Faa Form 8020 23 PDF Details

In the realm of aviation, accurate and comprehensive reporting is an essential component for maintaining safety and efficiency within the airspace. The FAA Form 8020-23 serves as a critical tool for documenting accidents and incidents, aiming to aggregate vital data that helps in understanding the factors contributing to such events. This form encompasses a wide spectrum of information, ranging from basic occurrence details, such as date and location, to more nuanced aspects like airworthiness certificates, types of operations, and weather conditions at the time of the event. It requires the enumeration of injuries onboard, provides a section for detailing the narrative of what transpired, and seeks information regarding pilot training. Moreover, it prompts an investigation into the cause, whether technical, operational, or related to human error, and mandates reporting on the corrective actions planned or initiated to prevent future occurrences. The detailed structure of the form, including the provision for both primary and secondary contributing factors, underscores the multifaceted nature of aviation incidents and the importance of a thorough investigation process. By cataloging this diverse array of information, the FAA 8020-23 form serves as a cornerstone in the ongoing effort to enhance safety protocols and mitigate risks within the aviation sector.

QuestionAnswer
Form NameFaa Form 8020 23
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesfaa 8020 form, faa 8020 30 pdf, faa form 8020, faa 8020

Form Preview Example

ATQA REPORT NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAA ACCIDENT / INCIDENT REPORT

2.

 

 

AMENDED DATE

MO

 

 

 

 

 

 

 

 

DA

 

 

 

YR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. FAR PART NUMBER

15A. TYPE OF AIRCRAFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

ACCIDENT

 

 

 

 

 

 

 

INCIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

91

 

 

 

 

 

 

AIRPLANE

 

 

 

BLIMP/AIRSHIP

 

ULTRALIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

91 SUBPART K (FRACTIONAL)

 

HELICOPTER

 

 

 

 

GYROPLANE

 

 

 

LIGHT SPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

103

 

 

 

 

 

 

GLIDER

 

 

 

 

 

 

 

 

HOMEBUILT/AMATEUR

 

UAS

 

 

 

3. DATE OF EVENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

105

 

 

 

 

 

 

BALLOON

 

 

 

EXPERIMENTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

MO

 

DA

YR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

121

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

125

 

 

 

 

 

15B. AIRWORTHINESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAA OFFICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

129

 

 

 

 

 

 

NONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

REGION

 

OFFICE NUMBER

 

 

 

 

 

 

 

 

 

 

 

133

 

 

 

 

 

 

STANDARD

 

 

 

 

 

 

PROVISIONAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135 ON DEMAND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

135 COMMUTER

 

 

 

RESTRICTED

 

 

 

 

 

 

 

PRIMARY

 

 

LIMITED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

137

 

 

 

141

 

 

SPECIAL LIGHT SPORT AIRCRAFT

 

 

 

 

 

 

 

 

5.

NTSB ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPERIMENTAL (SELECT CERTIFICATE PURPOSE BELOW)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

LOCATION: CITY/STATE/ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. POWER PLANT MAKE/MODEL SERIES

 

 

 

 

 

RESEARCH AND DEVELOPMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SHOWING COMPLIANCE WITH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGULATIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CREW TRAINING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXHIBITION

 

 

 

 

 

 

 

 

7.

OPERATOR NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

PROPELLER MAKE/MODEL SERIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

AIR RACING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MARKET SURVEY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOUR LETTER IDENTIFIER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OPERATING AMATEUR BUILT AIRCRAFT

 

8.

AIRPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

BIOHAZARD AREA

 

YES

NO

 

 

 

 

 

OPERATING PRIMARY KIT BUILT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIRCRAFT

 

 

 

 

 

 

 

 

 

(IF APPLICABLE)

 

 

 

 

 

 

3- OR 4- LETTER ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIOHAZARD PPE USED YES

NO

 

 

 

 

 

OPERATING LIGHT SPORT AIRCRAFT

 

 

9.

LOCAL TIME

 

 

 

 

 

 

 

24- HOUR CLOCK

 

 

 

 

 

 

 

 

 

 

 

 

 

19.

