Report a Safety Occurrence

13 March 2016 version

Complete this form in the event of an occurrence that was unsafe, or in other circumstances could have resulted in an unsafe situation. This occurrence report will not be used to apportion blame or liability, but will be used in the interest of safety to determine factors that will allow action to be taken to prevent a repeat occurrence. Once completed, this form will automatically send one copy to the Safety Manager, one copy to Operations and one copy to the Safety Team.

First Name

Optional

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Last Name

Optional

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Email Address

Optional

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Aircraft type and registration*
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Location*
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Date*
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Phase of flight
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NTPS occurrence report #:

(attributed by the Safety Team, format 3 digit number - year)

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Description of Event:

Reporter should describe the occurrence with sufficient details to allow meaningful analysis.

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Reporter recommendations:

Reporter may provide any recommendation to avoid such an occurrence in the future.

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