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HAZARD REPORTING FORM

SELECT A CLASSIFICATION

Confidential
Anonymous
Open

PLEASE DESCRIBE THE HAZARD (including aircraft reg, date/time/other aircraft/agencies/any other detail)

IN YOUR OPINION WHAT RISKS ARE ASSOCIATED WITH THIS HAZARD?

BY BY YOUR

PLEASE INDICATE BY SELECTING THE APPROPRIATE OPTION WHAT, IN YOUR OPINION, IS THE PROBABILITY OF THE HAZARD

Frequent (5)
Occasional (4)
Remote (3)
Improbable (2)
Extremely Improbably (1)

PLEASE INDICATE BY SELECTING THE DEGREE OF SEVERITY OF CONSEQUENCE SHOULD THE HAZARD ACTUALLY HAPPEN

Catastrophic
Hazardous
Major
Minor
Negligible

SELECT SAFETY RISK VALUE *

5A
5B
5C
5D
5E
4A
4B
4C
4D
4E
3A
3B
3C
3D
3E
2A
2B
2C
2D
2E
1A
1B
1C
1D
1E

Name (Not Required)

Surname (Not Required)

Email (Not Required)

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