In-Flight Illness Incident Report Form
Use this form to document details of an illness incident that occurred during a flight. Please provide clear and accurate information for incident tracking and follow-up.
Flight Number
*
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Seat/Row of Affected Individual
Location on Aircraft (e.g., cabin section)
Description of Illness or Symptoms Observed
*
Actions Taken (e.g., first aid, medical assistance, notification to captain)
*
Was medical assistance requested?
*
Yes
No
Age Group of Affected Individual
Please Select
Infant (0-2 years)
Child (3-12 years)
Adolescent (13-17 years)
Adult (18-64 years)
Senior (65+ years)
Unknown
Reporting Crew Member Name
*
Crew Member Contact (email or phone)
Submit Report
Should be Empty: