Your Information (optional)


Your Organization/Company


Cell Phone

Work Phone

Other Phone

Event Information (required)

Event Date

Event Local Time

Were injuries involved?

Was property damaged?

City or Nearest City

Event State/Province

Location Info (lat./long., mountain, helipad ID, "5 miles east of xxxxx", etc.)

Add'l Location Info (optional)

Customer/Contracting Agency

Aircraft Info

Category (required)

Type (Bell 206, UH-1, etc.)

Tail # (required)

Pilot Name

Other Aircraft Info

Event Narrative (required)

Please describe the event as completely as desired:

Remedy or Corrective Action (required)

Please describe any remedies or corrective actions taken, suggested or pending. If none, state "none" or "n/a".

Please confirm you are person: