Us Army 416x1j
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ABBREVIATED AVIATION ACCIDENT REPORT (AAAR)
REQUIREMENTS CONTROL SYMBOL CSSOCS-309
FOR ALL CLASSES C, D, E, F, COMBAT A AND B, AND ALL AIRCRAFT GROUND
For use of this form, see AR 385-40 and DA PAM 385-40; the proponent agency is OCSA COMPLETE BLOCKS 1-18 FOR ALL ACDTS. NO FURTHER ENTRY IS REQUIRED FOR CLASS D, E, AND F ACDTS NOT INVOLVING HUMAN ERROR / INJURY. 1. DATE/CASE a. (YYMMDD) b. Time (Lcl ) c. Acft Ser No. 2 a. Classification A B C D E F NO. OF . b. Category Flight Flight Related Aircraft ACCIDENT
Ground
3. TYPE OF ACFT (MTDS)
Dawn Dusk
4. PERIOD OF DAY
7. ACCIDENT LOCATION
a.
On-Post Off-Post
b. UIC (6 digit Unit Id Code)
INSTALLATION:
b. Acft Damage (Excl man hr)
a. Acft Total Loss c. No. Man Hrs
d.
Yes
Man Hr Cost
(1) Type (Tng, Svc , etc.)
e. Country (If not USA)
ORGANIZATION INVOLVED c. Home Station
d. MACOM
No e. Other Damage Mil
f. Civilian Damage
g. Injury Cost
h. Total (This acft)
I. Total (All acft)
b. Flight Plan c. Flight Data d. Night Vision Device / System In Recorder SingleNA VFR use Yes No If “Yes” Ship Installed Yes IFR specify type: Multi-Ship No f. Flammable Fluid Spillage (If “Yes” for Class A, B, g. Field Training Exercise (FTX) and C Yes No If “Yes” Name of FTX: acdts, attach DA Form 2397-6) Yes No
e. Fire
(2)
None Inflight Postcrash Other 12. FLIGHT Flight Phase of Operation DATA (Enter max of 3 codes from Duratio fig 3-5 DA Pam 385-40 or n specify phase (e.g. hover,
Altitude AGL
Airspe ed KIAS
Aircraft Weight
Ft
Kts
Lbs
Ft
Kts
Lbs
Overgross for Conditions
Yes No
NOE, etc.)
a. At Emergency
d. State
ORGANIZATION DEEMED ABLE (If same as block 8 leave blank) b. UIC (6 digit Unit Id c. Home Station d. MACOM Code)
10. ESTIMATED ACCIDENT COST
a. Msn
6. NEAREST MIL
c. City (Nearest to acdt site)
On Airfield Not on Airfield
9. a. Name of Unit
11. GEN. DAT A
Day Night
b.
8. a. Name of Unit
5. NO. ACFT INVOLVE D
Hours:
13. TYPE EVENTS (Enter max 3 codes from fig 3-4 DA Pam 385-40 or specify type event which best describe the acdt / incdt, e.g. tree strike, generator failure, eng overspeed, hard landing , fuel exhaustion, dropped cargo, oil cooler bearing failure, etc.)
Tenths: . At Impact/Acdt orTerminatio n
Hours: Tenths:
14. ACCIDENT CAUSE FACTORS a. Human Error b. MATERIAL FAILURE / MALFUNCTION c. Environmental (Enter D, S, or U to identify (If D or S (Includes mfg / design induced (If D or S complete blk Definite, Suspected, or complete blks failure) (If D or S complete blk 16) 17) Undetermined cause) 21, 23, & 24) 15. SUMMARY (Enter summary of acdt sequence from onset of emergency through termination of flight. For Class D, E, and F, include the type of material failure and / or environmental factors.)
16. COMPONENT AND PART FAILURE / MALFUNCTION DATA
(part that initiated failure /
malfunction.)
