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  • DGCA Form 19-02 Mandatory Occurrence Report - Aerrodrome and Facilities - Oct 2017

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    didik prihananto
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    The document is a mandatory occurrence report form from Indonesia's Directorate General of Civil Aviation (DGCA) for reporting occurrences related to aerodromes and facilities. The form collects information about the date and location of the incident, aircraft details like registration and type, the type of facility involved, and a description of the occurrence. Reporters must provide their function, contact details, and signature.

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    DGCA Form 19-02 Mandatory Occurrence Report - Aerrodrome and Facilities - Oct 2017

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    The document is a mandatory occurrence report form from Indonesia's Directorate General of Civil Aviation (DGCA) for reporting occurrences related to aerodromes and facilities. The form collects information about the date and location of the incident, aircraft details like registration and type, the type of facility involved, and a description of the occurrence. Reporters must provide their function, contact details, and signature.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    72 views1 page

    DGCA Form 19-02 Mandatory Occurrence Report - Aerrodrome and Facilities - Oct 2017

    Uploaded by

    didik prihananto
    The document is a mandatory occurrence report form from Indonesia's Directorate General of Civil Aviation (DGCA) for reporting occurrences related to aerodromes and facilities. The form collects information about the date and location of the incident, aircraft details like registration and type, the type of facility involved, and a description of the occurrence. Reporters must provide their function, contact details, and signature.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    MINISTRY OF TRANSPORTATION

    DIRECTORATE GENERAL OF CIVIL AVIATION


    Office Complex Soekarno-Hatta International Airport, C3 St., Tangerang, Banten- Indonesia
    Telp.(+6221) 225 66288, (+6221) 256 08887 Fax. (+6221) 225 66399
    Website: hubud.dephub.go.id; e-mail: daao_dgca@dephub.go.id

    MANDATORY OCCURRENCE REPORT


    OCCURRENCES RELATED TO AERODROME & FACILITY

    Occurrence : Runway Incursion


    Runway Excursion
    Failure or Significant Malfunction of Airfield Lighting
    Foreign Object Debris on Runway or Taxiway
    Type of Occurrence : Incident
    Serious Incident
    Accident

    A. General Information
    Date / Time of Incident (UTC) :
    Location :
    Name of Airport :
    Information Weather :
    B. Aircraft Information
    Flight Number :
    Aircraft Registration :
    Type Of Aircraft :
    Pilot In Command :
    Operator :
    Flight Operation :
    Flight Phase :
    C. Facility
    Type of Facility :
    Failure :
    Damage to Aircraft (if any) :
    D. Description
    Detail of Occurrence :

    E. Reporter Detail
    Function :
    Address :
    Signature :
    Telephone Number :

    DGCA Form No. 19-02 (Oct 2017) Page 1 of 1

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