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Flight Incident Form

  *Date:
  
*Hour:
Select Item010203040506070809101112131415161718192021222324 
*Min:
Select Item00153045 
*Location (Check all that apply):
 Classroom
 Lab
 Simulator
 MX Hangar
 A/C Hangar
 Ramp
 Taxiway
 Runway
 Airport
 Working Area

Other Location:

*Course:
Select Item Private 1 Private 2 Instrument 1 Instrument 2 Commercial 1 Commercial 2 Multi-Engine CFI CFII MEI Dispatch Other

Other Course:

*Activity Type (Check all that apply):
 Dual
 Solo
 Local
 X-Country
 Working Area
 Traffic Pattern

Other Activity:

*Mode of Flight:
Select Item Ramp Taxi Takeoff Climb Cruise Descent Approach Landing Brief Preflight Postflight Debrief Ground Other

Other Flight:

*Type of Incident (Check all that apply):
 Collision Hazard - Traffic Pattern
 Collision Hazard - Practice Area
 Runway Incursion
 Airspace Deviation
 Mechanical Failure
 Weather Related
 Wildlife/Bird Strike
 Lost Communication
 Lost Situational Awareness
 ATC Deviation
 Wake Turbulence
 Foreign Object Damage
 Crewmember Incapacitation
 Drone Hazard
 Laser Hazard
 Collision Hazard babyÖ±²¥app Country
 Dispatch
 Ground Event
 Safety Incident

Other Incident:

*Weather Conditions (Check all that apply):
 Indoor
 Day
 Night
 Windy
 Cloudy
 Precipitation
 Icing
 Turbulence
 Windshear
 T-Storms

Other Weather:

*Action Taken (Check all that apply):
 Filed This Report
 Told Instructor
 Told Chief Pilot (or Assistant)
 Declared Emergency
 Requested Crash/Fire/Rescue
 Needed Medical Assistance (Including First Aid)
 In-Flight Abort
 In-Flight Divert

Other Action:

*Description of the incident or observed hazard: 

*Recommendations to eliminate, correct, or minimize the hazard: 

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