NATIONAL AVIATION SAFETY PROGRAM
DIRECTORATE GENERAL CIVIL AVIATION
VOLUNTARY INFORMATION FOR SAFETY IMPROVEMENT IN AVIATION SYSTEM
Voluntary Reporting System
Your identity will be treated confidentially and will merely be used if the Directorate General of Civil Aviation considered necessary to contact you for further information and for safety analysis that needs to be conducted. Please fill marked (*) fields
Secret Information ( Your identity will be treated confidentially )
Name
(*)
:
Phone
(*)
:
Email
(*)
:
General Information
Year
:
Control Number
:
Title
:
Information of Reporter
Organization Type
(*)
:
AIR OPERATOR
AERODROME
AIR TRAFFIC SERVICE PROVIDER (ATS PROVIDER)
AIRCRAFT MAINTENACE ORGANIZATION
AIRPORT AUTHORITY OFFICE
Organization
:
Duty of Reporter
(*)
:
Affliaion of Reporter
:
INFORMATION OF RELATED TO EVENT
Category
:
Choose Category
Large Aircraft / Air Navigation Service
Small Aircraft / Air Navigation Service
Cabin / Mechanic / Airport / Other
Event Date & Time
(*)
:
Time Frame
:
Weather Condition
:
Fog
Hailstone
Haze
Icing
Moy / Smoke
Other
Rain
Snow
Thunderstorms
Turbulence
Wind Shear
Visibility
:
m
Location
:
AIRCRAFT INFORMATION
State Of Registry
:
Indonesia
Malaysia
Singapore
Thailand
Vietnam
Aircraft Registration
:
Manufacturer
:
Serial Number
:
Aircraft Model
:
Engine Model
:
Year Built
:
Other ( Specify )
:
FLIGHT DETAILS
Country
Airport
Other ( Specify )
Last Departure Point
:
Planned Destination
:
Operation Type
:
Phase
:
APPROACH
EMERGENCY DESCENT
EN ROUTE
GROUND CHECK
INFLIGHT
INITIAL CLIMB
LANDING
MANEUVERING
POST-IMPACT
PUSHBACK/TOWING
STANDING
TAKEOFF
TAXI
UNCONTROLLED DESCENT
UNKNOWN
Occ On Ground
DETAIL REPORT
Report Content
(*)
:
Report Comment
:
SUPPLEMENTARY MATTERS
Content
:
Supplementary Document
:
Yes
No
Document Upload
:
Browse File
Supplementary Photo/Map
:
Yes
No
File Upload
:
Browse File
Captcha
(*)
:
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