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Safety Shield
Voluntary Confidential Report
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Voluntary Reporting/Hazard and Risk Assessment
Form Type (mark ONLY one option)
Voluntary reporting
Normal assessment
or
Date of Occurrence
UTC Time of Occurrence (if available)
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Date Reported
UTC Time Reported
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Choose a time
Location of Hazard
Full Name
Email
Telephone
A/C Information (if available)
Mandatory Occurrence Report (MOR) filled ?
NO
YES
For
Voluntary
reports
ONLY
, this information may be left blank (empty)
Other information (if available)
MOR identification number
Description (of the Safety Issue or Hazzard)
Additional Comments (of the Safety Issue or Hazzard)
Suggestions for Correction Measures
In your opinion, what is the likelihood that a similar occurrence can happen again? (Circle ONLY one answer)
Extremely improbable
Improbable
Remote
Occasional
Frequent
What do you consider could be the worst possible consequence if this occurrence will happen again? (Circle ONLY one answer)
Catastrophic
Hazardous
Major
Minor
Negligible
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CEA-SFT-04
Apply for the next EAGLE ONE (0-ATPL(A)) Modular group - Admissions Q4 of 2024
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