TYPE OF LANDING GEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10A. LATITUDE

 

 

 

 

10B. LONGITUDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONVENTIONAL

 

SKIS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMPHIBIOUS HULL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRICYCLE

 

 

AMPHIBIOUS FLOATS

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

11.

AIRCRAFT DAMAGE

 

NONE MINOR

SUBSTANTIAL

DESTROYED

 

 

 

FLOATS

 

 

SKIDS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. COLLISION - BETWEEN TWO AIRCRAFT

 

 

 

 

YES

 

 

 

AIR

20.

 

INJURY/ON-BOARD SUMMARY

 

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

 

 

 

GROUND

 

 

 

 

 

FLT.CREW

CABIN CREW

PASSENGERS

 

 

OTHER

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. AIRCRAFT

REGISTRATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

UNINJURED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECOND AIRCRAFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MINOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGISTRATION

 

 

 

 

 

 

 

 

 

 

 

YEAR OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MANUFACTURE

 

 

 

 

 

 

 

 

 

 

 

 

SERIOUS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAKE/MODEL

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIRFRAME HRS.

 

 

 

 

 

 

 

 

 

 

 

 

FATAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SERIAL NO.

 

 

 

 

 

 

 

 

 

 

AIRFRAME CYCLES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21.FACTORS - IDENTIFY PRIMARY FACTOR AS A. IDENTIFY SECONDARY FACTORS, IF ANY, AS X.

CHECKING OF FACTORS IS THE OPINION OF THE INVESTIGATOR/INSPECTOR BASED ON THE INVESTIGATION.

22.

TYPE OF OPERATIONS

 

 

21A.

TECHNICAL FACTORS

 

NONE

21B. OPERATIONAL FACTORS

NONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GEAR COLLAPSE

 

 

 

LOST POWER

 

 

 

 

 

FUEL DEPLETION

 

 

 

SABOTAGE

 

 

 

 

 

UNKNOWN

 

 

 

 

GEAR UP LANDING

 

 

 

FOD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PILOT INDUCED ERROR

 

 

 

PILOT INCAPACITATED

 

PERSONAL

 

 

 

 

FIRE OR EXPLOSION

 

AUTO/IMPROPER FUEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GROUND CREW ERROR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PILOT INCP. ALCOHOL

 

CARGO

 

 

 

 

FUEL CONTAMINATION

 

CORROSION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER THAN PILOT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOWNWIND TAKEOFF

 

INSTRUCTION

 

 

 

 

BLADE/ROTOR FAILURE

 

INFLIGHT FIRE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PARACHUTE INCIDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESIGN OF AIRCRAFT

 

SMOKE/FUMES

 

 

 

 

 

 

CARBURETOR ICE

 

 

 

 

 

BUSINESS

 

 

 

 

METAL FATIGUE

 

 

 

INFLIGHT BREAKUP

 

 

OVER GROSS WEIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HIT KNOWN OBJECT

 

 

 

 

 

CORPORATE

 

 

 

 

IMPROPER MAINTENANCE

 

IMPROPER PART

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CG OUT OF LIMITS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMERGENCY LANDING

 

FERRY

 

 

 

 

 

 

 

 

 

IMPROPER INSTALLATION

 

AVIONICS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STRUCK ANIMAL

 

 

 

 

 

 

 

 

 

 

 

 

 

AD NON-COMPLIANCE

 

GYRO

 

 

 

 

 

 

 

 

 

HARD LANDING

 

 

 

 

 

AERIAL APPLICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAVIGATION SYSTEM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DECOMPRESSION

 

 

 

 

 

BIRD STRIKE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OVERSHOT RUNWAY

 

AERIAL OBSERVATION

 

 

FIRE AFTER LANDING

 

AUTO-PILOT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAX DISTURBANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SYSTEM FAILURE

 

 

 

ALTIMETER

 

 

 

 

 

 

 

 

UNDERSHOT RUNWAY

 

AMBULANCE / AIR EVAC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STOLEN AIRCRAFT

 

 

 

 

 

 

RADIO/COMMUNICATION

 

TRANSPONDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOSS OF CONTROL

 

 

 

 

 

FIREFIGHTING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21F. JASC CODE

 

 

 

COMPONENT FAILURE

 

 

 

 

HIJACK AIRCRAFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STALL/SPIN

 

 

 

 

 

BANNER TOW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21C. PART NAME

 

 

21D. MANUFACTURER

 

 

21E. PART NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MISMANAGED GEAR

 

 

 

 

 

AIR SHOW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23.

