WILDLIFE EVENT REPORT FORM

Registration ANV: Date: Código:

AIRCRAFT

Operator: Manufacturer: Model:

TYPE OF AVIATION:

ENGINE (Only of an engine was struck).

Manufacturer: Model:

PART OF THE DAY

Local time: GMT time-(Z): PERIOD :

AERODROME

ICAO indicator or name:

Runway used(direction of use): Ex.: 12R

Out of aerodrome / en route

Aerodrome Safety Area (ASA): Coordinates / Radial & Distance (nautical miles): Height (AGL): ft Speed (IAS): kt

PHASE OF FLIGHT

PART(S) OF AIRCRAFT

Struck		Damaged
	Radome
	Windshield
	Nose (excluding above
	Engine(s) (nº )
Engine Ingestion? Yes Multiple ingestion? Yes
	Propeller(s) (nº )
	Wing / Rotor
	Fuselage
	Landing Gear
	Tail
	Other ( )

None	Not reported
Aborted take-off	Precautionary landing
Destabilization in the approach path	Engine shut down / flame-out
Go around
Other