PEDALS
If you think that it is hazardous, we want to hear about it!
Last name
Optional
First name
Optional
Contact phone number
Optional
Reporter type
Instructor
Student
Mechanic
Other
Dispatcher
Date of event or situation
MM/DD/YYYY eg. 08/04/2008
Time of event or situation
Local time
0700
0730
0800
0830
0900
0930
1000
1030
1100
1130
1200
1230
1300
1330
1400
1430
1500
1530
1600
1630
1700
1730
1800
1830
1900
1930
2000
2030
2100
2130
2200
2230
2300
2330
2400
Type of Hazard / Event Title / Situation
Check all that apply
Flight Training
Weather / Flight conditions
ATC / airspace
Engine shutdown
Hard landing
Rwy / Twr incursion
Wake Turbulence
Airport
Ramp
Building
Diversion
Go around
Airplane
Solo / PIC
Physiological
Emergency
Fire / smoke
Near miss
Injury
Dual
Bird strike
FOD
FARS
Phase of Flight
Check those that apply
Parked
Taxi out
Takeoff
Initial climb
Climb
Cruise
Practice area
Holding
Descent
Approach
Traffic Pattern
Landing
Taxi in
Towing
Describe Event / Situation
Discuss the chain of events, safety issue, human performance, airmanship, considerations that you feel are relevant and anything else you think is important. Include what you believe really is the issue, and what can be done to prevent a recurrence, or correct the situation. Include relative factors (weather, ATC, airfield conditions, etc.)