.gif)
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4. Aircraft Registration![For US aircraft this should be the N#. (Example: N367DL)](images/question.gif)
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5. Date of Incident![Enter the date of the strike in local time (not Zulu or GMT). If reporting a carcass found and no strike was reported, enter the date the carcass was found.](images/question.gif)
![](images/calendar.png) mm / dd / yyyy
5. Date of Incident: You must enter an incident date.
5. Date of Incident: You must enter a valid incident date.
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6. Local Time of Incident![Enter the time of strike or the time the carcass was found if no strike was reported. Check the box that applies to the light conditions. (Dawn, Day, Dusk or Night).](images/question.gif)
:
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6A. Flight Number
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6B. Wildlife/Bird Remains:![If remains were found at the airport or on the aircraft check Collected. If the remains were also sent to the Smithsonian for identification, also check Sent to Smithsonian.](images/question.gif)
Collected
Sent to Smithsonian
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7. Airport Name/ID![Enter the 3- or 4-letter FAA code of the airport. (Example: L66 or KORD. The airport name will automatically be filled in unless this is the first strike for that airport.)](images/question.gif)
Type in a few letters contained within the Airport name or AirportID. Add
more if/as req'd. If found ,click that Airport Name from the listing so that
appear in the entry box. If not found, type in the Airport Name and if known,
the 3/4 letter Airport ID.
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8. Runway/Taxiway Used![Enter runway number or taxiway letter unless phase is En route. (Example: 9R for a runway; B or Bravo for a taxiway) Additional information about location can be entered into Box 21. Remarks.](images/question.gif)
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9. Location if En Route and/or Distance from Airport(Nearest Town/Reference
& State/Airport)
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10. Height (AGL)![Number of feet above ground level at time of strike. Taxi, take-off and landing should always be zero.](images/question.gif)
ft
10. Height (AG): Enter a valid Height in feet
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11. Speed (IAS)
kts
11. Speed (IAS): Enter a valid Speed in knots
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12. Phase of Flight![Check one. (If an altitude greater than 0 is entered, the phases taxi, take-off run and landing roll are not available as a choice.)](images/question.gif)
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13. Part(s) Struck or Damaged![Check part of a/c involved in the strike. Be sure to check both struck & damaged for each part damaged. If part is not listed, check N. Other and enter part(s) in the following box or in Remarks Box 21.](images/question.gif)
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13. (Con't)
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14. Effect on Flight![Check the box that indicates how the strike effected the flight. More than one might apply.](images/question.gif)
None
Aborted Take-Off
Precautionary Landing
Engine Shutdown
Other (Specify)
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15. Sky Condition
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16. Precipitation
Fog
Rain
Snow
None
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17. Bird/Other Wildlife Species![Only enter the type of bird or animal if you know what it is. Be specific if possible. (Example: Red-winged blackbird, barn owl, red-tailed hawk). Information follows on where to ship remains/blood samples to the Smithsonian Institution once the report is submitted.](images/question.gif)
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18. Number Seen and/or Struck![Check the number seen before the strike and the number hit. Estimate if you do not have exact number. If you know the exact number please enter it in comments. This applies for all animals, not just birds.](images/question.gif)
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19. Size of Bird(s)![Check box that applies. (Example: sparrow = small, gull = medium and vulture = large). This also applies to other wildlife.](images/question.gif)
Small
Medium
Large
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20. Pilot Warned of Birds/Wildlife?
Yes
No
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21. Remarks (Describe damage, injuries, and other pertinent information such as bird band numbers, fuel jettisons)![Any information that helps determine extent of damage is needed here. When there is damage, we need to know if it was Minor or Substantial. Also any remarks that you feel are interesting or important are welcome. If the bird or animal was found on the runway or within 250’ of the centerline, please include time it was found and where. Condition of bird/wildlife helps too (Example: was it old or freshly killed.)](images/question.gif)
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22. Aircraft time out of service![Enter the actual number of hours the plane was unavailable for use.](images/question.gif)
hours
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23. Estimated cost of repairs ![Enter any repair or replacement costs. This may not be known at first, so if there is someone who can be contacted at a later date to get this detail, please include their contact information. You may also revise the report once this information is known.](images/question.gif) or replacement (US $)
23. Estimated cost of repairs or replacement (US $): Enter a valid US dollar amount without $ sign
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24. Estimated other costs (US $)![Enter costs other than those entered in Box 23.](images/question.gif) (e.g., revenue loss, fuel, and aircraft inspection,
crew lodging or rescheduling, etc.)
24. Estimated other costs (US $): Enter a valid US dollar amount without $ sign
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Reported by![Name of person filling out form and their Title. (Example: Sandy Robins, Wildlife Biologist). If you can be contacted for questions regarding the strike please include a phone number or e-mail address.](images/question.gif)
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Title
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Date
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Email
Save my Information.
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Phone
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