Identification
Major Component
17. ENVIRONMENTAL (Check conditions at time of accident.)
Part
a. General (1)
IMC (2)
VMC (3)
Unknown
a. Nomenclatur e b. Type, Design, and Series c. Part Number d. NSN
b. Environmental Conditions (1) Weather Conditions (a) Hail (b) Sleet
(2) Other Conditions (a) Animals (b) Fowl
(c) (d) (e) (f)
(c) (d) (e) (f)
Fog Drizzle Rain Snow
Surface Noise Chemicals Radiation
e. Manufacturer ’s Code f. Part Serial No.
(g) Lighting (h) Thunderstorm (i) Gusty Winds
FGCODE:(USASC) TYPEFL (1) Material (2) Maintenance (3) Design (4) Manufacture 18. BOARD PRESIDENT / ASO / POC (Name, Signature, and SSN
g. Cause Failure /Malfunction
CAUFL
Address and Tel No.
Date)
Grade DATE:
DA FORM 2397-AB-R, JUL 94
(j) Freezing Rain (k) Other c.Acft Icing No Yes
Branch
DSN: COM:
(g) Glare (h) FOD (i) Temperature (j) Vibration (k) Dust d.Turb No
(DSN and Com)
Yes
COMPLETE BLKS 19-26 FOR ALL CLASS C, COMBAT CLASS A, B, ACFT GROUND CLASS A, B, C, AND ALL CLASS ACDTS INVOLVING HUMAN ERROR/INJURY
19. MOON ILLUMINATION DATA (For night Class A, B, C acdts. If “no” in block a, no other entry is required.) a. Moon Above b. Moon Visible c. Moon (Degrees d. Percent of Moon e. Moon (Clock Position from Horizon Yes Yes No Above Horizon % Illumination % Flight Path/Nose of Acft) No 20. WIRE STRIKE DATA (If “no” in block a, no other entry is required) a. Wire b. WSPS c. WSPS Engaged d. WSPS Cut e. WSPS Functioned as f. Wires Struck Strike Installed Wire Wire Designed Number: Yes Yes Yes Yes Yes Dia. (inches): No No No No No 21. PERSONNEL DATA
(Complete for each crewmember with access to flight controls or other personnel injured or having a contributing role in the accident; use additional
forms as needed.)
a. Name (Last, First, MI)
(8) On Flt Controls
Yes
(1) SSN
(9) Lab Test (Blood /
(10) Activity
Urine; for positive, attach AFIP report)
Pos
No
(2) Grade
(Last 24 hrs.)
Neg
(3) Sex
(a) Hrs Slept:
(4) Duty
(5) SVC
(6) UIC (Assigned)
(12) Injury (If “Yes”,
(11)
(b) Hrs Worked:
(7) Contributing Role D S N U
(a) RL
1
2
3
(b) FAC
1
2
3
complete DA Form 23979-R)
Yes
(13) Total Flt Hrs (acft MTDS)
No
(c) Hrs Flown: a. Name (Last, First, MI)
(8) On Flt Controls
(9) Lab Test (Blood /
(2) Grade (10) Activity
Urine; for positive, attach
(Last 24 hrs.)
AFIP report)
Pos Yes
(1) SSN
Neg
(3) Sex
(a) Hrs Slept:
(4) Duty
(5) SVC
(6) UIC (Assigned)
(12) Injury (If “Yes”,
(11)
(b) Hrs Worked:
No
(7) Contributing Role D S N U
(a) RL
1
2
3
(b) FAC
1
2
3
complete DA Form 23979-R)
Yes
(13) Total Flt Hrs (acft MTDS)
No
(c) Hrs Flown: a. Name (Last, First, MI)
(8) On Flt Controls
Yes
(1) SSN
(9) Lab Test (Blood /
(10) Activity
Urine; for positive, attach AFIP report)
No
Pos
(2) Grade
(Last 24 hrs.)
