Cabin Safety Report Form (*) Indicates the field is required Date of Event *Flight Segment (From-To): *Aircraft Type *Challenger 605Learjet 60Cabin Lighting Approximate time of Event (UTC): *Location of Event: *Aircraft Registration *A6-ASMA6-VGGA6-GOANot Applicable (N/A)Number of Passengers Flight No. *Gate/Stand: Weather conditions Number of Crew Flight phase: ParkedPushbackTaxi-OutTake-OffInitial ClimbClimbCruiseHoldingDescentApproachLandingTaxi-InEvent Title (check all that apply): Defective or Inadequate EquipmentCommunications System FailureDecompressionDisruptive PassengerEmergency Cabin PreparationEmergency LandingEmergency Equipment Missing or U/SEvacuationFire / Smoke / FumesDangerous Goods ExposureHealthIntoxicated PassengerDefective Jump SeatLavatory Water OverflowPotential of Injury (To Passenger / Cabin Crew)Problem Enforcing RegulationsSafety Related Interruptions During Sterile CockpitSafety Standards ReducedSignificant TurbulenceSmoke Detectors Activated / VandalizedUseful Information for Safety EnhancementOtherEvent Description *Factual description of event with all relevant information (weather, airfield facilities, cabin equipment, etc.).Recommendations: Use additional sheet if necessary.Image Upload Drop your file here or click here to upload You can upload up to 10 files. File Upload Drop your file here or click here to upload You can upload up to 10 files. Pilot In Command Staff Number Reporter’s Name First Officer Staff Number eSignature * ASM-SMS-F-6 EmailSubmit
