DOPLNKOVÉ HLÁSENIE O STRETE S VTÁKOM
Supplementary Bird Strike Reporting Form
Operator Costs And engine damage information

A. BASIC DATA

Aircraft Operator		
Aircraft Type/Make		
Engine Type/Make		
Aircraft Registration		
Date (dd.mm.yyyy)		
Aerodrome / Location if known		

B. COST INFORMATION

Aircraft time out of service:				hours	
Estimated cost repairs or replacement:	U.S.$ (in thousands)			
Estimated other costs (e.g. loss of revenue, fuel, hotels)	U.S.$ (in thousands)			

C. SPECIAL INFORMATION ON ENGINE DAMAGE STRIKES

Engine position No:		1	2	3	4	
					
Reason for failure/shutdown						
Unicontained failure					
Fire					
Shutdown-vibration						
Shutdown-temperature						
Shutdown-fire warning						
Shutdown-other (specify)						
Shutdown-unknown					
					
Shutdown-other (specify):		
		
Estimated % of thrust loss *)													
Estimated number of birds ingested													

Bird species:		
			
 *)  These may be difficult to determine but even estimates are useful.
Reported by:	Pracovisko (Organization)	__________________________________________________________________________________________
	Kontakt (Contact)	__________________________________________________________________________________________
	Dátum (Date) dd.mm.yyyy)	__________________________________________________________________________________________

odoslať na ( send to ):	LETECKÝ A NÁMORNÝ VYŠETROVACÍ ÚTVAR
Námestie slobody 6,  P.O.BOX 100
810 05 Bratislava
Slovenská republika
*	E-mail:	vysetrovanie@mindop.sk
4	Fax:	+421 2 5273 1442