APPENDIX - A (Attachment 4)
Tribhuvan International Airport Civil Aviation Office
Bird/Other Wildlife Strike Report Form
(To be filled by Pilots, ATC, Airport operator, Airline, Safety personnel, etc.)
1. CATEGORIES OF OCCURRENCE
ACCID INCID HAZARD BIRDSTRIKE WILDLIFESTRIKE (Shall fill one of first three boxes and one of the last two boxes)
2. Name of Operator 3. Aircraft Make/Model 4. Engine Make/Model
5. Aircraft Registration 6. Date of Incident(dd/mm/yyyy) 7. Time of Incident (UTC)
Dawn Dusk
Day Night
8. Airport Name 9. Runway Used 10. Location if en-route (Nearest city, place etc.)
11. FL/ALT/HT(ft) 12. Speed (IAS - kts)
13. Phase of Flight 14. Parts of Aircraft Struck or Damaged
A. Parked
B. Taxi
C. Take-off Run
D. Climb
E. Enroute
F. Descent
G. Approach
H. Landing Roll
  1. Radome
  2. Windshield
  3. Nose
  4. Engine No. 1
  5. Engine No. 2
  6. Engine No. 3
  7. Engine No. 4
Truck Damaged
  1. H. Propeller
  2. I. Wing/Rotor
  3. J. Fuselage
  4. K. Landing Gear
  5. L. Tail M. Lights
  6. M. Other: (Specify)
Truck Damaged
15.Effects On Flight
None
Aborted take-off
peacautionary Landing
Engine Shut Down
Other:(Specify) 		16. Sky Condition
No Cloud
Some Cloud
Overcast
17. Precipitation
Fog
Rain
Snow
None
18. Bird/Other WildLife
Species
 19. Number of Bird(s)/WildLife
Number Seen Struck
1
2-10
11-100
More Than 100
20. Size of Bird(s)/WildLife
Small
Medium
Large
21. Pilot warned of Birds yes No
22. Detail Information (Describe damage, injuries and other pertinent information)
Reported By 24. Title, Office 25. Date
Reported To : GM   ANSSSD   ASO   ASSD   FOD   AMD   Other
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