section 1 Name Of Operator Aircraft Make/Model Engine Make/Model Aircraft Registration Date Of Incident Local Time Of Incident Local Time Of Incident Dawn Dusk HR HR010203040506070809101112 MN000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 Local Time Of Incident2 Day Night am/pm am pm Airport Name Runway Used Location If En Route(Nearest town/reference and governorate) Height (AGL) Speed section 2 Phase Of Flight Parked Taxi Take-off Run Climp En Route Descent Approach Landing Roll Part(s) of Aircraft Struck or Damaged title Struck Damaged Radome Radome Struck Struck Radome_Damaged Damaged windshield windshield Struck Struck windshield_Damaged Damaged nose nose Struck Struck nose_Damaged Damaged Engin No 1 Engin No 1 Struck Struck Engin No 1_Damaged Damaged Engin No 2 Engin No 2 Struck Struck Engin No 2_Damaged Damaged Engin No 3 Engin No 3 Struck Struck Engin No 3_Damaged Damaged Engin No 4 Engin No 4 Struck Struck Engin No 4_Damaged Damaged Part(s) of Aircraft Struck or Damaged title Struck Damaged propeller propeller Struck Struck propeller_Damaged Damaged wing/rotor wing/rotor Struck Struck wing/rotor_Damaged Damaged fuselage fuselage Struck Struck fuselage_Damaged Damaged landing gear landing gear Struck Struck landing gear_Damaged Damaged tail tail Struck Struck tail_Damaged Damaged Lights Lights Struck Struck Lights_Damaged Damaged other section 3 Effect of Flight None Aborted Take-Off Precautionary Landing Engines Shut Down Other:(Specify) Sky Condition No Clouds Some Clouds Overcast Precipitation Fog Rain Snow None section 4 Pilot warned of Birds/Other Wildlife Strike Small Medium Large Bird/Other Wildlife Species Number of Birds/Other Wildlife seen and/or struck Number none12 - 1011 - 100more than 100 Number of Birds/Other Wildlife seen and/or struck Seen Struck section 5 Pilot warned of Birds/Other Wildlife Strike Yes No Remarks(Describe damage,injuries and other pertinent information) DAMAGE / COST INFORMATION Aircraft time out of service(hours) Estimated cost of repais or replacement(JD) Estimated other costs(JD) (e.g. loss of revenue, fule, hotels): Reported by (Optional) Title Date CARC Form DOASS-6 Provide your email if you want to receive a copy of this report:
