USAF MISHAP REPORT

usaf MISHAP REPORT . (Fill in all spaces applicable. If additional space is needed, use additional sheet(s).). FOR OFFICIAL USE ONLY (When filled in). 1. DATE OF 2. VEHICLES(S) OR MATERIEL INVOLVED 3. MISHAP EVENT NUMBER. OCCURRENCE (Mission Design Series and serial number if applicable). (Year, Month, Day). 4. LOCATION OF OCCURRENCE 5. LOCAL AND 6. ZULU TIME. DAY NIGHT. DAWN DUSK. 7. ORGANIZATIONS OWNING VEHICLE OR MATERIEL AT TIME OF MISHAP . MAJOR NAF/CENTER WING GROUP SQUADRON BASE AND ICAO. COMMAND OR UNIT OR SORTS CODE. 8. (List of organizations of second vehicle or materiel, if they differ from item 7 above). BASE AND ICAO. MAJOR NAF/CENTER WING GROUP SQUADRON. OR SORTS CODE. COMMAND OR UNIT. 9. ORGANIZATION AND BASE SUBMITTING REPORT (Do not abbreviate). 10. LIST OF PERSONNEL DIRECTLY INVOLVED. LAST NAME, FIRST NAME, ASSIGNED AERO DEGREE. MIDDLE INITIAL GRADE SSN DUTY RATING INJURY*. *Enter applicable letters in DEGREE INJURY column: No Lost Time-NL; Lost Time-LT; Permanent Partial-PP; Permanent Total-PT; Fatal-FT.

USAF MISHAP REPORT (Fill in all spaces applicable. If additional space is needed, use additional sheet(s).) FOR OFFICIAL USE ONLY (When filled in) 1. DATE OF 2. VEHICLES(S) OR MATERIEL INVOLVED

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