Da Form 2397 U – Fill Out and Use This PDF

UNMANNED AIRCRAFT SYSTEM ACCIDENT REPORT (UASAR)

REQUIREMENTS CONTROL SYMBOL

Use for all UAS Aviation Accidents

CSOCS-309

For use of this form, see DA Pamphlet 385-40; the proponent agency is OCSA.

1.

ACCIDENT CASE

a. Date (YYYYMMDD)

b. Time (Local)

c. UA Tail Number

INFORMATION

2.

ACCIDENT CLASS/

a. Classification

b. Category

3. UAS MTDS

CATEGORY

A

B

C

D

E

F

Flight

Flight Related

Aircraft Ground

4.

PERIOD OF DAY

5. AIRCRAFT

a. Number of Aircraft

b. In Flight/Mid-Air Collision

6. NEAREST MILITARY INSTALLATION

Dawn

Day

Dusk

Night

INVOLVED

Involved

Yes

No

Unknown

7.

ACCIDENT

a.

On-Post

b.

On Airfield

c. City

d. State

e. Country

f. Grid and/or Lat/Long

LOCATION

Off-Post

Not on Airfield

8. ORGANIZATION INVOLVED

a. Unit Designation

b. Unit Identification Code (UIC)

c. Home Station

d. Army Headquarters

10. ACCIDENT

a. UA Total Loss

b. UA Damage or replacement Cost

c. Number of

d. Man-Hours Cost

e. Other UAS Sub-System

COST DATA

Yes

No

(Excluding Man-hours) $

Man-Hours

$

Cost

$

f. Other Damage Cost-Military

g. Other Damage Cost-Civilian

h. Injury/Occupational Illness

i. Total Cost

(This UAS)

j. Total Cost

(All Aircraft)

$

$

$

$

$

11. GENERAL

a. Mission

a(1).

Type Mission

a(2). Aircraft Mode

a(3). Level of Interoperability (LOI)

DATA

Single-ship

Multi-ship

Manned/Unmanned Teaming

1

2

3

4

5

NA

a(4). Simultaneous UA Operation?

Yes

No

b. Flight Plan

c. Flight Rules

(If Yes, specify number & MTDS)

Military

Civil

Operation's Log

VFR

IFR

d. Mission/

d(1). At what level was mission/training conducted?

d(2). Who approved the mission/training? Rank & Position:

Training

Bde

Bn

Co

Plt

Sqd

Team

Crew

d(3). Was a mission brief completed?

d(4). Who was in charge during the mission?

d(5). Who was the senior leader present during the

Rank & Position:

mission/training? Rank & Position:

Yes

No

e. Risk

e(1). RM Performed?

e(2). Who performed the RM? Rank & Position:

e(3). RM Approved?

e(4). Who accepted risks?

Rank & Position:

Management

Yes

No

Yes

No

(RM)

e(5). What was the level of the risk after controls applied?

e(6). How was the RM process communicated?

(Check all that apply.)

Low

Moderate

High

Extremely High

Worksheet

Verbal Brief

Order

Not Communicated

e(7). Accident event identified/considered during RM process?

e(7)a. What was the level of the identified risk?

If yes, complete blocks 11a(7)a thru 11e(7)d)

Yes

No

Low

Moderate

High

Extremely High

e(7)b. Was the control measure(s)

e(7)c. Who was responsible for implementing the controls?

e(7)d. Was the potential for accident event

applied?

Rank & Position:

accepted as residual risk?

Yes

No

Yes

No

g. Fire

h. Hazardous Material Spillage

i. Did accident occur while on an exercise or at a training

None

Inflight

Postcrash

If yes & a Class A, B or C accident,

facility/center?

attach DA Form 2397-6)

(If yes, enter the name)

Other (Specify)

Yes

No

Yes

No

DA FORM 2397-U, FEB 2010

PAGE 1 OF 3

13. FLIGHT

Flight

Phase of Operation

Altitude

Altitude

Airspeed

UA

UA Overgross

14. TYPE EVENTS

DATA

Duration

(Enter max of 3 codes from Table

MSL

AGL

KIAS

Weight

Weight for

(Enter max of 3 codes from

3-4 of DA Pam 385-40 or specify

Conditions

Appendix F table F-3 of DA Pam

the phase if there is no code for it

Yes

No

385-40 or specify the type event

in the table)

which best describes the

accident/incident event if there is no

a. At

Hours

code for it in the table.)

Emergency/

Onset

Tenths

b. At

Hours

Impact/Acdt

or Termination

Tenths

c Flight Ctrl

Check all that apply:

Malfunction

Human

Environmental

Materiel

Hardware

Software

Component/Part

Not Applicable

15. ACCIDENT CAUSE FACTORS (For blocks 15a-c, D=definite, S=Suspected, U=Undetermined and N=No/None)

a. Human Factors (Check box D, S, U or N.

If D or S, complete blocks 15a(1)(a)-(e))

a(1). System Inadequacies

(Enter max of 3 codes in each block below from table B-5 (Additional codes in table

B-1) DA Pam 385-40 or if there is no code in the table, write in that which best describes the failure)

D

S

U

N

a(1)a. Support Failure

a(1)b. Standards Failure

a(1)c. Training Failure

a(1)d. Leader Failure

a(1)e. Individual Failure

b. Materiel Factors

b(1). Type

(Check all that apply.)

(Check box D, S, U or N. If D

D

S

U

N

Component/Part

Hardware

Software

or S, complete blocks 15b(1)-(2))

b(2). Component and Part (Part that initiated failure/malfunction)

UAS Subsystem

Major Component

Part

(UA, GCS, GDT, TALS, etc.)

a. Nomenclature

b. Type, Design,

and Series

c. Part Number

d. NSN/

Manufacturer's

Number

e. Manufacturer's