Izvješće o ugrožavanju sigurnosti / Aviation Safety Report
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2 REPUBLIKA HRVATSKA Agencija za istraživanje nesreća i ozbiljnih nezgoda zrakoplova Agencija za civilno zrakoplovstvo REPUBLIC OF CROATIA Aircraft Accident and Incident Investigation Agency Croatian Civil Aviation Agency Izvješće o ugrožavanju sigurnosti / Aviation Safety Report Proslijediti unutar 72 sata: To be forwarded within 72 hours to: 1. Vrsta ugrožavanja / Type of occurrence: Agencija za istraživanje-fax:+385/1/ Agencija za civilno zrakoplovstvofax:+385/1/ a) operacije zrakoplova / flight occurrence 1e) usluge u zračnoj plovidbi / ATM occurrence 1b) održavanje zrakoplova / maintenance occurrence 1f) problem zemaljskih usluga / ground services occurrence 1c) popravak zrakoplova / repair occurrence 1g) tehnička sredstva / technical facilities occurrence 1d) ugrožavanje na aerodromu / aerodrome occurrence 1h) drugo/other 2. Tip zrakoplova / aircraft type: 3. Registracijske oznake zrakoplova / Aircraft registration: 4. Pozivni znak zrakoplova / Radio callsign: 5. Datum i vrijeme ugrožavanja / Date and time: 6. Operator i vlasnik / Operator and Owner: 7. Broj leta / Flight no.: 8.: Mjesto polazišta / Departure place: 9. Mjesto odredišta / Destination point: 10. Mjesto događaja / Place of occurrence: 11. SSR kod / SSR code: 12. Pravila letenja / Flight rules: 13. Doba dana/light conditions: VFR IFR Dan/ Day Noć / Night Sumrak / Twilight 14 Broj uključenih / Involved: Zrakoplova / Aircraft Vozila / Vehicles Osoba / Persons 15 Faza leta / Flight phase: Tijekom stajanja / Parked Vožnja / Taxi Uzlijetanje / Take off Penjanje / Climb Na ruti / En route 16 Vrsta operacije / Type of operation: Međunarodni / International Domaći / Domestic Premještanje / Ferry Vlastite potrebe / Non commercial 17 Opasne tvari u zrakoplovu / Dangerous goods on board: 18 Broj osoba u zrakoplovu / Number of persons on board U prilazu / Approach Tijekom promjene razine / Flight level change Snižavanje / Descending Linijski / Scheduled Čarter / Charter Taksiprijevoz / Air Taxi Radovi iz zraka / Aerial work Posada / Crew: Životinja / Animals Vojnih zrakoplova / Military aircraft Drugo / Other Slijetanje / Landing Vožnja nakon slijetanja / Taxiing after landing Drugo / Other Putnički / Passenger Teretni / Cargo Izobrazba / Training Drugo / Other Putnika / Passengers: 19 Meteorološki uvjeti / Weather conditions: Općenito / General IMC VMC Vjetar / Wind Vidljivost / Visbility Oblaci / Clouds Temperatura / Temperature QNH Nema / None / kt m/km / ft C hpa nastavlja se na sljedećoj strani /continue over page
3 Izvještaj o ugrožavanju sigurnosti / Safety Occurrence Report Pojedinosti / In particular: Iznad oblaka / Above clouds Vedro / Sky clear Ispod oblaka / Below clouds Kiša / Rain U oblacima / In clouds Snijeg / Snow Između slojeva / Mid layers Magla / Fog nastavak / continuation Djelomično u oblacima / In and out clouds Grmljavina / Thunderstorm Turbulencija / Turbulence Smicanje vjetra / Wind shear 20. Oznaka uzletno sletne staze staze / Runway designator: 21. Stanje uzletno-sletne staze / Runway condition: Suha / Dry Vlažna / Wet 22. Sustav za uzbunjivanje / Alerts: ACAS/TCAS TA RA GPWS 23. Transponder: 24. Opis ugrožavanja / Brief description: Snijeg / Snow Led / Ice STCA MSAW Zadržavanje vode / Standing water RVR metara / meters A-SMGCS 25. Prilozi / Attachments: Skice / Sketches Izvješća / Reports Slike / Photographs Drugo / Other Osoba koja podnosi izvješće / Report submitter: Ime i prezime / Name: Telefon / Phone: Potpis / Signature: Ispunjava Agencija za istraživanje / For Investigation Agency use: Broj izvješća / Reference number: Planirane aktivnosti / Action: Datum primitka / Date: Ime službenika / Name: Daljnje aktivnosti / Further action required: / / Potpis / Signature: Prijedlog mjera (sigurnosne preporuke) / Safety Recommendations:
