Incident Report Form

Submitting an Incident Report is straight-forward and only takes a few minutes. Complete the fields below and press, Submit. The report will be de-identified (pilot's name & address will not be shown) and added to our incident database. Reports are subject to editing and are only intended for educational purposes. We share these to make the sport safer, not to place blame.

First Name:*

Last Name:*

Contact E-mail Address:*

Contact Phone Number:*

Title (enter a descriptive title, 50 characters or less):*

Location:*
(Site, City, State)

Pilot's Full Name:*

Address 1:

E-mail Address:

Age:

Gender:
Male
Female

Pilot weight (without motor):
(US Pounds)

Rating:
Not Applicable None Student Beginner (PPG1 or Equivalent) Intermediate (PPG2 or Equivalent) Advanced (PPG3 or Equivalent) Instructor Other Unknown

Experience:
Not Applicable Pre-Solo Less Than 10 Hours Solo 10-50 Hours Solo 50+ Hours Solo Unknown

Type of Incident:
Not Applicable Fall Hard Landing Collision with Terrain/Obstruction on Ground Wing Malfunction or Deflation Line Tangle/Damage Powerplant/Equipment Malfunction Handling Body Contact with Spinning Prop Collision with Other Aircraft/Ultralight Other Unknown

Primary Cause:
Not Applicable Pilot Error: Preflight/Postflight Pilot Error: On Launch Pilot Error: Inflight Pilot Error: On Landing Pilot Error and Mechanical Failure Pilot Error and Weather Mechanical Failure: Harness Mechanical Failure: Wing Mechanical Failure: Powerplant/Propeller Weather (Gust, Thermal, Rain, Wind increase, etc) Fuel Exhaustion Tight Takeoff/LZ Area Wake Other Unknown

Contributing Distractions:
Not Applicable None Activity in Takeoff/LZ (Cars, People, Gliders, etc.) Radio Transmission Camera Navigator (GPS) Other Flying Task (Kicking Cones, Picking Things Up, etc.) Other Aircraft (Airborne) Other Unknown

Windspeed:
Not Applicable Calm Light (Less than 5 MPH) Moderate (5-9 MPH) Strong (10-15 MPH) Very Strong (Greater than 15 MPH) Unknown

Wind Type:
Not Applicable Steady Variable Gusting Gust Front Thermal Dust Devil Tornado Unknown

Thermal Conditions:
Not Applicable None Light (Less than 300 FPM) Moderate (300-600 FPM) Strong (600 to 1000 FPM) Very Strong Unknown

Visibility (describe):

Surface:
Not Applicable Grass Sand Pavement Water - Moving Water - Still Scrub Trees Indoor Snow Crop Field Dirt or Small Rocks Wet Dirt and Mud Other Unknown

Terrain:
Not Applicable Mountainous Hilly Flat Other Unknown

Site Elevation:
(feet above sea level)

Phase of Flight:
Not Applicable Runup Inflation Takeoff Cruise Approach Landing After Landing Other Unknown

Purpose of Flight:
Not Applicable Recreation Recreation-Other Demonstration Instructional (Supervised Solo) Competition Commercial Aerobatics Other Unknown

Communications:
Not Applicable None Two-way Radio w/ Helmet Mike & PTT One-way Radio (Instructor to Student) In-flight Intercom (Tandem) Other Unknown

Damage to Pilot's Equipment:
Not Applicable None Minor (Less than 20% of New Price) Severe (Greater than 20% of New Price) Totaled Unknown

Wing (Make, Model, Size & Rating (DHV, ACPUL, SHV, etc.):

Motor (make, model, weight at time of incident):

Pilot/Passenger Injury Severity:*
Not Applicable None Minor Injury (No Hospital Visit) Minor Injury (Hospital Visit, Treated and Released) Major Injury Fatal Unknown

Hosipitalization:
Not Applicable None Some First-Air Applied Emergency Room Overnight 3+ Nights Unknown

Collateral Damage:
None
By-Stander
Other Pilot
Animal
Property
Unknown

Click the 'Browse' button to select the file from your hard drive. The photo must be in GIF or JPG format.

* Required fields