Preliminary Reporting Form: Harmful Radio Interference to Aircraftin cooperation with ICAO Frequency Spectrum Management Panel

Note: Only applicable fields need to be filled. Please submit the report to Head, ATM Engineering and Aviation Frequency Spectrum, IATA at pringvanin@iata.org.

Originator of this reportOrganisationDepartmentStreet / No.Zip-Code / TownName / SurnamePhone NumberE-mail addressDate and time of reportDescription of interferenceAircraft Type and Registration Date and Flight NumberAirway/route flown

Positions/Coordinates of the first point of occurrence Time (UTC)

Waypoint: Latitude: Longitude: UTC:

Positions/Coordinates of the last point of occurrence Time (UTC)

Waypoint: Latitude: Longitude: UTC:

Flight level or altitude at which it was detectedManufacturer, type, model of impacted equipmentDegradation of performance level [ ] Complete outage

[ ] False reading[ ] other (Please describe.)

Problem duration [ ] continuous [ ] intermittentEvent summary including description on impacts on aircraft operation

Description of potential source of harmful interference (if known)

Other information

Version 1.0 (April 2016)