Shannon School of Aeronautics

Safety Reporting Form

Personal Information and Incident

First Name *

Email (Optional)

Last Name *

Phone (Optional)

Role/Rating *

Aircraft Type *

Date of Operation *

Tail Number *

Time of Operation *

Description *

I have filed a NASA ASRS Form. (Link on "Safety" Page) *

Yes

Weather

Conditions *

Wind

Weather Comments/Other Conditions

Damage

Did any damage or injury result? *

Yes

If yes, please describe:

Reflections

What went wrong?

What went right?

How could we prevent this from happening again?

Were you under pressure to complete the operation?

Were you affected in any way by illness, medication, stress, fatigue or emotions?

Form Options

Confidential Report

I would like feedback on this report (email must be filled)

Send me a copy