WX. BRIEFING SOURCE

24.

PRECIPITATION

 

 

 

MISMANAGED CONTROLS

 

SIGHTSEEING

 

 

 

 

NOT APPLICABLE/NOT AVAILABLE

 

NOT APPLICABLE/NOT AVAILABLE

 

 

 

ABORTED TAKEOFF

 

 

 

 

 

SKYDIVING / PARACHUTE

 

 

NATIONAL WEATHER SERVICE

 

 

RAIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIRFRAME ICE/FROST

 

AIR TOUR

 

 

 

 

FLIGHT SERVICE STATION

 

 

HAIL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WAKE TURBULENCE

 

 

 

 

 

PUBLIC USE

 

 

 

 

COMMERCIAL WX. SERVICE

 

 

SLEET

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PATWAS

 

 

VOICE RESP. SYSTEM

 

SNOW

 

 

 

 

 

 

 

WEATHER

 

 

 

 

 

 

 

COMMERCIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPANY

 

 

TV/RADIO WEATHER

 

FREEZING DRIZZLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26.

 

 

PHASE OF FLIGHT

 

UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MILITARY

 

 

COMPUTER BRIEFING

 

FREEZING RAIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GROUND

 

 

 

CRUISE

 

 

 

 

 

 

MANEUVER

 

 

PIREP

 

 

UNKNOWN

 

 

DRIZZLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAXI

 

 

 

DESCENT

 

 

 

 

 

 

HOVER/HOLDING

 

 

OTHER

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAKEOFF

 

 

 

LANDING

 

 

 

 

 

CLIMB

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPARTURE ROLL

 

 

APPROACH

 

 

 

 

 

RUN-UP AREA

 

 

 

 

 

 

 

WEATHER FACTORS

 

 

 

 

 

 

 

 

 

 

25.

 

 

 

 

 

 

 

 

 

 

 

 

ROTATION

 

 

 

TOUCHDOWN

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NONE / NOT APPLICABLE

 

 

THUNDERSTORM

 

 

 

CLIMB OUT

 

 

 

ROLLOUT

 

 

 

 

 

 

 

 

 

 

 

 

 

HAZE

 

 

 

 

 

CROSSWIND

 

 

 

 

27.

 

ACTUAL WEATHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DUST

 

 

 

 

 

TURBULENCE/WINDSTORM

 

IMC

VMC

 

NOT AVAILABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SMOKE

 

 

 

 

 

DENSITY ALTITUDE

28. RUNWAY CONDITIONS

TIME REPORTED

 

 

 

 

FOG

 

 

 

 

 

LIGHTNING STRIKE

 

NOT APPLICABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BLOWING DUST

 

 

 

 

 

BLOWING SNOW

 

 

 

DRY

WET

SLUSH

 

SNOW (WET)

SNOW (DRY)

 

 

BLOWING SMOKE

 

 

 

 

 

WHITE OUT

 

 

 

SMOG

 

 

 

ICE (COVERED)

ICE (PATCHES)

STANDING WATER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ICING CONDITIONS

 

 

 

 

 

WIND SHEAR

 

 

SANDSTORM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GUSTY WINDS

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAA FORM 8020-23 (01-10) SUPERSEDES FAA FORMS 8020-5 AND 8020-16

INFORMATION IS PRELIMINARY AND SUBJECT TO CHANGE

NSN: 0052-00-923-1000

ATQA REPORT NUMBER

29. PILOT TRAINING (CHECK ALL THAT APPLY, RECORD THE TWO MOST RECENT TRAINING EVENTS, IF APPLICABLE/AVAILABLE.)

ALL UNKNOWN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

UNK

(MO / DA / YR)

(MO / DA / YR)

 

YES

NO

UNK

(MO / DA / YR)

(MO / DA / YR)

 

 

 

 

 

 

 

 

 

 

 

 

SAFETY SEMINAR/CLINIC

 

 

 

 

 

AIR CARRIER TRANSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WINGS PROGRAM

 

 

 

 

 

SIMULATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIR CARRIER INITIAL

 

 

 

 

 

COMM/THIRD PARTY

 

 

 

 

 

 

 

 

 

 

 

 

 

(CONTRACT TRAINING)

 

 

 

 

 

 

 

AIR CARRIER RECURRENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIR CARRIER RE-QUALIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

30.