Neg
(3) Sex
(4) Duty
(a) Hrs Slept:
(11)
(b) Hrs Worked:
(a) RL (b) FAC
(5) SVC
(6) UIC (Assigned)
(7) Contributing Role D S N U
(12) Injury (If “Yes”, 1 1
2 2
complete DA Form 23979-R)
3 3
Yes
(13) Total Flt Hrs (acft MTDS)
No
(c) Hrs Flown: 22. IMPACT / PROTECTIVE / ESCAPE / SURVIVAL / RESCUE DATA (For Class A, B, and C acdts) a. Acft Occupiable Space Compromised (If “yes”
Yes
a. Training Failure (Stds exist but not known or ways to achieve them not known.)
No
b. Escape / Survival Difficulties (If “yes”, DA Form
c. Protective / Restraint Equip Functioned as Designed (If “no”, DA
Form 2397-10-R required for the individual.) Yes No 23. ACDT CAUSE FACTORS (Blk 24 must all cause factors checked; see DA Pam 385-40 for definition of cause factors.) DA Form 2397-6-R required)
b. Standards Failure (Stds not clear, practical, or do not exist.)
24. FINDINGS AND RECOMMENDATIONS
USASC
Duty:
2397-10-R required for the individual)
Role
Yes
c. Leader Failure (Stds are known but not enforced.)
d. Individual Failure (Stds known but not followed)
e.
Failure (Inadequate equip / facilities / svcs / no or type personnel)
(See instructions in DA Pam 385-40 for writing findings and recommendations. Use additional sheet if required.)
D
S
Failure / Error Code
SI 1:
RM 1:
RM 2:
RM 3:
No
use Phase of OP: Task / part no: only 25. LIST OF ATTACHMENTS (CCAD, DA Form 2397-4, 8, 9, etc.)
SI 2:
RM 1:
RM 2:
RM 3:
26. COMMAND REVIEW (Required for Class A and B combat and all Class C acdts. Use separate sheet for non-concurrence, additional findings, and recommendations.)
Reviewer a. Unit Commander
Organization
Name (Typed / Printed)
b. Reviewing Official c. Approving Authority d. DA Review
US Army Safety Center
REVERSE OF DA FORM 2397-AB-R, JUL 94 Page 2
Rank
Signature
Comments Concur Non-concur Concur Non-concur Approved Disapproved Approved for entry into ASMIS (YYMMDD):
REQUIREMENTS CONTROL SYMBOL CSSOCS-309
FOR ALL CLASSES C, D, E, F, COMBAT A AND B, AND ALL AIRCRAFT GROUND
For use of this form, see AR 385-40 and DA PAM 385-40; the proponent agency is OCSA COMPLETE BLOCKS 1-18 FOR ALL ACDTS. NO FURTHER ENTRY IS REQUIRED FOR CLASS D, E, AND F ACDTS NOT INVOLVING HUMAN ERROR / INJURY. 1. DATE/CASE a. (YYMMDD) b. Time (Lcl ) c. Acft Ser No. 2 a. Classification A B C D E F NO. OF . b. Category Flight Flight Related Aircraft ACCIDENT
Ground
3. TYPE OF ACFT (MTDS)
Dawn Dusk
4. PERIOD OF DAY
7. ACCIDENT LOCATION
a.
On-Post Off-Post
b. UIC (6 digit Unit Id Code)
INSTALLATION:
b. Acft Damage (Excl man hr)
a. Acft Total Loss c. No. Man Hrs
d.
Yes
Man Hr Cost
(1) Type (Tng, Svc , etc.)
e. Country (If not USA)
ORGANIZATION INVOLVED c. Home Station
d. MACOM
No e. Other Damage Mil
f. Civilian Damage
g. Injury Cost
h. Total (This acft)
I. Total (All acft)
b. Flight Plan c. Flight Data d. Night Vision Device / System In Recorder SingleNA VFR use Yes No If “Yes” Ship Installed Yes IFR specify type: Multi-Ship No f. Flammable Fluid Spillage (If “Yes” for Class A, B, g. Field Training Exercise (FTX) and C Yes No If “Yes” Name of FTX: acdts, attach DA Form 2397-6) Yes No
e. Fire
(2)
None Inflight Postcrash Other 12. FLIGHT Flight Phase of Operation DATA (Enter max of 3 codes from Duratio fig 3-5 DA Pam 385-40 or n specify phase (e.g. hover,
Altitude AGL
Airspe ed KIAS
Aircraft Weight
Ft
Kts
Lbs
Ft
Kts
Lbs
Overgross for Conditions
Yes No
NOE, etc.)
