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Incident Reporting: Report an Aviation Incident
Privacy Statement
Provision of the information requested on this form is voluntary. The information is being collected for the purpose of responding to your query/comments. The information collected is described in a personal information bank entitled
Aviation Occurrence Information Sources, TC PPU 014.
Personal information that you provide is protected under the provisions of the
Privacy Act.
The Act provides you with the right of access to your information.
Disclaimer
Information submitted through this mechanism will be forwarded to a technical expert for review. Please note, however, that feedback on issues submitted through this means cannot be provided.
Should you wish information on Transport Canada Civil Aviation programs, services or other feedback mechanisms, please contact the Civil Aviation Communication Centre at
services@tc.gc.ca
or 1-800-305-2059.
Items marked with an asterisk (
*
) are mandatory items.
General Information:
Reported by
(required)
:
Telephone
(required)
:
ex.(555)555-5555
Fax:
ex.(555)555-5555
E-mail:
Organization:
Occurrence Information:
Incident type
(required)
:
Accidental Death or Serious Injury
Aircraft Accident
Aircraft Evacuation Due to Potential Hazard
Aircraft Hijacking
Aircraft Incident
Alleged Regulatory Infraction
Bird Strike/Wildlife Intrusion
Bomb Threat/Bomb Found
Dangerous Goods Spill Affecting Operations
ERS Response
Fuel Spill/Major Environmental Incident Affecting Operations
Glider Operations Incidents
High Profile or Media Sensitive
Hostage Taking
Item Unintentionally Dropped from Aircraft/Balloon/Airship
Labour Dispute Affecting Operations
Major System or Structural Failure Affecting Operations
Missing Aircraft/SAR
Other
Parachute Related Serious Injuries/Fatalities
Significant Building or Equipment Fire
Terrorist Activities
Unauthorized Incursion
Unavailability of a Runway
Unruly Passenger Incidents
Location
(required)
:
Incident Date
(required)
:
(yyyy-mm-dd)
Incident Time
(required)
:
ex.18:12 (24 hour, local)
Aircraft/Vehicle Information:
Aircraft/Vehicle Number 1
Identification:
Type/Model:
Registration:
Owner/Operator:
Route:
Departure:
En route stops:
Destination:
Persons Involved:
Total Crew:
Crew Killed:
Crew Injured:
Total Pax:
Pax Killed:
Pax Injured:
Total Other:
Other Killed:
Other Injured:
Aircraft/Vehicle Number 2
Identification:
Type/Model:
Registration:
Owner/Operator:
Route:
Departure:
En route stops:
Destination:
Persons Involved:
Total Crew:
Crew Killed:
Crew Injured:
Total Pax:
Pax Killed:
Pax Injured:
Total Other:
Other Killed:
Other Injured:
Persons Involved (Total):
Total:
Killed:
Injured:
Summary Description (including operational impact)
(required)
: (4000 Character Maximum)
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Date modified:
2021-01-14
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