Read U.S. DOD Form dod-da-7305-r text version

U.S. DOD Form dod-da-7305-r

WORKSHEET FOR TELEPHONIC NOTIFICATION OF AVIATION ACCIDENT/INCIDENT

For use of this form, see AR 385-40; the proponent agency is OCSA SHADED BLOCKS ARE FOR A. ASMIS CASE NUMBER USASC USE ONLY

NOTE: ITEMS 24 AND 25 ARE NOT REQUIRED FOR CLASS C ACCIDENT

B. TIME & DATE OPS RECEIVED REPORT a. Year b. Month c. Day

d. Time (local)

1. POINT OF CONTACT FOR a. Name ACCIDENT INFORMATION

Duty Commander Other (Specify) Safety Officer c. Phone

Number

DSN:

Commercial:

4. AIRCRAFT SERIAL NUMBER

2. ACCIDENT

CLASSIFICATION A Dawn Day B C

3. TIME & DATE OF ACCIDENT a. Year b. Month c. Day d. Time (local) 7. MISSION BEING PERFORMED a. Type (Training, Svc, etc.)

5. TYPE OF AIRCRAFT

6. PERIOD OF DAY

Dusk Night

b. Operation

Single-Ship Multi-Ship 11. MACOM

8. NOE Yes No

9. NIGHT VISION DEVICE a. In Use b. If Yes Yes No

10. UNIT OWING AIRCRAFT ANVIS AN/PVS-5 FLIR LLTV 13. EXACT ACCIDENT LOCATION

12. MILITARY INSTALLATION NEAREST ACCIDENT SITE

CHECK "YES" or "NO" FOR QUESTIONS 14 THROUGH 19

14. EXPLOSIVE/HAZARDOUS/SENSITIVE MATERIALS INVOLVED? 15. IF YES TO #14, ARE THEY SECURE? 16. ACCIDENT SITE SECURED IAW DA PAM 385-40? 17. HAS ACCIDENT SCENE BEEN DISTURBED? 18. IF YES TO #17, WERE PHOTOS, ETC. MADE BEFORE DISTURBING THE SCENE? 19. FLIGHT DATA RECORDER INSTALLED?

Yes No 21. PERSONNEL INVOLVED b. Total No. of

Personnel

a. No. of Personnel by Rank/Category Officer WO Enlisted c. Highest Rank Army Civilian

22. INJURIES (Enter # of each) Fatalities Non-Fatal Injuries

20. CLEARANCE WAS:

VFR 23. ACCIDENT SYNOPSIS (What Happened)

IFR

As soon as possible, the following additional information is required on all injured personnel; name, personnel classification, degree of injury, and SSAN.

24. NEWS MEDIA

25. NEAREST

a. Nearest that can handle C-12 (4,000 ft. min.)

AWARE OF ACCIDENT Yes No

AIRFIELD b. Nearest commercial airfield

26. WHO WILL

INVESTIGATE?

a. Installation Level Accident

Investigation (IAI) Board Appointed

Yes No

b. CAI Team Dispatched

Yes No

Team:

USAPPC V1.00

DA FORM 7305-R, APR 94

Information

U.S. DOD Form dod-da-7305-r

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