BRITISH PARACHUTE ASSOCIATION - DOC 16 by BevHde9

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									BRITISH PARACHUTE ASSOCIATION                                                                                                                  Appendix H
Wharf Way, Glen Parva, Leicester, LE2 9TF
Tele: 0116 278 5271, Fax: 0116 247 7662, e-mail: skydive@bpa.org.uk


                                                 PILOTS VOLUNTARY REPORTING

                                                                                                                                         □
                                                                                                                     If report is confidential place a X in the box
                                                                                                                     above. Please provide a Tel. No/Address


The object of this paper is to encourage aircraft Operators and/or Pilots to share information, following an occurrence or
incident. Identities will only be revealed with the informant’s permission. Please fill in each section with as much detail as
possible. If you do not wish to fill in a section, for the purpose of staying anonymous, strike a line through the section with
a pen.
Aircraft type          Registration            Operator              Date             Time            Location/Position/Runway                      Day
                                                                                                                                                    Night
                                                                                                                                                    Twilight


NATURE OF FLIGHT           S/L ROUND           S/L SQUARE       FS      CF     STYLE      MIXED           OTHER
FLIGHT PHASE           PARKED     TAXYING       TAKE OFF       INT CLIMB       CLIMB          JUMP RUN          CRUISE      DESCENT          APPROACH            LANDING

ENVIRONMENT DETAILS
      WIND             CLOUD                   PRECIPITATION                 OTHER METEOROLOGICAL CONDITIONS                                 RUNWAY STATE
        SPEED   TYPE     HT
DIR                             8TH   RAIN     SNOW    SLEET     HAIL        VISIBILITY       ICING           TURBULENCE      DRY      WET      ICE       SNOW     SLUSH
        MPH              (ft)
                                                                                          L     M     S   L      M     S      CAA Category
                                       LIGHT          MOD       HEAVY               KM                                                          P     1     11       111
                                                                                                                              of Airfield


Brief Title of Occurrence/Incident


Description of Occurrence/Mistake/Incident




                                                                                                                                      continue overleaf as necessary

Form 176 (i)                                                                                                                    (Issue 2, December 2000)
Description of occurrence continued




                                  The following information is voluntary, anonymity will be respected

Pilots Name                        Name of informant         No of years flying                 Total flying hours
                                                             Experience
                                                                                                Total hours on type
                                                             Age
                                                                                                Total hours in last six months

If report is submitted voluntarily                                 Signature of Informant   Address or Telephone No. (if reporter wishes to be contacted privately)
(ie, not subject to mandatory requirements).           Yes

Can identities be disclosed?                           No


ORGANISATION COMMENTS-ASSESSMENT/ACTION TAKEN/SUGGESTIONS TO PREVENT




Form 176 (ii)                                                                                                        (Issue 2, December 2000)

								
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