FLIGHT IRREGULARITY REPORT SP002 PAGE 1 OF 3

This form is used by CREW OR OPERATIONS to report flight operations irregularities to the Director of Operations, DOM (when applicable) and the Safety Manager Use First Report of Injury for passenger or crew injury, in addition to this report.
DATE	AIRCRAFT N #	FLIGHT #		TIME (local)	LOCATION
1	2	3		4	5
REJECTED TAKEOFF			BIRD / LIGHTNING STRIKE/CFIT
USE OF PIC EMERGENCY AUTHORITY			DEVIATION FROM ATC CLEARANCE
HARD LANDING			MAINTENANCE OTHER: ELECTRICAL HYDRAULIC, TRANSMISSION, ETC
ENGINE FAILURE INFLIGHT			IMPROPER AIRCRAFT LOADING/ WEIGHT AND BALANCE
OTHER ENGINE ISSUES			AIR TRAFFIC CONTROL DIFFICULTIES COMMUNICATIONS FAILURES
WEATHER RELATED ISSUES			DE-ICING PROBLEMS
TAXI INCIDENT / ACCIDENT			SICK OR INJURED PASSENGER OR CREWMEMBER
NEAR MIDAIR COLLISION			OTHER IRREGULARITY
ENGINE CHIP ISSUES			TRANSMISSION CHIP ISSUES

PASSENGER:

ILLNESS

7

INJURY

10

PAX NAME:

8

CPR ADMINISTERED

(Name of person performing CPR)

NAME: SEAT:

DOCTOR OR HEALTH PROFESSIONAL ASSISTING REASON:

9

NAME: SECURITY CALLED: _

(DIRECTOR OF OPERATIONS NOTIFICATION REQUIRED IF EMTs WERE REQUESTED TO MEET THE FLIGHT)

CREW	NAME	EMPLOYEE NO.
	11

See body of report on page 2 of this form

_

Signature of Pilot/Crew/Operations preparing this report

FLIGHT IRREGULARITY REPORT SP002 Page 2 of 3

FLIGHT IRREGULARITY REPORT (continued)

Narrative of Occurrence and Additional Information:

FLIGHT IRREGULARITY REPORT (FIR) INSTRUCTIONS

Pilots or Operations shall use this form for required written reports. Station Managers and Gate Agents may also use this FIR to report irregularities on the ground. Online submission,FAX or submit in person to the DOO or Quality & Safety Manager. “Intent to fly” should be the requirement to use this form in lieu of the Ground Occurrence Report.

Entries: (Refer to numbering on page 1 of this form as shown in the MH Forms Catalog)

Enter date irregularity occurred
Enter FULL aircraft number.
Enter flight number assigned. If no flight number assigned enter TYPE of flight (training, maintenance, ferry).
Enter time irregularity occurred (local time at location of occurrence).
Location of irregularity; will generally be the departure or destination airport (if in-flight, reference nearest airport).
Check appropriate boxes. Boxes which contain the statement (Dir. Ops. Notification required) or (Dir. Ops. & Maintenance Notification required) require that the person completing the report make immediate verbal contact with the Director of Operations (DO) AND the DOM (or their delegates) as soon as possible.
Enter passenger name and check appropriate block in cases of passenger Illness or injury.
If CPR was administered, enter the name of person who performed it (Dr., RN, paramedic, qualified passenger, etc.).
List name of doctor or health professional assisting (Ifapplicable).
Enter passenger name and seat assignment in all cases of unruly or intoxicated passenger problems (including smoking Incidents, failure to follow crew instructions, etc.). Check appropriate block(s) and state reason if passenger was deplaned.
Enter the names & employee numbers of flight crew and dispatcher (and Aircrew, if present).
For each item checked give complete details. Be specific. Outline times, places, and reasons for actions taken. Use page 2 for body of report to describe the irregularity or incident in detail.
Signature in Ink (required) of Pilot or Dispatcher preparing report.

Report due within 24 hours.

Aircraft Number:

FLIGHT IRREGULARITY REPORT SP002 Page 3 of 3

Technician’s Report of Corrective Action Taken:
Airframe Serial Number	Airframe Total Hours		Last Maintenance Check Completed		Date of Last Check	Hours Carried Out
Primary Affected / Failed Component (1)		Part Number (1)		Part Serial Number (1)		TSN (1)	TSO (1)
Primary Affected / Failed Component (2)		Part Number (2)		Part Serial Number (2)		TSN (2)	TSO (2)

	Technician (Printed Name )				Date		Time

	Maintenance Manager / Lead Technician Review (Printed Name )					Date
Director of Operations / Chief Pilot Review
Manager Comments:
Customer Delay:  YES  NO Hrs. Tenths
Incomplete Report:  YES
		Director of Operations / Chief Pilot (Printed Name)					Date

Mandatory Report:  YES  NO Date MOR Filed:					FAA/CAA Advised:  YES  NO
Company Investigation:  None  Open  Closed			Manufacturer Advised:  YES  NO
Additional Information:

	Name and Title of Person Reviewing this report					Date