Grassfield Incident Form 1 Page 1 of 2 2 Page 2 of 2 0% Accident/Incident Reporting Form Grassfield RC Model Aircraft Club Accident/Incident Details Please complete this form to report any accident or incident related to model aircraft activities at our club. Your report helps us maintain safety and improve our practices. All submissions are non-jeopardy and confidential. Reporter information: Name:* Contact Information* Email* Date* Time:* AMA#* Type of Incident Check all that apply* Crash outside FRIAA boundary (Mandatory Report) Personal Injury (Mandatory Report) Property Damage (Mandatory Report - photo documentation required Crash behind Flight Line (Larger aircraft over 35cc & electric of equivalent size) Other (please specify): Other: Brief Description of Accident/Incident Please describe what happened, including location and circumstances: Brief Description* Contributing Factors Check all that apply* Radio failure Engine failure Pilot error/Loss of orientation Mechanical Other (please specify): Other: Previous Next Additional Comments, Suggestions, Photo Documentation: Use additional pages as needed File Upload Attach File No Choosen File (Max 2 MB) Witness Section: Mandatory for Property Damage or Personal Injury Witness Name AMA# Brief Witness Description: For Club Use Only Received By: Date Received: Follow-Up Actions Submit Previous Next
