C.A.O Safety and Accident/Incident Department 

Aircraft Accident/ Incident/ Hazard Report Form New Edition

Provide as much details as possible immediately. The purpose of this form is to collect the Voluntary information pertaining to the Accident/Incident/Hazard for CAO to act immediately for the investigation and review the causes. Completed form should be submitted at the earliest possible to: vice president of civil Aviation in flight standard, Civil Aviation Organization, Mehrabad international airport, Tehran, Iran. Fax: +98-21-66036247 Tel: +98-21-61023210,

   E-mail: aig@cao.ir 

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Marked fields should be filled*



C.A.O Safety and Accident/Incident Department
Accident/Incident/Hazard Details:
* Date of Accident/Incident:
Time: UTC:
* Local:
* Location:
Last departure pt:
Intended Destination:
Actual Point of Landing (if different):
ATS Route:
Number of Person Onboard:
Total Crew Onboard:
No Injuries:
Minor Injuries:
Serious Injuries:
Total Pax Onboard:
No Injuries:
Minor Injuries:
Serious Injuries:
No. of Persons Injured On Ground:
Other Company Employees Onboard (specify duties):
Aircraft Damage:
Damage Description:
Airspace designation:
Runway State:
Type of Operation:
Wild Life Strike:
Was a Bird or Animal Involved:
No. of birds:
(All relevant information should be forwarded to CAO, attach additional paper if required).
(Attach additional paper if required).
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