4 REPUBLIC OF CROATIA Aircraft Accident and Incident Investigation Agency Croatian Civil Aviation Agency REPUBLIKA HRVATSKA Agencija za istraživanje nesreća i ozbiljnih nezgoda zrakoplova fax: +385/1/ Agencija za civilno zrakoplovstvo Fax:+385/1/ IZVJEŠĆE O SURU S PTICAMA/ BIRD STRIKE REPORT Operator 01/02 Izvedba/model zrakoplova/ 03/04 Aircraft Make/Model Izvedba/model motora/ 05/06 Engine Make/Model Utjecaj na let/ Effect on Flight Nema/ none 32 prekinuto uzlijetanje/ aborted take-off 33 slijetanje iz predostrožnosti/ precautionary landing 34 zaustavljeni motori/ engines shut down 35 ostalo (naznači)/ other (specify) 36 Registracija zrakoplova/ 07 Aircraft Registration Datum/ dan/ mjesec/ godina/ 08 Date day month year Mjesno vrijeme/local time 09 zora/ A dan/ B sumrak/ C noć/ D 10 dawn day dusk night Ime aerodroma/ 11/12 Aerodrome Name Uporabljena staza/ 13 Runway used Mjesto - ako je na ruti/ 14 Location if enroute Oblačnost/ Sky Condition 37 vedro/ no cloud nešto oblačnosti/ some cloud nebo prekriveno/ overcast A B C Oborine/ Precipitation magla/ fog 38 kiša/ rain 39 snijeg/ snow 40 Vrste ptica/ bird Species* 41 Broj ptica/ number of birds Ugledan/seen 42 Udaren/struck 43 1 A A 2-10 B B C C više/more D D Visina (AGL)/ ft 15 Height Brzina (IAS)/ kt 16 Speed Faza leta/ Phase of Flight 17 parkiran/parked A na ruti/enroute E u vožnji/taxi B snižavanje/descent F zatrčavanje/ take-off run C prilaženje/approach G penjanje/climb D zaustavljanje/landing roll H Veličina ptice/ Size of Bird 44 mala/small S srednja/medium M velika/large L Dio/Djelovi zrakoplova/ Udaren/struck Oštećen/damaged Pilot upozoren na ptice/ 45 da/yes y ne/no x Part(s) of Aircraft pilot warned of birds radarska kupola/radome 18 vjetrobran/windshield 19 Napomene/ Remarks: nos (osim gore navedenog)/ nose(excluding above) 20 (opiši štetu, ozljede i ostale bitne podatke)/ (describe damage, injuries and other pertinent information) 46/47 motor br. 1/ engine no motor br. 2/ engine no motor br. 3/ engine no motor br. 4/ engine no propeler/ propeller 25 krilo/rotor / wing/rotor 26 trup/ fuselage 27 podvozje/ landing gear 28 rep/ tail 29 svjetla/ lights 30 ostalo (naznači)/ other(specify) 31 * Molim priložite ostatke ptice zbog identifikacije. I najmanji dijelovi ptice mogu poslužiti, međutim što je uzorak veći identifikacija je lakša./ Enclose bird remains. No bird fragment is too small to be useful, but the larger the sample available the easier the task of identification. Izvještaj sastavio/ Reported by Datum/Date Letačka posada/ Flight crew Zemaljsko osoblje/ Ground servicing personel
5 CROATIA CONTROL,Croatian Air Navigation Service Limited. HRVATSKA KONTROLA ZRAČ PLOVIDBE d.o.o. Izvješće o opasnom približavanju zrakoplova, nepropisnoj primjeni postupka ili radu radionavigacijskog ili drugog sredstva Aircraft proximity, irregular procedure employment or work of radionavigation or other facility Report Form 1. Približavanje zrakoplova Airprox Postupak Procedure Zemaljsko sredstvo Facility 2 Pozivni znak zrakoplova / nadležna KZP Radio callsign of reporting aircraft/reporting ATC unit datum i vrijeme date and time UTC Pilot: