SIPAER

Bird/wildlife management system - Sigra

WILDLIFE EVENT REPORT FORM - (Ficha CENIPA 15)

Type of Event

Information in red are mandatory

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Warning!
All information herein contained has the solely purpose of wildlife strike accident prevention. Inappropriate use of the system should be avoided since data is the milestone of Safety Management System and its misuse impairs reporting by aviation stakeholders. The annual data summary feeds International Civil Aviation Organization databank in order to support the development of strategies to mitigate wildlife strike risk.

AIRCRAFT

TYPE OF AVIATION
ENGINE (Only of an engine was struck).

PART OF THE DAY
Local time: GMT time-(Z):
PERIOD :
AERODROME
Runway used(direction of use): Ex.: 12R
Out of aerodrome / en route
Aerodrome Safety Area (ASA):
Coordinates / Radial & Distance (nautical miles):
kt
PHASE OF FLIGHT
PART(S) OF AIRCRAFT
Struck
Damaged
Radome
Windshield
Nose (excluding above
Engine(s) (nº )
   
Propeller(s) (nº )
Wing / Rotor
Fuselage
Landing Gear
Tail
Other (
EFFECT ON FLIGHT
FAUNA SPECIES INVOLVED
'

Seen
Struck
Estimated individual animal size


DAMAGE / COST INFORMATION
Direct cost (inspection/repairs/replacement of items):
US$
Indirect cost - Estimated (lodging/profit losses):
US$

PILOT WARNED OF ANIMALS?

ADDITIONAL REMARKS

Describe personal injuries, aircraft damage, significative bird concentrations, attractants on the ground, estimated loss of thrust engine vibration, fire or any other valuable information.

Reported by: Role: :
:

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Warning! This form does not replace any notification reporting procedure to Cenipa!