Anonymous Safety Report
This form does not take the place of an Aviation System submission (ASRS "NASA" form). The contents of your submission are privileged safety information. Your identity will remain anonymous unless you choose to provide contact information.
Date
*
-
Month
-
Day
Year
Date
Time (HHMM Local time)
*
At which location did the discrepancy happen?
*
Manhattan, KMHK
San Diego, KMYF
This concern is related to the following: (choose all that apply)
*
Aircraft
Student
Instructor
Maintenance
Schedule
Please describe your safety concern in detail:
*
If this was in a resource (such as an aircraft) please give us the name of the resource (I.e. N98492, Redbird TD2)
If this was flight related, please list any external factors that may have impacted this incident. (I.e., weather conditions, crosswinds for landing).
What recommendations would you have so we can help prevent this kind incident in the future? This could be internal or external, such as working with ATC or maintenance.
If this is maintenance related and a squawk would be required, have you issued the squawk?
*
Yes
No
Not maintenance related
Would you like to submit your contact information?
*
No, remain anonymous
Yes
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Would you like a follow up on this concern?
*
Yes
No
Please verify that you are human
*
Submit
Should be Empty: