Occurrence Report
Ver. 4.6.1.4 © 2017 SMART Global Solutions Ltd.
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Risk/Event Report
Originator Details
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Department:
Anonymous (password should be left blank)
Awaiting Update
Password:
Anonymous submission.
Inform me of any updates to this report.
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Name:
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Email:
Important to remember:
This form allows you to identify and report a Hazard/Risk that can lead to an Occurrence, Incident or Accident.
This form is for reactive and proactive reporting but is also aimed at preventing this type of occurrence from happening.
This form must be filled as soon as possible upon identification of a hazard, but within a maximum of 24 hours
(To the manager of the Safety Management System or HSE)
This form does not devolve the responsibility of an individual to take immediate action to prevent an unsafe event.
In accordance with heliconia Just Culture principile, the company will not initiate a disciplinary procedure
against a staff member who has made a safety report in good faith. This principle does not apply to
cases of deliberate violations or criminal acts.
The editor of this form can choose to be identified or remain anonymous.
EVENTS DETAILS
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Location:
Marrakech
Oujda
Tangier
Laayoune
Nouakchott
Dakar
Others
Event area:
Flight operations
Ground Operations
Airworthiness
Maintenance
Training
Safety/ HSE
Infrastructures
Root cause:
Procedure
Equipment
Other
Weather
Behaviour
Recent change
Third Party
Type of Event:
Hazard (ProActive)
Accident (ReActive)
Incident (ReActive)
Hour of the event:
Activity:
Onshore
Offshore
Helicopter type:
AW139
AS350
EC135
Helicopter registration:
Phase of operation:
OFFICE / ADMINISTRATION
PARKED
START/RUNUP
RECEIVING/MAINTENANCE
PAX/CARGO HANDLING
PREDEPARTURE/TAXIOUT
TAKEOFF
CLIMB
CRUISE
DESCENT
APPROACH
LANDING
POST LANDING/TAXI-IN
FUELING
OTHERS
*
Reason:
Information
Sensitive event
Other
If Others, please define:
Fatigue
*
Was this event related to fatigue?:
Yes
No
If yes, please explain why:
ADDITIONAL INFORMATION & SUGGESTIONS
Additional Information: :
Suggestions of solutions:
Please consider this note
Please specify the exact ''LOCATION'' of the event into the "Description" box below (Marrakech, Oujda, Tanger, Laayoune, Dakar, Nouakchott...)
Occurrence Details
*
Severity:
Unassessed
High
Medium
Low
*
Summary:
*
Description:
*
Occurrence Date:
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February 2019
Mon
Tue
Wed
Thu
Fri
Sat
Sun
05
28
29
30
31
1
2
3
06
4
5
6
7
8
9
10
07
11
12
13
14
15
16
17
08
18
19
20
21
22
23
24
09
25
26
27
28
1
2
3
10
4
5
6
7
8
9
10
Today
Clear
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
OK
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