FICHA DE NOTIFICAÇÃO DE RAIO LASER

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Reporter's name:

Reporter's function:

Phone:

E-mail:

Operator:

Aircraft Model:

Date of the occurrence:

Time:

State:

Municipality:

Aerodrome:

If necessary, provide additional information on the site of occurrence:

phase of operation, in accordance with MCA 3-6:

Informações do Voo:

Aircraft position::

Position of laser beam emitting source relative to acft:

Estimated distance from laser beam emitting source, if possible:

laser color:

Green Red Other

Was the LB emitting source in motion?

Yes No it was not possible to say

Was the laser beam coming directly from source

Yes No, it was being reflected it was not possible to say

number of LB emitting sources:

One more than one

approximate duration of exposure:

Did the laser beam pointing seem intentional?

Yes No it was not possible to say

Was heading change or evasive maneuver necessary?

Yes No

Consequences for the pilot's vision acuity:

Distraction

Formation of fake images

Dazzle

Temporary Blindness

Retinal burn

Retina hemorrhage

Was the occurrence reported via radio to ATC or AFIS station?

Yes

There was neither ATC unit, nor AFIS Station

relevant information not previously mentioned

Type the code: