Hazard / Incident Report

 

*Date:
  

*Hour:     *Min:  

*Location:


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

*Activity Type:
 Dual Local Flight
 Dual XC Flight
 Solo Local Flight
 Solo XC Flight
 Taxi/Ramp Operations
 MX Activities
 Dual Traffic Pattern
 Solo Traffic Pattern
 Day
 Night
Other:


*Mode of Flight:
 Ramp
 Taxi
 Takeoff
 Climb
 Cruise
 Descent
 Approach
 Landing
Other:

*Type of Incident:
 Collision Hazard - Traffic Pattern
 Collision Hazard - Practice Area
 Runway Incursion
 Airspace Deviation
 Mechanical Failure
 Weather Related Incident
 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
Other:

*Weather Conditions:
 Precipitation
 Strong Winds
 Turbulence
 Icing
 Windshear
 Thunderstorm
 IFR
 MVFR
 VFR
Other:

*Action Taken:
 Declared Emergency
 Requested Crash, Fire, Rescue
 Requested Medical Response
 In-Flight Diversion
 No Actions Taken
Other:

*Description of the incident or observed hazard: 


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