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Utah State University
 
Safety Reporting Form  
   

Directions:

Fill out as much as possible, so a detailed report can be used for training or teaching. The more information we gather, the safer we can make the program.

Complete the process by clicking the "Submit" button at the bottom of the page.

Use this form for reporting:
Flight related incidents
Security concerns
Ground issues
Hangar condition
Facilities
Airport concerns
other.

Complete all requested information below: * = required!
* Date:
* Time:
First name:
Last name:

* Instructor:

Student Pilot:
E-mail address:
* Aircraft:
   
Please note: You may choose to provide your name, remain anonymous and/or receive confidential feedback from Aaron Dyches. Contact Aaron directly 753-4289.
* I would like this report kept confidential...
No
* Select all that apply below:
1. Did the incident occur while taxiing?


2. Did the incident create a runway incursion?


3. Was damage done to a ground object (such as a fuel truck, hangar, etc)? No
4. Did this involve another aircraft? No
5. Was there damage to another aircraft? No
6. Was there damage to a USU owned aircraft? No
7. Was anyone hurt? No
8. Did you observe, or did you take part:
* Complete the text areas below:
9.

Describe weather conditions at the time of the incident:

(Wind - Temp - Visibility - Runway Conditions -
Other aircraft involved i.e.type - other?)
 
10.

Below is where you tell us about what happened, and why you believe it did. Include as much data as possible. Please included any information that was selected above, and elaborate:

For example,"I failed to properly clear the area, and took the runway while another aircraft turned from base to final..."
*


 
 
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Utah State University
6000 Old Main Hill
Logan, Utah 84322-6000
Phone: 435-797-9169

        

 

 

 

 
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