Aerodrome Safety Circular

ASC 97-002
1997.09.11

Aviation Incident Report

AS OF: __________ __________
  Local Date Local Time

To: Aviation Operations Centre (24 Hrs)
Fax: 613-993-7768 Tel: 613-992-6853

From: __________ Tel: __________ Fax: __________

OCCURRENCE:  
a.  Type:  
b.  Location:  
c.  Date:  
d.  Local Time:  

AIRCRAFT/VEHICLES: Number One Number Two
a. Identification:    
b. Type/Model:    
c. Registration:    
d. Owner/Operator:    

ROUTE:  
a. Departure Point:  
b. Enroute Stops:  
c. Destination:  

PERSONS INVOLVED: Number One Number Two
  Crew Pax Other Crew Pax Other
a. Total:            
b. Killed:            
c. Injured:            

SUMMARY DESCRIPTION (including operational impact):
 
 
 
 
 
 
 
 
 
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