EVACUATION OVERVIEW (AIR CARRIER ONLY)

EVACUATION INITIATED

YES

NO

EVACUATION INJURIES

YES

NO

31.

PILOT INFORMATION

NOT APPLICABLE

CERTIFICATE TYPE

SECOND PILOT

 

NAME

 

 

 

 

 

RECREATIONAL

 

 

 

 

 

DATE OF BIRTH

 

 

 

 

STUDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MO

DA

YR

 

 

 

MO

DA

YR

 

DATE HIRED

 

 

 

 

 

PRIVATE

 

 

 

 

 

(AIR CARRIER ONLY)

 

 

 

 

 

 

 

 

 

MO

DA

YR

 

 

 

MO

DA

YR

 

 

 

 

 

 

 

 

DOMICILE

ZIP CODE

 

 

 

 

COMMERCIAL

 

 

 

 

 

HOURS IN MAKE AND MODEL

 

 

 

 

FLIGHT INST.

 

 

 

 

 

HOURS IN LAST 90 DAYS

 

 

 

 

ATP

 

 

 

 

 

HOURS IN LAST YEAR

 

 

 

 

FOREIGN PILOT

 

 

 

 

 

TOTAL HOURS

 

 

 

 

SPORT

 

 

 

 

 

CERTIFICATE NO.

 

 

 

 

NON-PILOT

 

 

 

 

 

REGULATORY CHECK RIDE

 

 

 

 

 

 

OTHER

 

 

 

 

 

 

 

MO

 

DA

 

YR

 

 

MO

 

DA

 

YR

 

 

 

 

 

 

 

32. CORRECTIVE ACTION(S) PLANNED OR INITIATED

NONE

44709 RE-EXAM SDR

COUNSELING

EIR

 

 

 

 

 

 

 

MALFUNCTION OR DEFECT REPORT

OTHER

 

 

 

 

 

 

 

33.NARRATIVE (ATTACH ADDITIONAL SHEETS AS NECESSARY)

(ONLY STATE FACTS OR SEQUENCE OF EVENTS THAT ARE RELEVANT TO THE ACCIDENT OR INCIDENT)

CONDUCT OF INVESTIGATION

34.

NTSB PARTICIPATION

 

 

ON-SCENE

LIMITED

 

NONE

 

35. FAAPARTICIPATION ON-SCENE

 

NOT ON-SCENE

 

 

 

SCENE NOT ACCESSIBLE

 

36.

 

FAA INITIAL NOTIFICATION

 

37.

 

 

 

FSDO NOTIFICATION

38.

 

FAA IIC ARRIVAL ON SCENE

 

 

 

 

 

DATE AND LOCAL TIME

 

 

 

 

 

 

DATE AND LOCAL TIME

 

 

 

 

DATE AND LOCAL TIME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MO

 

 

 

DA

 

 

YR

 

 

 

 

 

MO

DA

 

 

YR

 

 

 

MO

 

 

DA

 

 

YR

 

 

 

 

 

 

 

 

 

 

 

 

 

24 - HOUR CLOCK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24 - HOUR CLOCK

 

 

 

 

 

 

 

 

 

 

 

 

 

24-HR CLOCK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

39.

 

 

 

 

 

.

 

 

 

FAA HOURS USED FOR

40.

 

 

 

 

 

 

 

.

 

 

 

TOTAL HOURS USED

41.

 

 

 

 

.

