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USHPA ACCIDENT REPORTING FORM *****NOT FOR COMPLAINTS***** Use this form to submit information to USHPA regarding flying accidents ONLY. Your comments will be reviewed by our Accident Review Committee and kept anonymous. General Information  Hang Gliding or  Paragliding (check one) Reporter Name______________________________ Reporter Email address____________________________________________ Reporter Address_______________________________________________ City___________________________ State__________ Zip_______________ Work Phone_________________________________ Home Phone__________________________________ Pilot Name___________________________________ Pilot Email address_______________________________________________ Pilot Address____________________________________________________ City_________________________ State___________ Zip_______________ Work Phone_________________________________ Home Phone__________________________________ Pilot DOB____/____/____ Gender  Male  Female Height____’_____” Weight _____lbs Current USHPA Member Yes USHPA member number__________________  No Pilot rating____________________ Pilot Experience # of Flights______________ Pilot Experience Hours of Airtime______________ Pilot Years of Experience_________ Date of Accident/Incident____/____/____ Time of Accident/Incident____________ Site Accident/Incident __________________________________________________ Nearest Town____________________________ Launch Altitude_______________ LZ Altitude_______________ Did this flight occur under the supervision of an instructor?  Yes Instructor’s name___________________________________  No Was this a Tandem Flight?  Yes Tandem Instructor’s name_____________________________________________________  No Name & Phone Number/Email of Other Witnesses___________________________________________________________________ ___________________________________________________________________________________________________________ Launch Characteristics / Causes / Factors Site Characteristics:  Normal or Easy  Ramp  Cliff  Short  Safety Nets  Cross Wind  Hazards Launch Method:  Foot Launch  Platform Launch  Foot Launched Tow  Aerotow TOWLINE TENSION CONTROL DEVICE:  Static Line  Pay Out Winch  Stationary Winch Glider Manufacturer___________________________ Model___________________________ Size_______ Color________________ AFNOR/ACPUL/DHV Certification Level_________ Harness Model_______________________ Harness Cross-bracing_________________ Harness chest strap setting______________ Harness modifications?(describe)_________________________________________________________________________________ Helmet Model___________________ Full Face Protection: Yes No Reserve Make & Model_______________________________ Reserve Date of Manufacturer ____________ Was Reserve Deployed?  Yes  No CAUSES/FACTORS (check all that apply)  Preflight Error  Poorly Inflated Takeoff  Wake Turbulence  Thermal Turbulence  Shear Turbulence  Mechanical Turbulence  Rotor  Panic  Negative Spin  Strong Wind  Valley Wind  Gust Front  Cloud Suck  Flying in Cloud  Tail Wind LZ  Turning in LZ  Gradient LZ  Obstacle Collision  Object Fixation  No Brake Flare  Excessive Brake Flare  Outside LZ  Unknown LZ  Unusual LZ  Equipment Failure  Faulty Harness Adjustment  Aerobatics  Mid Air Collision  Hill Collision  Asymmetric Deflation  Spiral Dive  Parachutal Stall (deep or constant stall)  Other_______________________________________________________________________________________________________ Disposition INJURIES (check all that apply)  Head  Face  Neck  Chest  Back  Abdomen  Shoulder  Arm  Elbow  Forearm  Wrist  Hand  Pelvis  Thigh  Knee  Calf  Ankle  Foot  Other____________________ HOSPITALIZED OVERNIGHT?  Yes  No FATAL?  Yes  No Description of Accident/Incident and apparent causes. Include preflight, wind and weather, distractions, emotional factors and drug/alcohol use. Please give your opinion of cause & suggestions for prevention. Use additional paper if necessary. ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Form Revision: 01/2010 – Submit to: United States Hang Gliding and Paragliding Association, Inc.• PO Box 1330, Colorado Springs, CO, 80901-1330, 719-632-8300, www.ushpa.aero, info@ushpa.aero