Flight Event Reporting Form

The flight event reporting form

Type of Event/Situation: *

Other Type of Event/Situation (Please Specify).

Pilot Information

Name:

Email Address:

Total Flight Time:

Course:

Flight Information

Flight Type: *

Aircraft Tail #:

Instructor Name:

Instructor Type (If Dual):

Date and Time

Date of Occurrence:

Time of Occurrence:

Location

Altitude:

Practice area, distance/radial from airport/navaid/fix, or closest town::

Aircraft Status:

In Air

On Ground

Airspace and ATC

Airspace:

ATC/Advisory Service:

Weather/Meteorological Conditions

Flight Conditions:

Ceiling:

Visibility:

Surface Wind Speed:

Weather Call:

Estimated miss distance (in feet):

Horizontal:

Vertical:

Was evasive action taken?:

Yes

Description:

Cause:

Recommendations:

Would you be willing to have this incident discussed on the safety website?: *

Yes

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