 

 

 

 

TOTAL TRAVEL HOURS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL INVESTIGATION

 

 

 

 

 

 

 

 

 

 

 

AT ACCIDENT SCENE

 

 

 

 

 

 

 

 

 

TO & FROM SCENE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

42.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAA NINE RESPONSIBILITIES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IDENTIFICATION OF RESPONSIBILITIES IS THE INVESTIGATORS OPINION BASED ON HIS/HER INVESTIGATION

1. FAA FACILITIES

YES

NO

4. AIRMAN/AIR AGENCY COMPETENCE

YES

NO

7. SECURITY

YES

NO

2. NON FAA FACILITIES

YES

NO

5. FAR CHANGE NEEDED

YES

NO

8. AIRMAN MEDICAL QUALIF. YES

NO

3. AIRWORTHINESS

YES

NO

6. AIRPORT CERTIFICATION

YES

NO

9. FAR VIOLATION

YES

NO

43.BRIEF EXPLANATION OF ISSUES INVOLVED

44. FAA IIC NAME

DATE

REGION

DISTRICT OFFICE

 

 

 

FAA FORM 8020-23 (01-10) SUPERSEDES FAA FORMS 8020-5 AND 8020-16

INFORMATION IS PRELIMINARY AND SUBJECT TO CHANGE

NSN: 0052-00-923-1000

INSTRUCTIONS FOR FAA FORM 8020-23 ACCIDENT/INCIDENT REPORT

1. OCCURRENCE INFORMATION:

FAA FORM 8020-23 IS TO BE COMPLETED FOR EACH ACCIDENT AND INCIDENT AND FORWARDED TO THE RESPONSIBLE REGIONAL FLIGHT STANDARDS DIVISION WITHIN 30 DAYS. THE REGIONAL FS DIVISION WILL FORWARD ORIGINAL FAA ACCIDENT/INCIDENT REPORT TO AFS-620 AND A COPY OF ACCIDENT REPORT ONLY TO AAI-220 WITHIN 15 DAYS OF RECEIPT OF ORIGINAL.

2. AMENDED DATE:

INSERT AMENDED DATE FOR AMENDED REPORTS, FILL IN ITEMS 1, 2, 3, 5, AND 13, REGISTRATION NUMBER ONLY, AND NEW OR CHANGED INFORMATION PERTAINING TO ACCIDENT INVESTIGATION.

3. DATE OF THE OCCURRENCE:

COMPLETE THE EVENT DATE (MONTH/DAY/YEAR) IN FORMAT MMDDYY.

4. FAA (INVESTIGATING OFFICE):

THE FIRST TWO BLOCKS ARE THE REGION ID. THE SECOND TWO BLOCKS ARE THE NUMERICAL ID OF THE FSDO (E.G., EA 21).

5. NTSB ID:

INSERT NTSB REPORT NUMBER FOR ACCIDENTS AND INCIDENTS. THE NUMBER IS SUPPLIED BY THE NTSB OFFICE WITH JURISDICTIONAL RESPONSIBILITY.

6. LOCATION :

CITY: NEAREST CITY OR TOWN TO THE OCCURRENCE.

STATE: 2 LETTER IDENTIFIER OF THE STATE OR TERRITORY CODE.

ZIP CODE: ZIP CODE OF NEAREST CITY OR TOWN LOCATION.

7. OPERATOR:

PROVIDE THE NAME OF THE OPERATOR THAT HAS OPERATIONAL CONTROL OF THE AIRCRAFT INVOLVED IN THE EVENT. THE 4-LETTER DESIGNATOR IS FROM OPSS/SPAS/VIS.

8. AIRPORT:

PROVIDE THE AIRPORT NAME AND 4-LETTER ID IF OCCURRENCE TOOK PLACE ON AN AIRPORT. USE AIRPORT DESIGNATOR IAW FAA 7350.7B.

9. TIME:

PROVIDE THE TIME OF THE OCCURRENCE IN LOCAL 24 HOUR CLOCK.

10. LATITUDE / LONGITUDE:

PROVIDE GEOGRAPHIC INFORMATION FOR ALASKA AND OCEANIC EVENTS.

11. AIRCRAFT DAMAGE:

PROVIDE THE MOST SEVERE DAMAGE TO AIRCRAFT FROM CATEGORIES.

