Flight Disruption Impact Report This form is designed to document the operational failures and personal/financial consequences of Aurigny service disruptions. w 0 Question Title * 1. Passenger Name w 0 Please enter your email address below. This email address is only required to ensure legitimate responses are being entered. Submissions will remain anonymous and your email address will not be shared or used for marketing purposes. w 0 Question Title * 2. Email Address w 0 Question Title * 3. Date of Travel w 0 Enter date of travel Date Question Title * 4. Route (Origin & Destination): w 0 Flight Number Origin Destination Question Title * 5. Type of Disruption: w 0 Delay Cancellation Denied Boarding (Overbooking) Diverted Flight Arrived without luggage / luggage flown on different flight Question Title * 6. Scheduled Departure: [ HH : MM ] w 0 Question Title * 7. Actual Departure: [ HH : MM ] w 0 Question Title * 8. Total Length of Delay (Hours / Minutes) w 0 Question Title * 9. Reason for Disruption Given by Aurigny Staff w 0 Adverse Weather (wind etc) Fog Technical Issues Operational Issues Lack of Crew Medivac Other (please specify) If you have any further comments on the above, please add them to the Comment Box at the bottom of this survey. w 0 Question Title * 10. Please list all out-of-pocket expenses resulting from this disruption.(e.g., Meal at Airport, Hotel, Taxi) w 0 Meals & Hydration Accommodation Alternative Transport Other TOTAL LOSS £ Question Title * 11. Impact on Personal & Professional Life Check all that apply and provide brief details: w 0 Missed Work Days Missed Medical Appointment Missed Event Health Impact Please give further details to the above here. Financial impact (lost wages / unpaid leave etc), consequence of rescheduling appoinments, type of event missed, impact on health. Question Title * 12. Promptness of Communication (1 - Bad / 5 - Good) w 0 1 2 3 4 5 1 2 3 4 5 Comments Question Title * 13. Clarity of Information Provided (1 - Bad / 5 - Good) w 0 1 2 3 4 5 1 2 3 4 5 Comments Question Title * 14. Provision of Refreshments/Care(1 - Bad / 5 - Good) w 0 1 2 3 4 5 1 2 3 4 5 Comments Question Title * 15. Where did the service fail most? w 0 Question Title * 16. Suggestions for Improvement / Further Comments w 0 Done
