Aircraft Accident

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13/20 EXAMPLES

Text in this Example:

AIRPORT
DISTANCE OF CRASH FROM NEAREST AIRPORT:
FLIGHT WAS:
PRIVATE
COMMERCIAL
AGRICULTURAL
OTHER:
WAS A FLIGHT PLAN FILED?
IF YES, SUBPOENA AND SEND WITH INVESTIGATION
WAS AIRPORT IN RADIO CONTACT?
WAS DISTRESS MESSAGE RECEIVED?
OTHER AGENCY INVOLVED
NAME OF FAA/NTSB REPRESENTATIVE:
OTHER NON -LAW ENFORCEMENT INVESTIGATORS:
AGENCY:
IF BODIES WERE THROWN FROM THE AIRCRAFT, BE SURE TO DRAW A DIAGRAM OF THE SCENE ON A SUPPLEMENTAL REPORT INCLUDING POSITIONS OF BODIES AS FOUND. EACH BODY BAG SHOULD BE NUMBERED AND EACH NUMBER SHOULD BE IDENTIFIED ON THE SUPPLEMENTAL REPORT. BE SURE TO COLLECT PERSONAL EFFECTS WHICH WILL FACILITATE IDENTIFICATION. AIRCRAFT PARTS ARE NOT TO BE SENT IN WITH A BODY.
NAME OF INVESTIGATOR
DMI#
AIRCRAFT ACCIDENT
NAME OF DECEDENT:
This form is to completed in addition to the ROD form in these guidelines
DECEDENT'S POSITION IN AIRCRAFT
IF VICTIM REMAINED IN AIRCRAFT, POSITION IN AIRCRAFT:
LEFT SIDE
FRONT ROW
2ND ROW
SAFETY HARNESS (BELT):
PRESENT
NOT PRESENT
USED
NOT USED
UNABLE TO DETERMINE
SHOULDER STRAP:
DECEDENT WAS:
PILOT
CO -PILOT
STUDENT PILOT
DO OTHER OCCUPANTS HAVE ANY FLIGHT EXPERIENCE?
RATING TYPE:
YEARS EXPERIENCE:
HOURS FLYING TIME:
DATE OF LAST PHYSICAL EXAM:
NAME OF PHYSICIAN WHO PERFORMED LAST PHYSICAL:
CONTACT INFORMATION FOR PHYSICIAN:
IF THE DECEDENT WAS THROWN FROM THE AIRCRAFT, EXPLAIN HIS POSITION RELATIVE TO
THE AIRCRAFT:
IF THE DECEDENT WAS THROWN FROM THE AIRCRAFT, WHAT METHOD WAS USED TO
DETERMINE HIS POSITION IN THE AIRCRAFT PRIOR TO THE CRASH?
WERE OTHER FATALITIES INVOLVED:
IF YES, HOW MANY:
(BE SURE TO DESCRIBE EACH FATALITY ON SEPARATE PAGES.)
AIRCRAFT
AIRCRAFT OWNED BY:
MAKE:
MODEL:
SER#:
AIRCRAFT #:
ā€œNā€ NUMBER ON TAIL:
SINGLE -ENGINE
MULTI-ENGINE
NON-ENGINE
PROPELLERS
JET
GLIDER
AIRCRAFT WAS:
LANDING
TAKING OFF
BETWEEN DESTINATIONS
EVIDENCE OF AIRCRAFT DEFECT OR MALFUNCTION?
DID THE AIRCRAFT:
BURN
EXPLODE
TURN OVER
EXPLAIN: