Anonymous Incident Report Form Langley Flying School

Use this form to report any workplace accident, injury, incident, close call or Hazard.
This is Documenting a/an *
Lost Time / Injury
First Aid
Accident
Almost hit / Close Call
Observation
Row 1
Date of Report:
MM
/
DD
/
YYYY
Time of Event *
MM
/
DD
/
YYYY
Time
:
Location of Event:
Add aircraft's Ident if applicable
Weather Conditions:
Specify the followings: Wind Velocity, Gusting Wind, Prevailing Visibility, Ceiling Altitude
Special Weather
If Applicable.
Flight Rules
VFR
IFR
SVFR
Day Flight
Night Flight
Row 1
Description of Observation or Event: *
What Happened? in chronological order
Description of the Standards: *
What Should Have Happened? (In accordance to S.O.P, Airport’s Procedures, A.T.C., C.A.R., P.O.H, Airworthiness, Checklist)
Description of the Gap: *
What went wrong?
Required
Description of the Cause *
Why it happened the way it did?
Was the event / injury caused by an unsafe act (activity or movement) or an unsafe condition (machinery or weather)? *
Conclusions and Corrective Actions to be Taken
How can we prevent it from recurring?
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