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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 Cross 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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