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CAQA AeroTech Maintenance · Simulated workplace

Safety Occurrence and Hazard Report Form

FormControlled document
ATM-FRM-020
v2.2
Document ownerQuality and Safety Manager
Version2.2
Approved15 January 2026
Next review15 January 2027
StatusCurrent

Purpose. Use this form to report any occurrence, maintenance error, hazard, near miss, injury or lost tool so that it can be recorded, investigated and, where required, reported to the regulator.

1.When to use this form

Complete this form for any event that affected or could have affected the safety of an aircraft or a person, including errors you made yourself, tools unaccounted for, parts fitted incorrectly, injuries, fuel or fluid spills, ground equipment contact with aircraft and hazards you notice. Report to your supervisor first and complete the form on the same shift.

2.Just culture

Honest reports of errors will not lead to disciplinary action. The purpose of the report is to understand what happened and prevent it happening again. Reports may be made confidentially by speaking to the Quality and Safety Manager.

3.Describing the event

Describe what happened in the order it happened, the aircraft or component involved, the task being performed and the conditions such as time of shift, interruptions, lighting or pressure. Do not speculate on blame.

4.Immediate actions

Record what was done immediately, such as stopping the task, quarantining a part, searching for a tool, grounding the aircraft or giving first aid, and who was told.

5.Investigation and feedback

The Quality and Safety Manager will classify the report, decide whether it is reportable to the regulator, assign an investigator and provide feedback to the reporter within two working days.

6.Complete the form

ATM-FRM-020 v2.2 · CAQA AeroTech MaintenanceUncontrolled when printed. Simulated document created by CAQA for training and assessment.