FW INCIDENT
REPORT
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Complete form and enter ALL relevant information
Prior to selecting SUBMIT button.
CONTACT On Duty Supervisor at
(503) 726-3090 IMMEDIATELY AFTER SUBMISSION
Name *
Event Type
Event Date *
 mm/dd/yyyy
Event Time *
 hh:mm
Location and Equipment
N Number
Aircraft Type
Nearest Airport *
Based at
Phase of Flight
Weather Factors
PIC Duty Time
Event Details
# of Instructors
Ops Part
# of Students
Flight Type
# of Passengers
Email
 Email
Pilot Name
Feedback on your report?
CFI Name
 
Event Description (One Sentence Summary) (250 characters)
Describe the Incident & Sequence of Actions (1500 Characters)
What Different Actions Could Have Reduced or Mitigated Risk
What Additional Resources Could Have Reduced or Mitigated Risk
This Incident May Have Caused a Regulatory Deviation or Violation
This Incident was Non-Compliant with HAA SOP's and/or Policies & Procedures
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CONTACT On Duty Supervisor at (503) 726-3090
IMMEDIATELY AFTER SUBMISSION