12. COLLISION:

IDENTIFY IF TWO AIRCRAFT ARE INVOLVED; AND IF TWO COLLIDED IN THE AIR OR ON THE GROUND. TWO FAA 8020-23 FORMS REQUIRED IF BOTH AIRCRAFT WERE FLYING OR HAD THE INTENT TO FLY.

13. AIRCRAFT REGISTRATION NUMBER:

COMPLETE AIRCRAFT REGISTRATION INFORMATION (E.G. REGISTRATION: N1234M. MAKE/MODEL: E.G. DC-9-10. SERIAL NUMBER: 99347YT78. YEAR OF MANUFACTURE: E.G. 1994). ALSO PROVIDE AIRFRAME CYCLES AND AIRFRAME HOURS IN WHOLE NUMBERS.

14. FAR PART NUMBER:

PROVIDE THE FEDERAL AVIATION REGULATION THAT THE AIRCRAFT WAS OPERATING UNDER. NOTES: AN AIR CARRIER DOING POSITIONING, TRAINING IS PART 91. PART 135 AIR TAXI AND AIR AMBULANCE IS PART 91 UNTIL PASSENGER PICKUP. MEDICAL PERSONNEL ARE PART OF THE CREW.

15. TYPE OF AIRCRAFT:

PROVIDE THE TYPE OF AIRCRAFT AND AIRWORTHINESS CERTIFICATE (MORE THAN ONE TYPE MAY BE CHECKED IN SOME CASES).

16. POWER PLANT INFORMATION:

PROVIDE THE MAKE/MODEL/SERIES OF ENGINE ONLY IF RELEVANT TO THE ACCIDENT/INCIDENT.

17. PROPELLER INFORMATION :

PROVIDE THE MAKE/MODEL/SERIES OF PROPELLER ONLY IF RELEVANT TO THE ACCIDENT/INCIDENT.

18. BIOHAZARD AREA:

PROVIDE BIOHAZARD AREA INFORMATION. NOTE: SELECT 'YES' IF BODY FLUIDS PRESENT. ALSO PROVIDE USE OR NONUSE OF PERSONAL PROTECTIVE EQUIPMENT INFORMATION.

19. TYPE OF LANDING GEAR:

PROVIDE TYPE OF LANDING GEAR OF AIRCRAFT INVOLVED IN EVENT.

20. INJURY SUMMARY:

ENTER THE COUNT FOR EACH INJURY TYPE BY PERSON CATEGORY FOR ALL ON BOARD THE AIRCRAFT. ACCOUNT FOR PERSONNEL INJURED THAT WERE NOT ON THE AIRCRAFT UNDER OTHER.

21. FACTORS:

SELECT THE MOST APPROPRIATE PRIMARY FACTOR FROM EITHER TECHNICAL OR OPERATIONAL FACTORS. SELECT ALL SECONDARY FACTORS.

21A. TECHNICAL FACTORS:

SELECT ALL APPLICABLE FACTORS. THIS IS THE INSPECTOR/INVESTIGATOR OPINION BASED ON THE INVESTIGATION.

21B. OPERATIONAL FACTORS:

SELECT ALL APPLICABLE FACTORS. THIS IS THE

INSPECTOR/INVESTIGATOR OPINION BASED ON THE INVESTIGATION.

21C. PART NAME:

IDENTIFY THE PART NAME THAT FAILED OR IS SUSPECTED OF

FAILURE BY THE PROPER NOMENCLATURE THAT IS DEPICTED

IN THE MANUFACTURERS PARTS CATALOGUE.

21D. MANUFACTURER:

IDENTIFY THE MANUFACTURER OF THE PART, IF KNOWN.

21E. PART NUMBER:

IDENTIFY THE MANUFACTURER PART NUMBER. THIS WOULD BE THE SAME NUMBER NEEDED TO REQUISITION A REPLACEMENT PART.

21F. ATA CODE:

ENTER ATA CODES IAW TABLES IN THE FLIGHT STANDARDS GUIDE TITLED: JOINT AIRCRAFT SYSTEM AND COMPONENT CODE TABLE AND DEFINITIONS.

22. TYPE OF OPERATIONS:

SELECT TYPE OF OPERATIONS AIRCRAFT PERFORMED AT TIME OF OCCURRENCE.

