Voluntary Safety Hazard Report Form Question Title * 1. Name (optional) OK Question Title * 2. Company (optional) OK Question Title * 3. Contact number/email address (optional however no feedback can be given if left blank) OK Question Title * 4. Type of Event Air Traffic Control Aircraft Aircraft taxi / towing / pushback Airfield Layout / facilities Driving standards Equipment / vehicle safety Jet blast Marshalling / AVDGS Other unsafe act Passenger handling Slip / trip / fall Stand Equipment Other (please specify) OK Question Title * 5. Date of Event Date / Time Date OK Question Title * 6. Time of Event Date / Time Time AM/PM - AM PM OK Question Title * 7. Location OK Question Title * 8. Weather Conditions Dry Icy Raining Snowing Sunny Thunderstorm Wet Windy OK Question Title * 9. Lighting Conditions Daylight Twilight Night time OK Question Title * 10. Flight Number (if applicable) OK Question Title * 11. Aircraft Type (if applicable) OK Question Title * 12. Vehicle Reg / ID (if applicable) OK Question Title * 13. Vehicle / Equipment Type (if applicable) OK Question Title * 14. Description of event / hazard observed. Include as much detail as possible. OK Question Title * 15. Describe any immediate actions taken. (e.g removed hazard, reported incident) OK Question Title * 16. Other information or suggestions for preventative actions. OK SUBMIT