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BIRD/OTHER WILDLIFE STRIKE REPORT

1. Name Of Operator
 2. Aircraft Make/Model
 3. Engine Make/Model
4. Aircraft Registration
 5.Date Of Incident
6. Local Time Of Incident
Dawn Dusk  
Day   Night   AM   PM
7. Airport Name
8. Runway Used
9. Location If En Route(Nearest town/reference and governorate)
10.Height (AGL)
11. Speed
12. Phase Of Flight


A. Parked
B. Taxi
C. Take-off Run
D. Climp
E. En Route
F. Descent
G. Approach
H. Landing Roll
13. Part(s) of Aircraft Struck or Damaged
 
Struck
Damaged
  
Struck
Damaged
A. Radome
B. Windshield
C. Nose
D. Engin No 1
E. Engin No 2
F. Engin No 3
G. Engin No 4
H. Propeller
I. Wing/Rotor
J. Fuselage
K. Landing Gear
L. Tail
M. Lights
N. Other
14. Effect of Flight
None
Aborted Take-Off
Precautionary Landing
Engines Shut Down
Other:(Specify)  		15. Sky Condition

No Clouds
Some Clouds
Overcast		 16. Precipitation

Fog
Rain
Snow
None
17. Bird/Other Wildlife Species
 18. Number of Birds/Other Wildlife seen and/or struck 19. Size of Bird/Other Wildlife Strike seen and/or struck

Small
Medium
Large
Number
Seen
Struck
1
2 - 10
11 - 100
more than 100
20. Pilot warned of Birds/Other Wildlife Strike yes    No
21. Remarks(Describe damage,injuries and other pertinent information)
DAMAGE / COST INFORMATION
22. Aircraft time out of service(hours)
 23.Estimated cost of repais or replacement(JD)
 24. Estimated other costs(JD) (e.g. loss of revenue, fule, hotels):
Reported by (Optional)
 Title
 Date
CARC Form DOASS-6
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