reg. oznaka zrakoplova aircraft registration vrijeme u min /sek između prvog kontakta i najmanjeg odstojanja time in min/sec elapsed between first sighting and closed proximity akcija izbjegavanja: avoiding action ako da, na temelju TCAS if yes, based on TCAS tip zrakoplova type of aircraft aerodrom odlaska aerodome of departure aerodrom odredišta aerodrome of destination u komunikaciji s: in communication with frekvencija radarska frequency identifikacija radar identification informacija o prometu dobivena traffic information received SSR kod/ SSR code 3 4 Pozicija Position Visina leta FL, altitude or height 2) kod prvog kontakta on first sighting m/ft/fl 5 2) pojedinosti in particular Meteorloški uvjeti Flight weather conditions iznad oblaka on top smijer ruta ili rute heading or route 1) za vrijeme događaja at time of occurence m/ft/fl horizontalni let horizontal flight ispod oblaka below clouds 1) općenito in general penjanje climb u oblacima in clouds snižavanje descend horizontalni let/ horizontal flight TAS kt postavljanje visinomjera altimetter setting IMC VMC između slojeva btn. layers djelomično u oblacima in and out of clouds penjanje climb snižavanje descend vedro sky clear hpa inch 3) odstojanje od oblaka distance from clouds vertikalno vertical m/ft horizontalno horizontal m/ft/nm naoblaka sky coverage 4) vidljivost u letu flight visibility: km/nm 6 u sunce into sun Opis drugog zrakoplova Description of other aircraft od sunca out of sun u sumaglici in haze 1)registracijska oznaka / pozivni znak aircraft registration/radio callsign primjedba remarks 2)tip zrakoplova type of aircraft 3) oznaka, boje i/ili svjetla markings, colours and / or lights maskirni camouflage 4) oblik zrakoplova shape of aircraft 5) niskokrilac low horizontalni let horizontal flight visokokrilac high penjanje climb srednjokrilac shoulder wing snižavanje descend 6) broj i smještaj motora no. and position of engines 8) dopunska informacija other relevant information 7) procijenjeni smjer leta/estimated heading lijevi zaokret/left desni zaokret/left SSR kod SSR code
6 7 Opis: Description: (u slučaju približavanja zrakoplova uključ. relativnu putanju leta vertikalno i horizontalno odstojanje od drugog zrakoplova u prom kontaktu i u trenutku događaja obavljena i/ili uočene mjere izbjegavanja) (in case of airproc including relative flight path, vertical and horizontal distance to prior aircraft at first sighting and at time of incident, executed and / or observed involving action.) 8 Informacije jedinice KZP Information from ATC unit 1) informacija o prometu izdana traffic information issued Navedi razlog, ako nije izdana. State reason, if none issued. 2) sadržaj izdane informacije u prometu information issued. smjer udaljenost smjer leta direction distance heading 3) najmanje odstojanje između ciljeva closed proximity observed between targets 4) Dopunsko izvješće slijedi Supplementary report to follow: Proslijeđeno Forwarded to Primio Received by Tlocrt Planview Nacrt Profileview Stotina metara stotina stopa stotina metara metara Popis osobe koja podnosi izvješće Signature of a reporting person Datum / Date Prezime/Surname Ime / Given name Adresa / Address
