RELATRIO DE PREVENO RELPREV

AIR SAFETY REPORT ASR

CENIPA 08

De acordo com as regulamentaes brasileiras, este relato (ou parte dele) somente ser usado para a
preveno de acidentes aeronuticos, a fim de aumentar a segurana operacional. Este relato no precisa ser
identificado. Caso o relator se identifique, o mesmo ser informado sobre as medidas adotadas.
In accordance with Brazilian regulations, this report (or any part of it) shall only be used for preventing
aeronautical accidents, and has the sole purpose of enhancing safety. This report does not need to be identified.
Should the reporter, however, chose to identify him/herself, he/she will be informed on the measures adopted.

DADOS GERAIS DA OCORRNCIA (OCCURRENCE INFORMATION)

LOCAL (PLACE):
DATA (DATE):

HORA (TIME):
PESSOAL ENVOLVIDO E/OU AERONAVE (PERSONNEL AND/OR AIRCRAFT INVOLVED)

SITUAO (SITUATION):

RELATOR (REPORTER):
E-MAIL/TELEFONE PARA CONTATO (CONTACT INFORMATION) ____________________________________________________________

ENCAMINHAMENTO DO ELO-SIPAER (TO BE FILLED BY BRAZILIAN SAFETY PERSONNEL)

/
NUMERO

DO:_________________________

/
ELO-SIPAER

ANO

PARA:___________________________________ DATA:_____/____/_____

ASSINATURA

PARECER DO SETOR RESPONSVEL:

ASSINATURA

AES CORRETIVAS RECOMENDADAS PELO ELO-SIPAER:

AVALIAO DO RISCO:

ASSINATURA