23. WEATHER BRIEFING SOURCE:

SELECT WEATHER SOURCE PROVIDING WEATHER AT TIME OF OCCURRENCE.

24. PRECIPITATION:

SELECT ALL APPLICABLE PRECIPITATION FACTORS AT TIME OF OCCURRENCE.

25. WEATHER FACTORS:

SELECT ALL APPLICABLE WEATHER FACTORS AT TIME OF OCCURRENCE.

26. PHASE OF FLIGHT:

SELECT PHASE OF FLIGHT WHERE ACCIDENT OR INCIDENT SEQUENCE STARTED.

27. ACTUAL WEATHER CONDITIONS:

SELECT ACTUAL WEATHER CONDITION AT TIME OF OCCURRENCE.

28. RUNWAY CONDITIONS:

ENTER RUNWAY DESIGNATOR AND RUNWAY INFORMATION IF EVENT OCCURRED ON A RUNWAY.

29. PILOT TRAINING INFORMATION:

ENTER TYPE AND DATE OF ALL TRAINING RECEIVED WITHIN LAST 24 MONTHS.

30. EVACUATION OVERVIEW:

SELECT IF AN EVACUATION WAS INITIATED; AND SELECT IF INJURIES OCCURRED ATTRIBUTABLE TO EVACUATION.

31. PILOT INFORMATION:

REQUIRED ONLY IF PILOT ACTIONS OR LACK OF ACTIONS CONTRIBUTED TO THE ACCIDENT/INCIDENT. ENTER ALL PILOT INFORMATION, INCLUDING THE HIGHEST CERTIFICATE MAINTAINED BY PILOT.

32. CORRECTIVE ACTION:

SELECT APPLICABLE CORRECTIVE ACTION(S) PLANNED OR INITIATED.

33. NARRATIVE:

ONLY STATE FACTS OR SEQUENCE OF EVENTS THAT ARE RELEVANT TO THE ACCIDENT OR INCIDENT.

34. NTSB PARTICIPATION :

IDENTIFY LEVEL OF NTSB PARTICIPATION IN INVESTIGATION.

35. FAA PARTICIPATION:

IDENTIFY LEVEL OF FAA PARTICIPATION IN INVESTIGATION. ON-SCENE CAN BE CHECKED IF THE INSPECTOR/INVESTIGATOR PARTICIPATES IN THE INVESTIGATION BEYOND USE OF THE TELEPHONE, I.E. ENGINE TEARDOWN, INTERVIEW, OR WRECKAGE INVESTIGATION NOT AT THE SCENE OF THE ACCIDENT.

36. FAA INITIAL NOTIFICATION:

IDENTIFY THE TIME THE FIRST FAA FACILITY IS MADE AWARE OF THE OCCURRENCE EITHER THROUGH DISCOVERY OR NOTIFICATION NOTE: USUALLY FIRST NOTIFICATION IS TO AIR TRAFFIC.

37. FSDO NOTIFICATION:

IDENTIFY THE FIRST CALL ON THE OCCURRENCE RECEIVED BY THE FSDO.

38. FAA IIC ARRIVAL ON SCENE:

IDENTIFY THE DATE AND TIME THE FAA IIC ARRIVES ON THE SCENE.

39. FAA HOURS USED FOR TOTAL INVESTIGATION:

IDENTIFY TOTAL HOURS FAA SPENT ON THE INVESTIGATION. THIS INCLUDES ON- SCENE, TRAVEL HOURS, AND NON-SCENE ACTIVITIES IN WHOLE HOURS ONLY.

40. TOTAL HOURS USED AT ACCIDENT/INCIDENT SCENE:

IDENTIFY TOTAL HOURS FAA SPENT AT THE SCENE IN WHOLE HOURS ONLY.

41. TOTAL TRAVEL HOURS TO & FROM SCENE:

IDENTIFY TOTAL HOURS FAA SPENT ON TRAVEL TO AND FROM SCENE IN WHOLE HOURS ONLY.

