APPENDIX - A (Attachment 2)
Tribhuvan International Airport Civil Aviation Office
Aerodrome Operator Report Form
(To be filled by Aerodrome operator, Aerodrome personnel, Aerodrome Safety Personnel)
1. CATEGORIES OF OCCURRENCE
ACCID   INCID   HAZARD   RWY INCURSION   RWY EXCURSION
2. Name of Operator 3. Aircraft Registration 4. Aircraft Type
5. Aircraft Name

*

6. Date of Occurrence(dd/mm/yyyy)

*

7.Time of Occurrence (UTC)

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Dawn   Dusk   Day   Night
8. Phase of Flight
Parked   Taxi   Take-off Run   Landing Roll
9. Location at the airport
Runway   Taxiway   Apron   RWY Strip
Fence
Other (specify)  
10. Speed
High   Medium   Normal   Slow  Rest
11. Aircraft Parts' Struck or Damaged Effect on Flight
None   Aborted Take-off
Precautionary Landing   Engine Shut Down
Other (specify)  

12. Precipitation
Fog   Snow   Rain   None
Struck Damaged Struck Damaged
A. Windshield H. Wing/Rotor
B. Nose I. Fuselage
C. Engine No. 1 J. Landing Gear
D. Engine No. 2 K. Tail
E. Engine No. 3 L. Lights
F. Engine No. 4 M. Other:
G. Propeller (Specify)
13. Other damages or injuries to:
Parked   Taxi   Take-off Run   Landing Roll
14. Witness information,
if any (Name, address, telephone, etc.)
Other aircraft   Infrastructures   Vehicles   People  Equipment
15. Detail Information (Describe about Occurrence, damage, injuries and other pertinent information)
16. Reported By

*

17. Title, Office

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18. Date

*