Reporting Schemes | Belize Department of Civil Aviation

BELIZE DEPARTMENT OF CIVIL AVIATION

PHILIP S. W. GOLDSON INTERNATIONAL, LADYVILLE

P.O. BOX 367, BELIZE CITY, BELIZE

Mandatory Occurrence Report Form

All fields maked with (*) are REQUIRED

Are you concerned about the confidentiality of this report and wish to be contacted? If so, please ensure you provide us with your contact details. Confidential? Yes No

MY E-MAIL *

This is the email you will use to load this form.

BDCA OCCURRENCE NUMBER *

This is the number you will use to load this form.

AIRCRAFT TYPE & SERIES *

REGISTRATION *

DATE (dd/mm/yyyy) *

TIME OF EVENT UTC (HH:MM) *

DAY NIGHT TWILIGHT *

OPERATOR *

LOCATION / POSITION / RW *

FLIGHT NO. *

ROUTE FROM *

ROUTE TO *

FL ALT/HT (FT) *

IAS (KT) *

IFR VFR *

TCAS * Yes No

ETOPS * Yes No

NATURE OF FLIGHT * Specify other Nature of Flight:

FLIGHT PHASE * Specify other Flight Phase:

ENVIRONMENTAL DETAILS

WIND

DIRN.

SPEED

CLOUD

TYPE

HT (ft)

PRECIPITATION

PRECIPITATION 1 PRECIPITATION 2

OTHER METEOROLOGICAL CONDITIONS

VISIBILITY KM NM

ICING

TURBULENCE

OAT(°C)

RUNWAY STATE

GROUND STAFF / MAINTENANCE ORGANISATION REPORT

ENGINE SERIAL NO.

ENGINE TYPE/SERIES

ETOPS APPROVED
Yes
No

GROUND PHASE
MAINTENANCE
GROUND HANDLING
UNATTENTED

MAINTENANCE ORGANISATION

TEL.

COMPONENT/PART

MANUFACTURER

PART NO.

SERIAL NO.

REFERENCES:- MANUAL/ATA/IPC

COMPONENT OH/REPAIR ORGANISATION

ORGANISATION AND APPROVAL REFERENCE

NAME

POSITION

DATE (dd/mm/yyyy)

Address (if reporter wishes to be contacted privately).

Tel no.

NOTE 1: If additional information, as below, is available, please provide.
NOTE 2: If the occurrence is related to a design or manufacturing deficiency, the manufacturer should also be advised promptly.
NOTE 3: Where applicable, a report of this incident should be forwarded directly to other agencies involved, e.g. Aerodrome Authority, ATC agency.

REPORTING ORGANISATION - REPORT

ORGANISATION COMMENTS - ASSESSMENT / ACTION TAKEN / SUGGESTIONS TO PREVENT

UTILISATION - AIRCRAFT

HOURS

CYCLES

LANDINGS

UTILISATION - ENGINE / COMPONENT

HOURS

CYCLES

LANDINGS

MANUFACTURER ADVISED

Yes
No

REPORTING ORGANISATION *

TEL. *

REPORTER'S REF *

REPORT *
NEW
SUPPLIED

REPORTER'S INVESTIGATION *
NIL
OPEN
CLOSED

FDR DATA RETAINED *
NEW
SUPPLIED

E-MAIL *

FAX *

NAME *

POSITION *

TEL *

E-MAIL *

DATE *

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Mandatory Occurrence Report Form

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ENVIRONMENTAL DETAILS

GROUND STAFF / MAINTENANCE ORGANISATION REPORT

REPORTING ORGANISATION - REPORT