Wings Of Rogallo Accident Report Form

On-line Accident Report Form

Please fill out this form to the best of your ability whenever you witness an incident, especially if it is at a WOR site. Information will go to the WOR flight director, site commitee chairmen and President.

Please consider all fields but skip the ones you don't know, especially if it isn't important to analysis of the accident. For example, if you don't know the make and model of the pilots parachute, or don't know his home address just skip it and send the form in anyway. Incomplete information is better than none at all. If you get more info later, submit another form later.

Required fields are shown in red.

Submitters name:

Submitters email address:

Submitters phone:

Pilot name:

Pilot Home Address:

Pilot phone:

Pilot age:

WOR member:
Yes No

Wing type involved (check all involved):
Hang Glider Paraglider Unknown wing type

Pilot rating:
Student Novice Intermediate Advanced Master Don't Know

Experience: (Total hours flying time or years of experience)

Date of accident:

Accident location:
Ed Levin Mission Diablo Other (Specify below)

IF WOR SITE Launch Signoffs obtained:

IF WOR SITE Sponsor name:

IF WOR SITE Instructor name:

IF WOR SITE Observer name:

Glider mfg:

Glider model:

Glider size:

Harness make and model:

Parachute deployed:
Yes No Don't Know

Chute make and model:

Helmet make and model:

Backup hang strap installed and used:
Yes No Don't Know

Locking carabiner installed and used:
Yes No Don't Know

Condition of glider and other equipment:

Description of glider damage if any:

Description of injuries if any:

Description of emergency medical care given if any. (eg. Ambulance called? By Whom? First aid rendered? Injured party refused treatment? If hospitalized, where? Doctors name?)

Description of flight (Launch, flight path, landing/ground contact, accident location):

Description of accident:

Description of weather and wind conditions:

Apparent cause of accident:

Mental condition of victim before and after accident:

Other factors (distractions, alcohol, emotional state):

Vehicle accident description if applicable: