1. REFERENCE INFORMATION			
1.1 Operator
	1.2 Aircraft Manufacturer and Type/Model	1.3 Aircraft Registration	
1.4 Flight number	1.5 Date (dd/mm/yyyy) and Time (UTC)	1.6 Departure Airport	1.7 Arrival Airport	
2. CONDITIONS OF ENCOUNTER	
2.1 Flight level or altitude	2.2 Geographic Position	
2.3 Meteorological Conditions:

 VMC              IMC	2.4 Light Conditions:

 Daylight          Dusk/dawn        Night	

3. ASH DESCRIPTION AND ENCOUNTER PHASE 	
3.1 Ash cloud visible?      No                   Yes
	3.4 Encounter Phase 	
3.2 Colour of ash cloud

 White               Light grey                Dark grey 

 Black               Other…..………………	 Taxi 
 Take-off 
 Climb 
 En-Route 	 En-Route (flight level change)
 Descent 
 Approach 
 Landing 	 Hovering
 Ground Handling 
 Unknown 
 Other, specify: …..…………………..	
3.3 Density of ash cloud

 Wispy (thin)       Moderately dense   Very dense
	3.5 Estimated duration of encounter (hh:mm)   	
4. SEVERITY OF ENCOUNTER (multiple boxes may be marked as appropriate)	

0	 Sulphurous odour noted in the cabin.
 Anomalous atmospheric haze observed.
 Electrostatic discharge (St. Elmo's fire) on windshield, nose, or engine cowls.
 Ash reported or suspected but no other effects or damage noted.	

1	 Light dust observed in cabin.
 Ash deposits on exterior of aircraft.
 Fluctuations in exhaust gas temperature (EGT) with return to normal values.	

2	 Heavy cabin dust (“dark as night" in cabin).
 Contamination of air handling and air conditioning systems requiring use of oxygen.
 Abrasion damage to exterior surfaces, engine inlet, and compressor fan blades.
 Pitting, frosting, or breaking of windscreen or windows.
 Minor plugging of pitot-static system insufficient to affect instrument readings.
 Deposition of ash in engine.	

3	 Vibration or surging of engine(s).
 Plugging of pitot-static system to give erroneous instrument readings.
 Contamination of engine oil or hydraulic-system fluids.
 Damage to electrical or computer systems.
 Engine damage.	
4	 Temporary engine failure requiring in-flight restart of engine.	
5. FURTHER INFORMATION AND ATTACHMENTS	
Description of Occurrence (continue in separate sheet if necessary):
	5.2 Attachments
 Photos
 Sketch(es)
 Other, specify	

6. CONTACT INFORMATION 	
6.1 Contact Name	6.2 E-mail address	6.3 Telephone / Fax	

Send form by e-mail to volcano@easa.europa.eu or by fax to +49 221 89990 4453.

These completion instructions relate to the use of EASA Volcanic Ash Report for the reporting of technical occurrences. 

1 REFERENCE INFORMATION
This block contains reference information on the reporting organisation or person to facilitate the general conditions and aircraft involved.
1.1 Operator – Name of aircraft operator.
1.2 Aircraft Manufacturer and Type/Model – The name of the aircraft manufacturer and type designation in full as defined in the type-certificate.
1.3 Aircraft Registration. – Nationality and registration marks assigned to the aircraft. 
1.4 Flight number – The alphanumeric number of the undertaken flight as stated in the flight plan.  
1.5 Date of occurrence – day, month and year when the encounter occurred, e.g. 09.11.2006.
1.6 Departure Airport– ICAO code of airport from which the flight departed.
1.7 Arrival Airport – ICAO code of airport to which the flight intended to arrive.

2 CONDITIONS OF ENCOUNTER
This block contains information on the general conditions during which the encounter with volcanic ash occurred.
2.1 Flight level or altitude – The flight level or altitude at which the first encounter occurred.
2.2 Geographic Position – The geographic coordinates where the first encounter occurred.
2.3 Meteorological Conditions – Mark the box corresponding to the predominant meteorological conditions when the encounter occurred. 
2.4 Light Conditions – Mark the box best corresponding to the light conditions when the encounter occurred.

3 ASH DESCRIPTION AND ENCOUNTER PHASE
This block contains information on the potentially visible ash cloud and the phase of flight at which the encounter first occurred. 
3.1 Ash cloud visible – Mark the box as appropriate.
3.2 Colour of ash cloud – If the ash cloud was visible, mark the box corresponding best to the colour of the cloud.
3.3 Density of ash cloud – Mark the box corresponding best to the perceived density of the cloud.
3.4 Encounter phase – Mark the appropriate box indicating during which phase the encounter with volcanic ash occurred. 

3.5 Estimated duration of encounter – Estimated duration of volcanic ash encounter in hours and minutes e.g. 01:35   

4 SEVERITY OF ENCOUNTER
Mark the boxes describing best the events prior, during or following the encounter with volcanic ash. Multiple boxes may be marked, as appropriate.

5 FURTHER INFORMATION AND ATTACHMENTS– Additional information and items suggested to be attached to the occurrence report. This is a free text field to include the details of the occurrence. Mark the relevant box (Sketches or Photos) or specify the nature of the attachment under “Other”. Please always specify the name or contents of the attachment.
  
6 CONTACT INFORMATION AND ATTACHMENTS
Contact information of person reporting.