Form 5200-7 Bird/Other Wildlife Strike Report

FORM APPROVED OMB No. 2120-0045
Exp. 7/31/2013

BIRD / OTHER WILDLIFE STRIKE REPORT
U S. Department of Transportation
Federal Aviation Administration
Paperwork Reduction Act Statement: The information collected on this form is necessary to allow the Federal Aviation Administration to assess the magnitude and severity of the wildlife-aircraft strike
problem in the U.S. The information is used in determining the best management practices for reducing the hazard to aviation safety caused by wildlife-aircraft strikes. A federal agency may not conduct or
sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act
unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0045. Public reporting for this collection of information is
estimated to be approximately 6 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the
collection of information. The information collected is voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, AES-200.

1. Name of Operator

2. Aircraft Make/Model

3. Engine Make/Model

4. Aircraft Registration

5. Date of Incident

6. Local Time of Incident

/

/

Month

6A. Flight Number

Day

Year

☐ Dawn

☐ Dusk

__HR __MIN

☐ Day

☐ Night

☐ AM ☐ PM

6B. Wildlife/Bird Remains:
☐ Collected

7. Airport Name/ID

☐ Sent to Smithsonian

8. Runway Used

9. Location if En Route (Nearest Town/Reference &
State/Airport)

10. Height (AGL)

11. Speed (IAS)

12. Phase of Flight

13. Part(s) of Aircraft Struck or Damaged
Struck
Damaged

☐
☐
☐
☐
☐
☐
☐
☐

A. Parked
B. Taxi
C. Take-off Run
D. Climb
E. En Route
F. Descent
G. Approach
H. Landing Roll

Struck

Damaged

H. Propeller

☐

☐
☐

☐

I. Wing/Rotor
J. Fuselage

☐
☐

☐

☐

☐

K. Landing Gear

☐

☐

E. Engine No. 2

☐

☐

L. Tail

☐

☐

F. Engine No. 3

☐

☐

M. Lights

G. Engine No. 4

☐

☐

☐

☐

N. Other: (Specify)

☐

☐

A. Radome

☐

☐

B. Windshield

☐

☐

C. Nose

☐

D. Engine No. 1

Specify if “N. Other” is checked:

Bird(s) Ingested? ☐ Yes

16. Precipitation
☐ Fog
☐ Rain
☐ Snow
☐ None

15. Sky Condition
☐ No Cloud

14. Effect on Flight
☐ None
☐ Aborted Take-Off

☐ Some Cloud

☐ Precautionary Landing

☐ Overcast

☐ Engines Shut Down
☐ Other: (Specify)
17. Bird/Other Wildlife Species

18. Number of birds seen and/or struck
Seen
Struck
Number of Birds
1
2-10
11-100
more than 100

20. Pilot Warned of Birds

☐ Yes

☐
☐
☐
☐

19. Size of Bird(s)
☐ Small

☐
☐
☐
☐

☐ Medium
☐ Large

☐ No

21. Remarks (Describe damage, injuries and other pertinent information)

DAMAGE / COST INFORMATION
22. Aircraft time out of service
hours

23. Estimated cost of repairs or replacement (US $)

$

Reported by (Optional)

Title

Email

Phone

FAA Form 5200-7 (5/13) SUPERSEDES PREVIOUS EDITION

24. Estimated other Cost (U.S. $) (e.g. loss of revenue,
fuel, hotels)

$

Date

U.S. Department of
Transportation

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

Federal Aviation
Administration
800 Independence Ave SW
Washington DC 20591
Official Business
Penalty for Private Use, $300

BUSINESS REPLY MAIL
FIRST CLASS PERMIT NO. 12438 WASHINGTON D.C.
POSTAGE WILL BE PAID BY FEDERAL AVIATION ADMINISTRATION

Federal Aviation Administration
Office of Airport Safety and Standards, AAS-300
Attn: Wildlife Strike Report
800 Independence Avenue SW
WASHINGTON DC 20591

FOLD AND TAPE HERE