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US Army: DAForm-7305-R

US Army: DAForm-7305-R

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Published by: Army on Jan 28, 2008
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05/08/2014

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WORKSHEET FOR TELEPHONIC NOTIFICATION OF AVIATION ACCIDENT/INCIDENT

For use of this form, see AR 385-40; the proponent agency is OCSA SHADED BLOCKS ARE FOR USASC USE ONLY POINT OF CONTACT FOR ACCIDENT INFORMATION Commander A. ASMIS CASE NUMBER B. TIME AND DATE OPS RECEIVED THIS REPORT a. Year b. Month c. Day

d. Time (Local)

NOTE: ITEMS 24 AND 25 ARE NOR REQUIRED FOR CLASS C ACCIDENTS

1 .

a. Name Safety Officer c. Phone Number 4. AIRCRAFT SERIAL NUMBER 8. NOE Yes No 11. MACOM 5. TYPE OF AIRCRAFT DSN: Commercial: ( ) -

b. Duty

Other (Specify) 2. ACCIDENT 3. TIME AND DATE OF ACCIDENT CLASSIFICATION a. Year b. Month c. Day d. Time (local) A B C 6. PERIOD OF DAY Dawn Day Dusk Night 9. NIGHT VIDION DEVICE a. In Use a. If Yes Yes 7. MISSION BEING PERFORMED a. Type (Training, Svc, etc.)

b. Operation

Single-Ship Multi-Ship 10. UNIT OWNING AIRCRAFT

ANVIS FLIR No AN/PVS-5 LLTV 12. MILITARY INSTALLATION NEAREST ACCIDENT SITE CHECK “YES” or “NO” FOR QUESTIUONS 14 THROUGH 19 14. EXPLOSIVES/HAZARDOUS/SENSITIVE MATERIALS INVOLVED 15. IF YES TO #13, ARE THEY SECURE? 16. ACCIDENT SITE SECURED IAW DA PAM 385-40? 17. HAS ACCIDENT SCENE BEEN DISTURBED? 18. IF YES TO #16, WERE PHOTOS ETC. MADE BEFORE DISTURBING THE SCENE? 19. FLIGHT DATA RECORDER INSTALLED? 20. CLEARENCE WAS: VFR IFR 23. ACCIDENT SYNOPSIS (What Happened)

13. EXACT LOCATION YES NO 21. PERSONNEL INVOLVED b. Total No. of Personnel a. No. of Personnel by Rank/Category Officer WO Enlisted Army Civilian Non- Army Civilian
As soon as possible, the following additional information is required on all injured personnel: name, personnel classification, degree of injury, and SSAN

22. INJURIES (Enter # of Each) Fatalities Non-Fatal Injuries

24.

NEWS MEDIA AWARE OF ACCIDENT Yes No

25. NEAREST AIRFIELD

a. Nearest that can handle C-12 (4,000 ft. min.)

b. Nearest Commercial Airfield

26.

Who will Investigate?

a.

DA FORM 7305-R, APR 94

Installation Level Investigation (IAI) Accident Board Appointed

Yes No

b.

CAI Team Dispatched

Yes No

Team:

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