Incident Investigation Form Page 1 of 4 Please complete all required fields! Incident Details Club Name(*) Invalid Input Name of Member involved Invalid Input Contact Name(*) Invalid Input Contact Email(*) Invalid Input Contact Number(*) Invalid Input Date of incident(*) Invalid Input Time of incident(*) Invalid Input Place of Incident(*) Invalid Input Supporting Information Invalid Input File Upload Invalid Input Next > Details of Model Type(*) Type Free Flight Control Line Radio Control Other Invalid Input Other Invalid Input Built From(*) Built From ARF Kit Plan Design Other Invalid Input other Invalid Input Wingspan - cm(*) Invalid Input Weight - kg(*) Invalid Input Engine Capacity/Thrust(*) Invalid Input Type of Model(*) Invalid Input Description(*) Invalid Input Power Plant(*) Invalid Input Construction Materials(*) Invalid Input Brand and Model Number Receiver(*) Invalid Input Brand and Model Number of Transmitter(*) Invalid Input < PrevNext > Weather Conditions Wind Strength(*) Invalid Input Cloud/Sun(*) Invalid Input Visibility(*) Invalid Input Wet/Dry(*) Invalid Input Number of flights that day prior to incident(*) Invalid Input Total flight time that day prior to incident(in Minutes)(*) Invalid Input Brief Description(*) Invalid Input Radio Frequencies in use(*) Invalid Input Were the transmitter batteries charged prior to the first flight of the day?(*) Were the transmitter batteries charged prior to the first flight of the day? Yes No Invalid Input Was a range check carried out prior to the first flight of the day and result?(*) Was a range check carried out prior to the first flight of the day and result? Yes No Invalid Input Were the reciever batteries charged prior to the first flight of the day?(*) Were the reciever batteries charged prior to the first flight of the day? Yes No Invalid Input Primary CauseChoose one. ...(*) Primary Cause</br><sub>Choose one. ...</sub> Pilot Error Pilot Skill Inadequate Rules Not Following Rules Field Layout Weather Radio Problems Mechanical Failure Other Invalid Input Other Cause Invalid Input Secondary Causes (choose all relevant) Secondary Causes (choose all relevant) Pilot Error Pilot Skill Inadequate Rules Not Following Rules Field Layout Weather Radio Problems Mechanical Failure Other Invalid Input Other Secondary Cause Invalid Input < PrevNext > Post Incident and Prevention What was the result of the post incident investigation of the model/s equipment?(*) Invalid Input Recommended corrective action to prevent re-occurence(*) Invalid Input Name of Submitter Invalid Input Position(*) Position Club Safety Officer Contest Director Other Invalid Input This Form is for information purposes only. The conclusions set out in the Form are as a result of a preliminary investigation by the signatory and do not constitute in any way an admission or acceptance of any liability by or on behalf of the MAAA, its Members, or Affiliate Members. (*) Invalid Input < PrevSubmit Incident Investigation Form
