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Our mission is to collect these reports on safety and health hazards and incidents so that we can better understand the problems and do our best to make change. All of the personal information that we collect is treated as strictly confidential. We only ask you for contact information so that we can call or email you to clarify what happened, if necessary.

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About You
Describe yourself as:
If you chose "Other" above, please describe:

Today's Date: January 7, 2009


Please provide the following contact information:

Name:
Phone:
E-Mail:
Street Address:
City:
U.S. State:
or non-U.S. Province:
Postal Code/Zip:
Country:
Required Date of Incident (mm/dd/yy):
Airline:
If you chose "Other" above, please describe:
Do you think that this incident either could have been prevented or could be prevented in the future? Yes No Don't Know
Did this incident occur ON or OFF the aircraft? ON OFF