a. At Emergency
d. State
ORGANIZATION DEEMED ABLE (If same as block 8 leave blank) b. UIC (6 digit Unit Id c. Home Station d. MACOM Code)
10. ESTIMATED ACCIDENT COST
a. Msn
6. NEAREST MIL
c. City (Nearest to acdt site)
On Airfield Not on Airfield
9. a. Name of Unit
11. GEN. DAT A
Day Night
b.
8. a. Name of Unit
5. NO. ACFT INVOLVE D
Hours:
13. TYPE EVENTS (Enter max 3 codes from fig 3-4 DA Pam 385-40 or specify type event which best describe the acdt / incdt, e.g. tree strike, generator failure, eng overspeed, hard landing , fuel exhaustion, dropped cargo, oil cooler bearing failure, etc.)
Tenths: . At Impact/Acdt orTerminatio n
Hours: Tenths:
14. ACCIDENT CAUSE FACTORS a. Human Error b. MATERIAL FAILURE / MALFUNCTION c. Environmental (Enter D, S, or U to identify (If D or S (Includes mfg / design induced (If D or S complete blk Definite, Suspected, or complete blks failure) (If D or S complete blk 16) 17) Undetermined cause) 21, 23, & 24) 15. SUMMARY (Enter summary of acdt sequence from onset of emergency through termination of flight. For Class D, E, and F, include the type of material failure and / or environmental factors.)
16. COMPONENT AND PART FAILURE / MALFUNCTION DATA
(part that initiated failure /
malfunction.)
Identification
Major Component
17. ENVIRONMENTAL (Check conditions at time of accident.)
Part
a. General (1)
IMC (2)
VMC (3)
Unknown
a. Nomenclatur e b. Type, Design, and Series c. Part Number d. NSN
b. Environmental Conditions (1) Weather Conditions (a) Hail (b) Sleet
(2) Other Conditions (a) Animals (b) Fowl
(c) (d) (e) (f)
(c) (d) (e) (f)
Fog Drizzle Rain Snow
Surface Noise Chemicals Radiation
e. Manufacturer ’s Code f. Part Serial No.
(g) Lighting (h) Thunderstorm (i) Gusty Winds
FGCODE:(USASC) TYPEFL (1) Material (2) Maintenance (3) Design (4) Manufacture 18. BOARD PRESIDENT / ASO / POC (Name, Signature, and SSN
g. Cause Failure /Malfunction
CAUFL
Address and Tel No.
Date)
Grade DATE:
DA FORM 2397-AB-R, JUL 94
(j) Freezing Rain (k) Other c.Acft Icing No Yes
Branch
DSN: COM:
(g) Glare (h) FOD (i) Temperature (j) Vibration (k) Dust d.Turb No
(DSN and Com)
Yes
COMPLETE BLKS 19-26 FOR ALL CLASS C, COMBAT CLASS A, B, ACFT GROUND CLASS A, B, C, AND ALL CLASS ACDTS INVOLVING HUMAN ERROR/INJURY
19. MOON ILLUMINATION DATA (For night Class A, B, C acdts. If “no” in block a, no other entry is required.) a. Moon Above b. Moon Visible c. Moon (Degrees d. Percent of Moon e. Moon (Clock Position from Horizon Yes Yes No Above Horizon % Illumination % Flight Path/Nose of Acft) No 20. WIRE STRIKE DATA (If “no” in block a, no other entry is required) a. Wire b. WSPS c. WSPS Engaged d. WSPS Cut e. WSPS Functioned as f. Wires Struck Strike Installed Wire Wire Designed Number: Yes Yes Yes Yes Yes Dia. (inches): No No No No No 21. PERSONNEL DATA
(Complete for each crewmember with access to flight controls or other personnel injured or having a contributing role in the accident; use additional
forms as needed.)
a. Name (Last, First, MI)
(8) On Flt Controls
Yes
(1) SSN
(9) Lab Test (Blood /
(10) Activity
Urine; for positive, attach AFIP report)
Pos
No
(2) Grade
(Last 24 hrs.)
