1. Name of Operator/Carrier
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
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3. Engine Make/Model
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4. Aircraft Registration
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5. Date of Incident
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
:
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6A. Flight Number
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6B. Wildlife/Bird Remains:
Collected
Sent to Smithsonian
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7. Airport Name/ID
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
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9. Location if En Routeand/or Distance from Airport(Nearest Town/Reference
& State/Airport)
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10. Height (AGL)
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
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13. Part(s) Struck or Damaged
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13. (Con't)
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14. Effect on Flight
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
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18. Number Seen and/or Struck
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19. Size of Bird(s)
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)
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22. Aircraft time out of service
hours
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23. Estimated cost of repairs 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 $) (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
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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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