Contact and Charter Report

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In the event of an emergency notification, damage, injury or regulatory violation, contact Franz Bergtold at 503-648-2831 or 503-799-6401 prior to submitting this form.

Your Name*

Your Email*

Location*

Date*

Time*

Notification type*

Perceived Urgency*

N Number*

OPS Part*

Phase of Flight*

PIC Name*

Notification Summary (One Sentence)*

Notification Description*

What should have been done?*

What could be a preventative measure?*

This event may have caused a violation or deviation from the FAR

This event involved Hazardous Materials (HazMat)

I consent to my submitted data being collected and stored.