OSU Safety Reporting System Input

If you think that it is hazardous, please invest in your program - we want to hear about it!

Name (Optional) Name (Optional) First Last
Phone (Optional) Phone (Optional) - ### - ### ####
Reporter Type

Reporter Type Student CFI Check Airmen DPE Mechanic Dispatcher Other
Date of Event or Situation Date of Event or Situation / MM / DD YYYY
Time of Event or Situation Time of Event or Situation : HH MM AM/PM
Aircraft Tail Number (N-number)
Type of Hazard/Event Title/Situation

Type of Hazard/Event Title/Situation Airplane Airport ATC/Airspace Bird Strike Building Diversion Dual/Solo (PIC) Emergency Engine Shutdown Fire/Smoke FOD FAR (Concern/Violation) Flight Training Go-Around Hard Landing Injury Near-Miss (Aircraft separation of less than 500ft.) Physiology Ramp Runway Incurtion Wake Turbulance Weather/Flight Conditions Other (Please Indicate)
Phase of Flight (choose all that apply)

Phase of Flight (choose all that apply) Parked Taxi Out Takeoff Initial Climb Climb Cruise Practice Area Holding Descent Approach Traffic Pattern Landing Taxi In Towing Other (please indicate)
Describe Event/Situation
Follow-Up Action (Please document what actions or notifications you have taken in regard to your submission. This is especially important if your report suggests a downing aircraft status should be the result of your safety report.)