Lodge a New Accident or Incident

Person Reporting

Role

Member Number

Date of birth

Name

Contact Phone

Address

Postcode

Flying hours

Total flying hours

Hours last 90 days

Hours on type

Hours on type last 90 days

Incident Information

Incident date

Time

Type of Event

Location

State

Details of incident/accident (Please give a clear and accurate description of what happened)

Damage to aircraft

Most serious injury to pilot

Passenger details Please supply names of other passenger if applicable

Passenger injury (most serious injury)

Persons on the ground injury (most serious injury)

Description of damage to aircraft

Maintainer Name

Maintainer Member Number

Maintainer Level

If this incident is an Immediately Reportable Matter has it been reported to the ATSB by phone?

Yes No

ATSB can be contacted on 1800 011 034

What may have contributed to the event?

Do you have further suggestions on how to prevent similar occurrences?

Is this an Immediately Reportable Matter (IRM) or a Routine Reportable Matter (RRM)?

Immediately reportable matter

Routinely reportable matter

Attachments

Upload photos and videos as evidence. Additionally include engine, propeller and airframe maintenance inspection documentation from logbooks as it pertains to the report.

File	Name

Maximum upload size is 75MB

Aircraft Information

Registration number

Registration status

Serial number

Make

Model

Type

Year built

Total airframe hours

Engine Details

Engine make

Engine model

Engine serial

Total engine hours

Total hours since service

Propeller Details

Propeller make

Propeller model

Propeller serial

Personal Locator Beacon carried

Yes No Don't know

Pilot in Command

Date of birth

Member Number If the pilot was not a member, leave blank.

Name

Contact Phone

Flying hours

Total flying hours

Hours last 90 days

Hours on type

Hours on type last 90 days

Flight details

Departure location

Destination location

Landing (if different to destination)

Type of operation

Name of Flight Training School

Phase of flight

Effect of flight

Flight Rules

Flight Conditions

Airspace

Airspace class

Airspace type

Altitude ft

Altitude type

Environment

Light conditions

Temperature °C

Visibility NM

Visibility reduced by

Wind direction

Wind speed knots

Wind gusting

Not Sure Yes No

Bird/animal strike

Type of strike

Was the pilot warned of birds or animals?

Unknown Yes No

Part of aircraft damaged

Bird or animal activity

Species

Number (approx)

Number struck (approx)

Size