7 REPUBLIKA HRVATSKA Agencija za istraživanje nesreća i ozbiljnih nezgoda zrakoplova Prisavlje 14, Zagreb Fax:+385/1/ Izvješće o nesreći ili ozbiljnoj nezgodi zrakoplova Notification of an Aircraft Accident or a Serious Incident REPUBLIC OF CROATIA Aircraft Accident and Incident Investigation Agency Prisavlje 14, Zagreb Fax:+385/1/ Ovo izvješće treba se proslijediti telefonom ili faksom. Upišite ili označite rubrike. This notification should be transmitted by phone or by fax. Please enter or mark fields. a Osoba koja prijavljuje Person reporting Ime i prezime/name Mjesto/Location Telefon/Phone b c d Mjesto nesreće ili ozbiljne nezgode, Regija/Država Location of the Accident or Serious Incident, District/State Datum, vijeme i tijek događaja Date, Time and Timeline Zrakoplov Aircraft Kategorija Weight category Registracija i pozivni znak Registration and Call sign Operator zrakoplova Name of operator Adresa i država operatora Address & State of operator (MTO) Mjesto/Location više od 20t more than 20 t Regija/Država/District/State Datum/Date Vrijeme/Time Timeline UTC MET MEST Proizvođač/Manufacturer između 14 t - 20 t between 14 t - 20 t Registracija/Registration Operator zrakoplova/name of operator Adresa operatora/address of operator više od 5,7 t 14 t between 5,7 t 14 t između 2,0 t 5,7 t between 2,0 t 5,7 t Model/Model ispod 2,0 below 2,0 nepoznato unknown Pozivni znak/call sign Država operatora/state of operator e Vrsta zračnog prometa Type of operation Međunarodni International Redovni Scheduled Putnički Passenger (Air transport operations) Domaći Čarter Teretni Doemstic Charter Cargo Premještanje Ferry Izobrazba Training Drugo Other Vrsta zračnog prometa (Opća Drugo Rekreacija avijacija) Instrukcija/Instructional Other Pleasure Type of Operation (Gen. Aviat.) _ Poslovno Business Samostalno Single Duplo Dual Provjera Check Nepoznato Unknown Odlazak,odredište i plan leta Odlazak/Departure Odredište/Destination Plan leta/flight plan Departure, destination & FPL f Zapovjednik zrakoplova Prezime/Surname Ime/First name Pilot in command g Broj osoba u zrakoplovu Posada/Crew Putnici/Passengers Drugi/Others Number of persons on board h Broj ozlijeđenih osoba Number of persons injured Posada/Crew Putnici/Passengers Drugi/Others - smrtno fatal - ozbiljno serious - lakše minor - neozlijeđeni none Šteta na zrakoplovu Damage to the aircraft uništen destroyed oštećen substantial mala minor nikakva none nepoznata unknown Šteta nanijeta trećim osobama (građevine, vozila, flora,...) Third party damage (buildings, vehicles,plants,...) i Opasne robe u zrakoplovu Dangerous goods on board nema none *Za svaki zrakoplov potrebna je odvojena prijava (nastavlja se na slijedećoj stranici / will be continued at the next page)
8 Izvješće o nesreći ili ozbiljnoj nezgodi zrakoplova Notification of an Aircraft Accident or a Serious Incident j Opis nesreće ili ozbiljne nezgode Desription of the Accident or Serious Incident Faze leta Tijekom slijetanja Landing Phase of flight Vožnja Taxi Uzlijetanje Take-of Neuspjelo prilaženje Missed approach Penjanje Climb Na ruti En-route Tijekom promjene razine Flight level change (nastavak/continuation) Snižavanje Descent Slijetanje Landing Voženje nakon slijetanja Taxing after landing Drugo Others Napišite kratak opis okolnosti koje su dovele do nesreće ili ozbiljne nezgode, oštećenja, vrste ozljeda i meteorološke informacije. Please give a short description of the circumstances of the accident or serious incident,damages,type of injuries and meteorological informations. Doba dana Light conditions Dan Daylight Svitanje Dawn Tamna noć Night-dark Nepoznato Unknown Sumrak Dusk/twilight Mjesečina Night-moonlight Meteorološki uvjeti Weather conditions VMC IMC CAT ATIS Potvrda Confirmation Mjesto/Location Datum/Date Potpis/Signature
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