Laser Report Form

Laser Report Form
Captain's Name

First Name Last Name
First Officer's Name

First Name Last Name
Company/Organisation
Flight Number
Date of incident

Month Day Year Date Picker Icon
Time of incident in UTC

: Hour Minutes AM/PM Option
Position when incident occurred (reference to navaid or other prominent feature, such as a runway
Phase of flight

Take-off Climb Cruise Descent Approach Landing Taxi
Altitude
Visibility
Atmospheric conditions
Colour of laser
Did the colour change during exposure? If so, describe
Did you attempt an evasive manoeuvre or any other avoidance techniques? If so, did the beam follow you through the manoeuvre?
Can you estimate how far from the aircraft the source of the laser was?
What was the position of the laser in relation to the aircraft?
Was the source moving?

Yes No
Was the laser coming directly from its source or did it appear to be reflected?

Yes No
Were there multiple sources of light?

Yes No
How long was the exposure?
Did the light seem to track your flight path or was there incidental contact?

Yes No
What tasks were you performing when the exposure occurred?
Did the exposure prevent or hamper your performance of those tasks, or was it more of an annoyance? Please specify what impact it had on the performance of your duties.
What were the visual after-effects that you experienced (ie. after-image, blind spots, flash-blindness, glare, etc) and how long did it last?
Did you report the incident to ATC?

Yes No
Were you warned about a possible exposure?

Yes No
Any other pertinent information?
Should be Empty:

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