Occurrence Report | NZ Skydiving

PLEASE NOTE:

This form is for the notification of parachuting-related accidents and incidents. On submission of the form, you will be directed to a printer-friendly page that contains all of your inputted data.

General Information

CAA Tandem Rego Number

Write N/A if the incident does not involve a tandem

CAA Client No.

Contact Email Address

Contact Phone Number

Name of Operator

Location of Occurrence

Date of Occurrence

Time of Occurrence

:

Persons Involved

Classification of person(s) involved

Exit weight (kg)

Parachutist in Command (PIC) total # of jumps

PIC jumps in last 90 days

PIC total # of tandems (if applicable)

PIC tandems in last 90 days (if applicable)

About the Occurrence

Classification of occurrence

Specify Other (classification of occurrence)

Consequence

Specify Other (Consequence)

Flight Phase

If "other" was selected above please use this box to explain

Exit altitude AMSL

Is there camera footage available?

Yes

Equipment Details

Harness/Container Model & Manufacturer

Harness/Container # of jumps

Main Canopy

Main canopy # of jumps

Main line-set # of jumps

Reserve Canopy

Type of AAD

Incident Details

Describe the event

Suspected causal factors

Resulting Action Taken

Sharing Information

Copy this email to CAA

Yes

I consent to the information in this report being shared with the wider skydiving community

Note: we will try to remove all identifying details before sharing

Yes

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Untitled

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Occurrence Type