REPORTING SYSTEM SMS WAC

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This form is to be used for all occurrences, incidences, hazards or any safety related events at Waterford Aero Club. By submitting this form, the reporter is fulfilling their reporting obligation under EU No 376/2014. On submission of the report, the reporter gives consent to the data (de-identified) being shared with the relevant authorities. Under EU No. 376/2014 the reporter is entitled to the confidentiality of the Safety Office and the Just Culture policy at Waterford Aero Club".

Date of Occurrence *

YYYY

Time of Occurrence (zulu time) *

Time

Location *

Occurrence Classification *

Phase Of Occurrence *

Pre-Flight

Start Up

Taxi (Post or Pre Flight)

Engine Run Up

Take-Off

Climb

Cruise

Descent

Approach

Landing

Shut Down

Other:

Weather (ATIS/METAR)

Pilot Operating Capacity *

Pilot In Command (PIC)

Dual (Under Instruction)

EI-GWY Cessna 172R

EI-EAZ Cessna 172R

EI-GVL Cessna 172S

Other:

Flap Configuration

Flaps Up

Flaps T/O

Flaps APPR

Flaps FULL

Clear selection

Damage to aircraft?

Yes

Other:

Number of Occupants On Board

One

Two

Three

Four

Other:

Clear selection

Any injury caused to Crew or Passengers? *

Narrative of event (detailed) *

Email address (Required) *

Reported By (Required) *

Submit

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