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6. Location (city or town, state, and site name):
7. Brief Description:
6. Operator's Ultralight Experience:
7. FAA Rating(s)?:
Total Hours:
8. Condition: Excellent Normal Tense Tired Medical Problem Intoxicated Unknown Other Other:
1. Make And Model: Single Seat Two-Place
2. Serial Number: 3. Engine:
4. Registered With USUA?: Yes No Unknown 5. USUA Registration Number: (if applicable)
6. Modifications:
7. Hours On Vehicle: 8. Persons On Board: 1 2
9. Equipment:
10. Ownership: Owned - Purchased new Owned - Purchased used Rented Borrowed Stolen Unknown Other Other:
11. Storage: Hangar Barn Garage Trailer Tiedown Other Other:
1. Area: Urban Suburban Rural Other:
2. Site/Terrain:
3. Airspace: UnControlled Controlled Other Other:
4. Elevation: (MSL)
1. Source of Flight: Airport Flightpark Field Road/Street Other Other:
2. Purpose Of Flight: Recreation Training Test Ferrying Competition Demonstration Military Other Other:
3. Phase Of Flight: Ground Taxi Takeoff Climb Level Flight Maneuvering Descent Approach Landing Unknown Other Other:
4. Length Of This Flight: (hh:mm)
5. Altitude: (above ground level)
1. Sky Conditions: Clear Scattered Clouds Broken Clouds Fog/Haze Overcast
2. Light: Dawn Day Dusk Night
3. Turbulence: None Negligible Marginal Critical Severe Unknown
4. Visibility: (miles)
5. Temperature: (F)
6. Wind Velocity: (mph) Gusting to: (mph)
1. Third Party Injuries: None Minor Serious Fatal
2. Third Party Damage: None Minor Substantial Other:
3. Components Damaged:
4. Cause Factors:
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