Blank Witness Report Forms - Excel by opq71500


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									Malfuntion/Abnormality Report Form (MARs)

Purpose: Identifcation of trends based on jump experience, currency, equipment, fire incidents, or aircraft

Instructions: Complete form after experiencing a incident or adnormality. Turn directly in to OPS via spotter,
LO, COP, etc.

Mars Number (YY-Record Number-AK or BOI)

             Last Name:

              First Name

              Home Unit:

          Date of Event:

          Incident Name

       Incident Number:

      State or Location:

           Activity Type: Jumping     Fire          Aircraft        P/C         Other

Jumper Narrative: (Describe Event)

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Witness Narrative: (Describe Event)

Responsible Department:          Loft         Air OPS        OPS   Training   Rx
Conclusion and Corrective action

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If the event was parachute or parachute equipment related fill out the sections below.

          Total Jumps: <20                      Jumps this Season:        Days Since Last Jump:
                       20 to 49                 <5                        <5
                       50 to 99                 6 to 10                   6 to 10
                       100 to 149               11 to 15                  11 to 15
                       150 to 199               16 to 20                  16 to 20
                       200 to 249               21 to 25                  21 to 25
                       250 to 299               >25                       >25
          Body Weight: < 130 lb                 Aircraft Type: Banderiate
                       130 to 149 lb                           Casa 212
                       150 to 169 lb                           Caravan
                       170 to 189 lb                           Dornier 228
                       > 189 lb                                DC-3
                                                               Twin Otter
Malfunction or Problem Drogue-in-tow                           Main AAD Deployed:         Yes
                  Type: Spinning                                                          No
                        Streamer                               Main Canopy Cut-a-Way:     Yes
                        Horseshoe                                                         No
                        Lost Handle                            RSL Deployed Reserve:      Yes
                        Collision                                                         No
                        Dual Canopies                          Reserve Manually Deployed: Yes
                        Released Riser 3-ring                                             No
                        Twisted Riser(s)                       Reserve AAD Deployed:      Yes
                        Rips or Tears                                                     No
                        Tension Knot
                        AAD Misfire
                        AAD Problem
                        Broken Brake Line
                        Unstowed Brake(s)
                        Rogue Drogue
                        Unstable Drogue Ride
                        Delayed Drogue 3-ring release
                        PG Bag Problem

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Drogue#:                Drogue Rigger:                     Drogue Rig Date:
Drogue Rig Location:    AK Loft               Drogue Manufacturer:  AK loft              Precision
                        BOI Loft                                    BOI loft             Strong
                        Field Rigged                                Butler               Wingate
                        Other                                       Paraflite
Drogue Service Date:                                                Paranetics

Main #:                 Main Rigger:                        Main Rig Date:
     Main Rig Location: AK Loft               Main Canopy           Main Manufacturer:   Gaurdian
                        BOI Loft                 Type: DC-7                              Paraflite
                        Field Rigged                   EIFF                              Percision
                        Other                        MT-1S                               Other
Main Service Date:                            Number of Jumps on Main:

Reserve#:               Reserve Rigger:                      Reserve Rig Date:
Reserve Rig Location:   AK Loft                                  Reserve Manufacturer: Paraflite
                        BOI Loft                                                       Other
                        Other                                Reserve Service Date:

Harness #:                                    CYPRES#:

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