See reverse for mailing details / YES / NO(If YES please provide preferred contact details)
…………………………………………………………………………..
CATEGORY: / Occurrence / Safety Concern / Accident / Improvement / Other (please specify)
Event date / Aircraft Type / Registration / Location / Flt.No./Operator
Work Order/Job Card Number etc. / Related Document Reference / Other ref’s – i.e. SB, AD, etc.
Component / Part No. / Serial No.
Brief Title of Report:
Details/Description(please provide photos if applicable)
Immediate Corrective action taken
Suggestions to prevent further occurrence
Has this been reported to any one previously – YES / NO
If so please provide details:
Reporters Name (Optional) / Job Title / Base/Dept. / Date
Stamp U/S label with MOR for associated components and return to Stores for the attention ofthe Engineering Safety Team.
Use and Explanation of Terms Used
Confidential Report / If you wish the ESR to be treated as confidential, circle “YES” where prompted and provide details of how you would like the Engineering Safety Team to contact you. See below for mailing details.Category
Occurrence / Please select the appropriate category based on the nature of the report
An event that presented or would / could present a hazard to the safe operation of an aircraft/business
Safety Concern
Accident / Something that nearly or might have happened, a near miss, a situation or condition that has the potential to cause adverse consequences to the operation of TUI’s business
Please give details of the accident, but always ensure a ‘Personal Accident and incident Report Form’ is completed
Improvement
Other / Anything that would improve how we do things. Please give as much detail as possible of the problem and what could be done to solve it.
If there is something you wish to report, that is not covered within the noted criteria, please annotate the nature of the occurrence in the space provided, and provide details in the ‘Details/Description’ box
Event Date
Aircraft Type / Provide date of the event
a/c type (e.g., B737-800)
Registration / full registration (e.g. G-TUIA)
Location / airport (e.g. LGW)
Flt No. / Operator / Flight no. if applicable and operator (e.g. TUI, SWG, etc.)
Workorder / Job Card / Number / source document recording event (if applicable)
Related Document Reference
Other References / Please give full reference to any applicable AMM/CMM/IPC etc.
Please give full reference to any other related documents (i.e. Service Bulletin, Airworthiness Directive etc.)
Component / Description of component (e.g. BSCU, IDG, Oven etc.)
Part No. / part no. from data plate
Serial No. / serial no. from data plate
Details / Description / Record as much detail as possible about the event – what happened, where did it happened, who did it happen to. You may not be able to answer how it happened or why it happened but if you can, please record this.
If it has been possible to take photographs, record where they have been stored following download or who they were emailed to. Photos are invaluable in explaining an event – please take photos whenever possible.
Immediate Corrective Action / Record exactly what has been carried out to correct the reported issue (if applicable)
Suggestions to Prevent Further Occurrence / If there is something you are aware of that may prevent a reoccurrence record it here
Repeat Occurrence / Are you aware of a similar occurrence?
Completed forms should be submitted by one of the following methods:
- Email to
- Mail to FAO E&M Risk and Safety Manager, Hangar 61, London Luton Airport, Luton, LU2 9LX
- Click on ‘Press to Submit’ below
- Follow these instructions when pressing ‘Press to Submit’
- Are you sure you would like to send the ESR now? select ‘yes’
- Would you like to save this ESR? select ‘yes’ and save a copy (or the ESR that sends will be blank)
Confidential Reports should be sent by mail marked as “Private Confidential” to
Daniel Leinhardt,Hangar 61, London Luton Airport, Luton, LU2 9LX
or by e-mail to:
NOTE:Safety Reports will always be accepted if submitted anonymously. Please be aware though that on occasions there may be a need to gain further information regarding the nature of the report, and without a reporters name, carrying out a full and through investigation may be hindered.
FORM NO. ENG/1099 - Issue 23 - Page 2 of 2