42. FAA NINE RESPONSIBILITIES:

IDENTIFY FAA AREAS OF RESPONSIBILITY INVOLVED. DETERMINATION OF RESPONSIBILITIES IS THE OPINION OF THE INSPECTOR/INVESTIGATOR BASED ON BACKGROUND, TRAINING, SKILL, AND EXPERIENCE. ANNOTATION OF ONE OR MORE RESPONSIBILITIES DOES NOT HAVE TO BE JUSTIFIED OR PROVEN. AN AIRMAN WHO MAKES A MISTAKE, WHICH RESULTS IN AN ACCIDENT IS ANNOTATED UNDER AIRMAN/AIR AGENCY COMPETENCE. IT IS NOT NECESSARY TO SUBMIT AN EIR BECAUSE OF ANNOTATION OF VIOLATION.

43.BRIEF EXPLANATION OF ISSUES INVOLVED FOR EACH OF THE NINE RESPONSIBILITIES INVOLVED.

DESCRIBE RELEVANT ISSUES SURROUNDING THE OCCURRENCE. IF NO ISSUES, EXPLAIN WHY.

44.FAA IIC INFORMATION:

ENTER IIC INFORMATION NAME AND OFFICE,AND DATE FORM COMPLETED.

FAA FORM 8020-23 (01-10) SUPERSEDES FAA FORMS 8020-5 AND 8020-16

INFORMATION IS PRELIMINARY AND SUBJECT TO CHANGE

NSN: 0052-00-923-1000

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1. Start filling out your 8020 report with a group of major blanks. Gather all of the important information and be sure absolutely nothing is forgotten!

Step no. 1 for submitting faa form 23

2. The next step would be to submit the following blanks: AIRCRAFT REGISTRATION, MAKEMODEL, SERIAL NO, YEAR OF MANUFACTURE, TOTAL, AIRFRAME HRS, AIRFRAME CYCLES, SERIOUS, FATAL, TOTAL, FACTORS IDENTIFY PRIMARY FACTOR, CHECKING OF FACTORS IS THE OPINION, TECHNICAL FACTORS, OPERATIONAL FACTORS, and NONE.

How you can fill in faa form 23 portion 2

In terms of AIRFRAME CYCLES and YEAR OF MANUFACTURE, be certain that you review things in this section. Both of these are the key ones in the PDF.

3. Within this stage, examine COMMERCIAL WX SERVICE PATWAS, VOICE RESP SYSTEM, SNOW, COMPANY, MILITARY, TVRADIO WEATHER, FREEZING DRIZZLE, COMPUTER BRIEFING, FREEZING RAIN, PIREP UNKNOWN OTHER, DRIZZLE, OTHER, WEATHER FACTORS, THUNDERSTORM, and CROSSWIND. Each of these are required to be filled out with highest focus on detail.

COMPUTER BRIEFING, DRIZZLE, and MILITARY of faa form 23

4. Filling out PILOT TRAINING ALL UNKNOWN, CHECK ALL THAT APPLY RECORD THE, YES NO UNK, MO DA YR MO DA YR, YES NO UNK, MO DA YR MO DA YR, ATQA REPORT NUMBER, SAFETY SEMINARCLINIC, WINGS PROGRAM, AIR CARRIER INITIAL, AIR CARRIER RECURRENT, AIR CARRIER REQUALIFICATION, AIR CARRIER TRANSITION, SIMULATOR, and COMMTHIRD PARTY CONTRACT TRAINING is paramount in this next step - be sure to spend some time and fill in every single blank!

Filling out part 4 in faa form 23

5. This final section to conclude this form is critical. Be certain to fill in the required fields, which includes MO DA YR, MO DA YR, CORRECTIVE ACTIONS PLANNED OR, NONE MALFUNCTION OR DEFECT REPORT, REEXAM, OTHER, SDR COUNSELING EIR, NARRATIVE ATTACH ADDITIONAL SHEETS, ONLY STATE FACTS OR SEQUENCE OF, NTSB PARTICIPATION, ONSCENE, LIMITED, NONE, FAA PARTICIPATION, and ONSCENE, before using the pdf. If you don't, it can contribute to an incomplete and probably incorrect document!

Ways to fill in faa form 23 stage 5

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