SAFA Number of Pilot Involved

Occurrence (incident / accident) Definitions on Website Please select... Accident - Damage to persons or property Incident Including Near Miss Non Compliance - Breach of Club Rules Montes Emergency Landing Other

Location of occurrence

Occurrence happened during

Occurrence happened during

Other - Please specify

Pilot qualification level

Instructor Name and School (if during training)

Wing/Motor/Equipment

Was a parachute fitted

Was a parachute deployed

Total number of hours

Weather Conditions

Did an Injury occur (If yes, please complete Injury report) Please select... No Yes

Were emergency services contacted or did they attend

Description of Injury/Medical treatment/Hospital Involved Please select... Please Complete Injury Report

Did a fatality Occur (If yes, please specify) Please select... Yes No

Immediate actions taken

Safety Committee Outcome:

Was and AIRS report Submitted. Please select... Yes No (if no enter reason below)

Reason for NOT submitting an AIRS report.

Prove you're human: add one & two together:*