Neg
(3) Sex
(a) Hrs Slept:
(4) Duty
(5) SVC
(6) UIC (Assigned)
(12) Injury (If “Yes”,
(11)
(b) Hrs Worked:
(7) Contributing Role D S N U
(a) RL
1
2
3
(b) FAC
1
2
3
complete DA Form 23979-R)
Yes
(13) Total Flt Hrs (acft MTDS)
No
(c) Hrs Flown: a. Name (Last, First, MI)
(8) On Flt Controls
(9) Lab Test (Blood /
(2) Grade (10) Activity
Urine; for positive, attach
(Last 24 hrs.)
AFIP report)
Pos Yes
(1) SSN
Neg
(3) Sex
(a) Hrs Slept:
(4) Duty
(5) SVC
(6) UIC (Assigned)
(12) Injury (If “Yes”,
(11)
(b) Hrs Worked:
No
(7) Contributing Role D S N U
(a) RL
1
2
3
(b) FAC
1
2
3
complete DA Form 23979-R)
Yes
(13) Total Flt Hrs (acft MTDS)
No
(c) Hrs Flown: a. Name (Last, First, MI)
(8) On Flt Controls
Yes
(1) SSN
(9) Lab Test (Blood /
(10) Activity
Urine; for positive, attach AFIP report)
No
Pos
(2) Grade
(Last 24 hrs.)
Neg
(3) Sex
(4) Duty
(a) Hrs Slept:
(11)
(b) Hrs Worked:
(a) RL (b) FAC
(5) SVC
(6) UIC (Assigned)
(7) Contributing Role D S N U
(12) Injury (If “Yes”, 1 1
2 2
complete DA Form 23979-R)
3 3
Yes
(13) Total Flt Hrs (acft MTDS)
No
(c) Hrs Flown: 22. IMPACT / PROTECTIVE / ESCAPE / SURVIVAL / RESCUE DATA (For Class A, B, and C acdts) a. Acft Occupiable Space Compromised (If “yes”
Yes
a. Training Failure (Stds exist but not known or ways to achieve them not known.)
No
b. Escape / Survival Difficulties (If “yes”, DA Form
c. Protective / Restraint Equip Functioned as Designed (If “no”, DA
Form 2397-10-R required for the individual.) Yes No 23. ACDT CAUSE FACTORS (Blk 24 must all cause factors checked; see DA Pam 385-40 for definition of cause factors.) DA Form 2397-6-R required)
b. Standards Failure (Stds not clear, practical, or do not exist.)
24. FINDINGS AND RECOMMENDATIONS
USASC
Duty:
2397-10-R required for the individual)
Role
Yes
c. Leader Failure (Stds are known but not enforced.)
d. Individual Failure (Stds known but not followed)
e.
Failure (Inadequate equip / facilities / svcs / no or type personnel)
(See instructions in DA Pam 385-40 for writing findings and recommendations. Use additional sheet if required.)
D
S
Failure / Error Code
SI 1:
RM 1:
RM 2:
RM 3:
No
use Phase of OP: Task / part no: only 25. LIST OF ATTACHMENTS (CCAD, DA Form 2397-4, 8, 9, etc.)
SI 2:
RM 1:
RM 2:
RM 3:
26. COMMAND REVIEW (Required for Class A and B combat and all Class C acdts. Use separate sheet for non-concurrence, additional findings, and recommendations.)
Reviewer a. Unit Commander
Organization
Name (Typed / Printed)
b. Reviewing Official c. Approving Authority d. DA Review
US Army Safety Center
REVERSE OF DA FORM 2397-AB-R, JUL 94 Page 2
Rank
Signature
Comments Concur Non-concur Concur Non-concur Approved Disapproved Approved for entry into ASMIS (YYMMDD):
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