USHPA - Online Accident Report Form

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toll free: 800.616.6888
direct: 719.632.8300
fax: 719.632.6417

Hours: 8am-5pm MST M-F

Mailing Address
USHPA
P.O. Box 1330
Colorado Springs, CO
80901-1330

Physical/Parcel Shipping
USHPA
1685 W. Uintah St.
Colorado Springs, CO
80904

Online Accident Report Form

Please fill out this report form as completely as possible, and use the submit button on the bottom of the page. If you experience problems submitting an accident report please contact us.

Hang Gliding or Paragliding?	Hang Gliding Paragliding
Person Reporting This Accident/Incident:
Reporter Name
Reporter Street address
Reporter Address (cont.)
Reporter City
Reporter State/Province
Reporter Zip/Postal code
Reporter Country
Reporter Home Phone
Reporter Work Phone
Reporter E-mail
Pilot Information:
Pilot Name
Pilot Street address
Pilot Address (cont.)
Pilot City
Pilot State/Province
Pilot Zip/Postal code
Pilot Country
Pilot Work Phone
Pilot Home Phone
Pilot E-mail
Pilot Date of birth
Pilot Gender	Male Female
Pilot Height
Pilot Weight
Pilot USHPA Member?	YES NO
If Member--USHPA #
Pilot Rating:
Pilot Experience # Of Flights:
Pilot Experience Hours of Airtime:
Pilot Years of Experience:
Date of Accident/Incident:	-- mm/dd/yy
Time of Accident/Incident:
Site of Accident/Incident:
Nearest Town:
Launch Altitude:
LZ Altitude:
Did this flight occur under the radio supervision of an instructor?	YES NO
Instructor's Name
Was This a Tandem Flight?	YES NO
If YES, Name of tandem instructor
Name and Phone Numbers of other witnesses:
Launch Site Characteristics (check all that apply):	Normal or Easy Ramp Cliff Short Steep Safety Nets Cross Wind Hazards
Method of Launch:	Foot Launch Platform Launch Tow Foot Launched Tow
Towline Tension Control Device:	Static Line Pay Out Winch Stationary Winch
Glider Manufacturer:
Model:
Size & Color:
AFNOR/ACPUL/DHV certification level:
Harness Model:
Harness chest strap setting:
Harness Modifications? Describe:
Helmet Model:
Face Protection:
Reserve Make, Model & Size:
Reserve Date of Manufacture:
Was Reserve Deployed?	YES NO
Causes/Factors (check all that apply):	Preflight Error Poorly Inflated Takeoff Wake Turbulence Thermal Turbulence Shear Turbulence Mechanical Turbulence Rotor Panic Strong Wind Valley Wind Gust Front Cloud Suck Flying in Cloud Gradient LZ Tail Wind LZ Turning in LZ Obstacle Collision Object Fixation No Brake Flare Excessive Brake Flare Unusual LZ Outside LZ Unknown LZ Equipment Failure Faulty Harness Adjustment Mid-Air Collision Hill Collision Asymmetric Deflation Spiral Dive Parachutal Stall (Deep or Constant Stall) Negative Spin Aerobatics Structural Failure/Broken Line(s) Tangle or Debris in Lines Dragged on Launch Scratching Too Low Frontal (Symmetric) Collapse Cravat Other (describe below)
Injuries: (check all that apply):	Head Face Neck Chest Back Abdomen Shoulder Arm Elbow Forearm Wrist Hand Pelvis Thigh Knee Calf Ankle Foot Other (describe below)
Hospitalized Overnight?	YES NO
Fatal?	YES NO
Description of Accident/Incident: Describe flight, accident/incident, and apparent causes. Include preflight, wind, weather, distractions, emotional factors, and drug or alcohol use. Please give your opinion of cause and suggestions for prevention. Take as much space as needed.

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