AIRLINE

Part 1. DAMAGE BY

GROUND INCIDENT/ACCIDENT/DAMAGE REPORT

Title: One line statement of the main features of the incident/accident ()

AIRPORT

Other Aircraft Ramp Equipment Vehicle Foreign Object Jet Blast Unknown (Previously Unreported) Other (specify) Part 2. DETAILS OF DAMAGE

Date Time of Occurrence Phase of Operation Area (Stand, etc.) Aircraft Reg. Aircraft Type Flight Nr. Scheduled Ground Time Flight Delay hrs. min. Flight Cancelled YES/NO (delete as appropriate) Part 3. NUMBER OF CASUALTIES Fatalities Employees Passengers Others Non Fatal

Part 4. VEHICLE/RAMP EQUIPMENT DETAILS AND CONDITION REPORT Serviceable () Faulty () Serial Fleet Nr. Type Owner Area (Stand, etc.) Age of Vehicle/Ramp Eq. Last Overhaul

Tyres Brakes Steering Lights Wipers Protection Warning Devices Stabilisers Tow Hitch Field of vision from driving position

Remarks Remarks

Part 5. DETAILS OF PERSONNEL INVOLVED 1 Name Job Title Company Staff Nr. Licence Part 6. CONDITIONS Weather Use of official met. report Visibility Wind/gust Temperature m km / If kts c rain snow sleet hail fog

Name Job Title Company Staff Nr. Licence

Name Job Title Company Staff Nr. Licence Lighting Good Poor Day Night Twilight

Surface dry wet snow slush ice contamination

Part 7. CONTRIBUTORY FACTORS Identify by code from the checklist factors which in your opinion contributed to the incident/accident by major factor Other factors (specify) Which of these contributory factors are normal practice?

Part 8. SKETCH

Part 9. NARRATIVE Give a description of what happened. Include details of relevant contributory factors identified.

Part 10. INITIAL FINDINGS

Part 11. INITIAL ACTION TAKEN

Part 12. CLOSING ACTION

Part 13. PREPARED BY Signature

Name (Block Capitals) Status PAGE 2 OF 2

SPECIMEN OF A SUMMARY FORM

AIRLINE: Statistical Summary of Damages to Aircraft by Ground Support Equipment REFERENCE PERIOD: FROM TO ESTABLISHED BY:

TOTAL NUMBER OF FLIGHT DEPARTURES IN REFERENCE PERIOD: WIDE BODY A/C CONV. A/C TOTAL

Category / Type of Equipment Involved WIDE BODY A/C 1. PASSENGER HANDLING EQUIPMENT Air jetties (passenger bridges) Passenger stairs/steps Mobile lounges (elevating) Invalid handling vehicle Passenger coaches/buses Others Sub total 2. AIRCRAFT LOADING EQUIPMENT Ramp tractors Baggage/cargo carts/dollies Container/pallet loaders Forklifts Belt conveyors Catering/cleaning trucks (elev.) Others Sub total 3. AIRCRAFT SERVICING EQUIPMENT Toilet /water vehicles Fuelling trucks/services Aircraft tow tractors/tow bars Air start/ground power units Engineering access equipment High lift equipment/De-icers Others Sub total 4. MISCELLANEOUS Motor vehicles Others Sub total 5. FOREIGN OBJECT DAMAGE Subtotal 6. JET BLAST DAMAGE Subtotal 7. PREVIOUSLY UNREPORTED DAMAGE Subtotal TOTAL

Total Number of Damages Recorded

Damage Rate per 1000 Flight Departures

CONV. A/C

TOTAL

WIDE BODY A/C

CONV A/C

TOTAL