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Pilot Information

Reporter & pilot details

Person Reporting

Role *

Date of Birth

Please Specify Role *

Member Number

Leave blank if not a member

First Name *

Last Name *

No member found with Member Number .

⚠️ Member number does not match the surname provided.

Member number must be exactly 6 digits.

Email *

Contact Phone *

Phone number requirements for Australia:

Must start with 0

Must follow the format: 04XX XXX XXX

Must be exactly 10 digits long

Field must not be empty (required)

Pilot in Command

If different from the person reporting. Leave blank if you were the pilot.

Member Number

Must be exactly 6 digits. Leave blank if not a member.

No member found with Member Number .

⚠️ Member number does not match the surname provided.

Member number must be exactly 6 digits.

Date of Birth

First Name

Last Name

Contact Phone

Phone number requirements for Australia:

Must start with 0

Must follow the format: 04XX XXX XXX

Must be exactly 10 digits long

Field must not be empty (required)

Flying Hours

Hours Last 90 Days

Total Flying Hours

Hours on Type

Hours on Type (90 Days)

Occurrence Information

Occurrence Date *

Occurrence Time *

State *

Location *

Latitude (set by map)

Longitude (set by map)

Type a location above and press Search Map, use My Location, or click anywhere on the map to drop a pin.

Details of Incident/Accident (Please give a clear and accurate description of what happened) *

characters — more needed

Be as detailed as possible. Include what you saw, heard, felt, and any actions taken.

Damage to Aircraft *

Most Serious Injury to Pilot *

Passenger Injury

Persons on the Ground Injury

Passenger Details

Description of Damage to Aircraft *

Did this occurrence involve an aircraft conducting IFR or air transport operations (airline/charter/cargo/medical) YES/NO *

Did the occurrence take place in controlled airspace or special use airspace(military/danger/restricted/prohibited)? YES/NO *

Did this occurrence involve a near miss with another aircraft? YES/NO *

Did this occurrence involve a Bird or Animal Strike YES/NO *

Did this occur in the vicinity of an aerodrome?

Vicinity Aerodrome (Y Code)

Near Collision with another aircraft

Second Aircraft Registration

Second Aircraft Manufacturer

Second Aircraft Model

Relative Track *

Horizontal Proximity Unit

Horizontal Proximity

Vertical Proximity Unit

Vertical Proximity

Avoidance Manoeuvre Needed?

Alert Received

Bird/animal strike

Type of Strike

Size

Species

Number (approx)

Number Struck (approx)

Maintainer First Name

Maintainer Last Name

Maintainer Member Number

No member found with Member Number .

⚠️ Member number does not match the surname provided.

Member number must be exactly 6 digits.

Maintainer Level

Is this Occurrence an Accident or an Incident? *

Accident

Accident Definition

An occurrence where a person suffers serious or fatal injuries; or the aircraft sustains damage or structural failure which adversely affects the structural strength, performance or flight characteristics of the aircraft and would normally require major repair or replacement of the affected component.

Incident

Incident Definition

Any occurrence, other than an accident, that is associated with the operation of an aircraft and affects, or could affect, the safety of the operation of the aircraft.

What may have contributed to the event? *

Do you have further suggestions on how to prevent similar occurrences? *

Is this an Immediately Reportable Matter (IRM) or a Routinely Reportable Matter (RRM)? *

Immediately reportable matter

Immediately Reportable Matter (IRM)

An aircraft accident; or a loss of separation standards between two aircraft receiving an air navigation service provider (ANSP) separation service; or an occurrence resulting in serious damage to property outside the aircraft.

Routinely reportable matter

Routinely Reportable Matter (RRM)

A routinely reportable matter is a transport safety occurrence that has not had a serious outcome and does not require an immediate report, but where transport safety was affected or could have been affected.

Immediately reportable matters are required to be notified to RAAus via phone as soon as practicable. RAAus can be contacted on 02 6280 4700.

Flight Details

Type of Operation *

Please Specify *

Phase of Flight *

Name of Flight Training School *

Departure Location

Destination Location

Landing

Effect of Flight

No Effect Rejected Take-off Precautionary Landing Engines Shut Down Unknown Forced Landing

Flight Rules

Airspace

Airspace Class

Airspace Type

Altitude

Altitude Type

Environment

Light Conditions

Visibility

Visibility Reduced By

Cloud Fog Smoke Dusk Haze Other

Please Specify

Wind Speed

Wind Direction

Wind Gusting

Temperature

Aircraft Information

Aircraft data loaded for ( fields populated) - propeller data included

Please check pre-populated data is correct and amend any incorrect fields.

Unable to lookup aircraft data. Please try again.

Registration Number Prefix*

Registration Number Suffix*

Serial Number*

Make*

Model*

Registration Status*

Type*

Year Built*

Total Airframe Hours

Personal Locator Beacon carried *

PLB Activated *

Engine Details

Engine Make*

Engine Model

Engine Serial

Total Engine Hours

Total Hours Since Service

Propeller Details

Propeller Make

Propeller Model

Propeller Serial

Attachments

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Aircraft Data Modified

You have modified the prepopulated aircraft data. Please provide a reason for the changes.

Fields Changed:

Reason for Edit *

I acknowledge that Recreational Aviation Australia will submit a copy of my report to the ATSB on my behalf in accordance with mandatory reporting requirements under the Transport Safety Investigation (TSI) Act. *

Pilot Information

Please correct the following errors:

Person Reporting

Pilot in Command

Flying Hours

Occurrence Information

Near Collision with another aircraft

Bird/animal strike

Flight Details

Airspace

Environment

Aircraft Information

Engine Details

Propeller Details

Attachments

Aircraft Data Modified

Fields Changed: