Birdstrike Occurrence Form

To be completed on discovering evidence that a birdstrike has occurred.

To be completed for all confirmed, unconfirmed, or 'near miss' birdstrike occurrences, in accordance with the guidance and information in Chapter 5 of CAP 772.

Guidance for web-based form submission

In order that we may properly consider your submission, the following guidance may be helpful in submitting this form:

Please fully complete your contact details so that we may contact you if necessary
Please complete a new form for each birdstrike occurrence

When you have finished, click "Submit Form" at the bottom of this page. If the form has not been completed correctly incomplete fields will be identified. Once the form has been completed correctly you will be presented with your completed form. You can then either "Change Form Details" or "Send Form". Once a form is sent, a page confirming submission will appear with a link to a printer friendly version of the form. This form will have a unique reference id which should be used in all correspondence with this birdstrike occurrence. In addition, if you have supplied a valid email address, an acknowledgement of receipt containing the printer friendly link will be sent.

Reporter Details

*

denotes mandatory.

Name :

*

Role:

*

Unknown

Employer :

Telephone No :

*

EMail Address :

*

Birdstrike Details

Birdstrike Status :

*

ConfirmedUnconfirmedNear Miss

Aircraft Operator :

*

Unknown

Aircraft Registered :

*

UKNon-UKUnknown

Aircraft Type & Series :

*

Unknown

Date (dd/mm/yyyy) :

*

Time (local) :

*

: Unknown * Unknown

Precipitation:

*

Unknown

Location
(Aerodrome or En-route):

*

Unknown

Runway in use:

*

Unknown

Height (agl):

*

Unknown

Speed (IAS):

*

Unknown

Phase of Flight:

*

Unknown

Note 1: A copy of this Birdstrike Report will be automatically submitted to the CAA Safety Investigation & Data Department, under the auspices of the Occurrence Reporting Scheme (MOR), by virtue of selecting any of these categories;

Part(s) of Aircraft - Where Damaged is selected
Effect on Flight - Where "Returned", "Take-Off Aborted" or "Diverted" selected

Once submitted, this report cannot be withdrawn.

Part(s) of Aircraft

Radome :

StruckDamaged

Windshield :

StruckDamaged

Nose (if not one of the above):

StruckDamaged

Engine Nos 1 :

StruckDamaged

2 :

StruckDamaged

3 :

StruckDamaged

4 :

StruckDamaged

Propeller :

StruckDamaged

Wing/rotor (inc high lift devices) :

StruckDamaged

Fuselage :

StruckDamaged

Landing Gear :

StruckDamaged

Tail :

StruckDamaged

Lights :

StruckDamaged

Other :

StruckDamaged

Effect on Flight:

*

Other* (describe max 200 chars)

Other Reports raised:

Mandatory Occurrence Report (MOR)
Air Safety Report (ASR)
Other* (specify)

* (specify max 100 chars)

Species Type :

*

BirdsOther Wildlife

If you are not certain of the bird species, please send a copy of this form and any remains or a digital image of the bird or remains (e.g. a wing, but even the smallest of remains are useful) to:-

Wildlife Management Unit, The Food Environment Research Agency (FERA), Sand Hutton, York. YO41 1LZ

Please mark the container "Bird Remains" Costs for this identification service are charged directly to the customer. For further information see the FERA web site http://www.fera.defra.gov.uk/wildlife/birdManagement/ or EMail birdmanagement@fera.gsi.gov.uk

Bird remains:
sent for identification

*

Number of birds seen:

*

Unknown

Number of birds struck:

*

(* enter actual number if known) Unknown

Note 2: The reporter should ensure, irrespective of this report having been filed, that details of this birdstrike occurrence are notified to the appropriate airline or aerodrome operator, as soon as practicable.

Remarks & Other Relevant Information :
(max 2000 chars)

Civil Aviation Authority

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