If you have encountered an aviation situation you deem hazardous, please describe
it below, then submit this form. Please include type of license, ratings held and
aircraft operated. Your name, e-mail, and telephone number are optional but useful
should our editors need further details.

The following are required fields...

Full Name:

License (highest held): None Private/Recreational Commercial ATP

Ratings and Certificates (all that apply): Instrument CFI/CFII Helo A&P

Type ratings held:

I currently fly a:

Total time: hours

To help us determine if the responsible agencies are aware of the hazard,
please check the appropiate boxes below. This Av Hazard was also reported to:

Local ATC, Local FSDO, NASA ASRS, Own company, Military,

Other

Copies may be sent to the above with without my name, address and telephone.

Optional information... E-mail:

Telephone number: