Hazard Report Form
This form is intended to collect information regarding safety related incidents within the Southern Illinois University Carbondale aviation flight program. Please include all pertinent information within the fields of this form. Thank you for your response.
Pilot's Name
Your answer
Type of Event/Situation
Explain Other Type of Event/Situation
Your answer
Course
Flight Type
Aircraft Tail Number
Your answer
Date
MM
/
DD
/
YYYY
Time
Time
:
Altitude (ex. 010)
Your answer
Location Fix
Was Evasive Action Taken?
Description of Event
Your answer
Cause of Event
Your answer
Recommendations
Your answer
Would you be willing to allow this incident to be used for discussion purposes?
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