Mandatory Occurrence Report Libyan Civil Aviation Authority

Date of Occurrence

Time

Local

UTC

Occurrence Location

Aircraft Manufacturer and Model

Aircraft Registration 5A -

Client ID

Pilot Information

Pilot in Command's Name

Pilot Licence Number

Pilot Flight Hours (Last 90 Days)

Pilot Flight Hours on Type

Pilot Total Flight Hours

Last Checked - IFR

Last Checked - BFR

Last Checked - 6 month flight competency

Date Checked

Pilot ID (Check)

Operational Details

Flight Number / Call Sign

Runway Used

Departure Point

Destination Point

Nearest Reporting Point (NRP)

Distance (NM)

VFR

IFR

VMC

IMC

Scheduled Flight

Non-Scheduled Flight

Domestic

International

ETOPS

Nature of Flight

Passenger A to A

Passenger A to B

Freight Only

Agricultural

Other Aerial Work

Business/Executive

Training Dual

Training Solo

Test or Ferry/Position

Private / Other

Parachuting

Air ambulance

Other Flight Purpose (Specify)

Flight Phase

Parked

Taxiing

Takeoff

Climb

Hover

Cruise

Circuit

Aerobatics

Holding

Descent

Approach

Landing

Weather Information

Wind

QNH

Visibility

Precipitation

Fz

Dz

Rn

Sn

Nil

<4/8>

4

Wind Direction

Wind Speed (kts)

Visibility

Clouds No

Temperature (°C)

Dew Point (°C)

Effect on Flight

Nil

Flight Delayed/Cancelled

Aborted Takeoff

Failure To Get Airborne

Emergy/Precautions Descent

Emergy/Precautions Ldg

Go-Around/Missed App

Abnormal Approach

Diversion

Turn Back

Engines(s) Shutdown

Sig loss Of Control Perform

Avoiding Action

Overweight Landing

Abnormal Landing

Runway Excursion

Other (specify)

Description & Type of Occurrence

Description of Occurrence

POB

FatalCrew

FatalPax

SeriousCrew

SeriousPax

MinorCrew

MinorPax

Accident/incident

Collision/Strike Object

Component/System Failure/Malfunction

Loss of Control

Engine Power Loss

Damage to Aircraft

Airframe Failure

Fire/Explosion/Fumes

Fuel/Fluids Occurrence

Flight Crew Illness/Incapacitance

Injuries To Persons

Failure of Emergency Equipment/Procedures

Evacuation

Pax/Cargo Related Occurrence

Valid Warning/Alert System

Invalid Warning/Alert System

Emergency Declaration

Other Occurrence Type (Specify)

Airspace incident

Airspace ID

Near Collision

Loss of Separation

Unauthorized Altitude penetration

Unauthorized Airspace Incursion

Breach Of Clearance

Pilot Flight Planning Deficiency

Clearance/Instruction Deficiency

Flight Information Deficiency

Other Airspace Incident

TCAS Information

TCAS Alert

RA

TA

Intruder Relative Altitude (feet)

Relative Position (o'clock)

Risk Assessment

High

Medium

Low

None

Facility Malfunction

Facility ID

Facility Name

Facility Type

Failure/Non Availability

Coverage/Intensity Deficiency

Alignment/Course Deficiency

Excessive Bends/Roughness

False Overhead Distance Indication

Identification Deficiency

Readability Deficiency

Interference

Other Facility Issue

Aerodrome Occurrence

Physical Surface Deficiency

Surface Marking Deficiency

Wildlife Incursion

Physical Obstruction

Equipment/Installation Deficiency

Apron Management Deficiency

Public Protection Deficiency

R/W Incursion

R/W Excursion

Other Aerodrome Issue

Dangerous Goods

Spillage/Leakage

Fumes/Gas/Smoke/Fire

Mis/Non-Declaration

Other Dangerous Goods Issue

Bird Hazard

Strike

Near Strike

Species

Small

Medium

Large

1

2-10

11-100

1

2-10

11-100

Parts of the Aircraft Struck

IsRadomeStruck

IsWindshieldStruck

IsNoseStruck

IsEngineStruck

IsWingStruck

IsGearStruck

IsOtherPartStruck

OtherPartStruck

Parts of the Aircraft Damaged

IsRadomeDamaged

IsWindshieldDamaged

IsNoseDamaged

IsEngineDamaged

IsWingDamaged

IsGearDamaged

IsOtherPartDamaged

OtherPartDamaged

Wake Turbulence

Position

IsTurningYes

IsTurningNo

IsBuffetYes

IsBuffetNo

IsStickShakerYes

IsStickShakerNo

IsPitchChange

IsRollChange

IsYawChange

IsAlertedByAtc

IsAlertedByTraffic

IsAlertedNot

Aircraft Defect / Engineering Details

Major Component/System Affected

ATA Code

Part Defective

Manufacturer

Model

Part Number

Serial Number

TTIS Hours

TTIS Cycles

TSO Hours

TSO Cycles

TSI Hours

TSI Cycles

Unscheduled

Scheduled maintenance

Manufacturer Advised Yes

Manufacturer Advised No

Compliance with AD

Compliance with SB

Specify Reference

Maintenance Organisation

Client ID

Maintenance Organisation Telephone

Destroyed

Substantial

Minor

Other

Write-Off

Repair

Unknown

Other

Engineering Description Of incident

sketches

reports

photos

Others

Open

Closed

Upload Images

Upload PDF(s)

Mandatory Occurrence Report

Our dedicated support team is ready to assist you. Contact us for assistance with any issues or concerns

Our dedicated support team is ready to assist you.
Contact us for assistance with any issues or concerns