Safety Reporting Form Company Date Time First name (Optional) Last name (Optional) Email address (Optional) Instructor (Optional) Which Aircraft Were You Flying? CessnaHuskySeminoleGliderMountain Ridge HelicopterUSU AircraftOtherN/A - I was a ground observer Did the incident occur while taxiing? YesNo Did the incident create a runway incursion? YesNo Was damage done to a ground object? (e.g. fuel truck, hangar, etc…) YesNo Did this involve another aircraft? YesNo Was there damage to another aircraft? YesNo Was there damage to LEA aircraft or LEA property? YesNo Tail number(s) involved: Was anybody hurt? YesNo Did you observe or take part? Caused, or was the reason for the incidentInvolved, but was not the reasonObserved, but was not involved Describe the weather conditions.(Wind – Temp – Visibility – Runway Conditions – Other aircraft involved i.e. type – other) Describe what happened. Tell us about what happened, and why you believe it did. Include as much data as possible. Please include any information that was selected above, and elaborate
