Instructions for uilding an MRP Binder - NETC - US Navy
INITIAL AVIATION MISHAP NOTIFICATION
Instructions for building an MRP Binder
Parts required (available from Staples.com)
1 x Extra Wide Binder, 1.5”, made by Avery, Staples Item #AVEVSX1115WE ($13.25)1 x 5 pack of Extra Wide View Dividers, made by Avery Staples Item #430478 ($4.69)1 x 1-15 index divider set, made by Avery, Staples Item #463026 ($4.15)2 x 1-5 index divider set, made by Avery, Staples Item #463000 ($1.59)
1 x 50 pack of 3-hole punched sheet protectors, Staples Item #656157 ($8.79)1 x Set of Black/Yellow striped binder cover insert (front, spine, back) See CSFWP Safety
1 x Squadron Zapper
Assembly:
Believe it or not, it required a significant amount of research and trial and error to come up with the right combination of tabs and binders so that tabs didn’t stick outside the binder and so that inserted pages did not cover up index numbers. You can try using other parts, but no guarantee they will all work together. The above combination will work. Use the Extra wide view dividers to create the Admin, Start Here, Section 1, Section 2 and Section 3 dividers. Insert the TAB cover sheets into the respective view dividers (printing the TAB cover sheets double-sided is helpful too). The smaller 1-15 index dividers go in section 1. One set of the smaller 1-5 index dividers goes into section 2 and section 3. Now take the rest of the pages and place them into the sheet protectors and then into their appropriate tab. This will require 3-hole punching on alternating sides of pieces of paper as you go through. To save time, consider punching 3 holes down each side of all the pieces of paper (print shops can do this also). The pages will look a little funny with the holes not being used on one side, but it is easier than trying to tell the print shop which pages to punch on the left and which on the right.
Post Assembly:
1-1TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
Some of the pages are intended to be removed and written on. An example of
this is the Initial Notification Worksheet (Section 1, Tab 1). To facilitate
removal without having to open the 3-ring binder, cut 5/8 of an inch off of the
right or left edge so that the rings don’t hold it in. If you leave the color
original locked in and make several copies which you then trim, you will have
a reasonable supply of sheets and not have to replace them constantly. You
can also look to make some of the sheets a single, double-sided sheet rather
than two single-sided sheets. There are sections where phone numbers will
need to be written and names filled in (flt surgeon info and AMB). I
recommend just writing those in pencil so they can be easily changed as
people come and go. There are placeholders for squadron recall info in
Section 1, Tab 5. That info can either be put there or a note to “reference the
squadron recall binder” can be written across that page depending on how
squadrons handle recall info.
ADMIN SECTIONADMIN SECTION
CSFWP INSTRUCTION 3750.1A COVER LETTER
START HERE SECTIONSTART HERE SECTION
MISHAP/INCIDENT CATEGORY DETERMINATION
SECTION I: AVIATION MISHAPSSECTION I: AVIATION MISHAPS
INITIAL AVIATION MISHAP NOTIFICATION.......................TAB 1
SAR ININIATION / ODO PHONE REPORT..........................TAB 2
MISHAP CATEGORY and CLASSIFICATION......................................TAB 3
OPREP-3 VOICE REPORT.......................................TAB 4
SQUADRON RECALL............................................TAB 5
COMMODORE / CAG PHONE REPORTS..............................TAB 6
OPREP-3 MESSAGE............................................TAB 7
COLLECTION OF MISHAP RELATED RECORDS.......................TAB 8
60 MINUTE VOICE REPORTS....................................TAB 9
PAO DRAFT PRESS RELEASE....................................TAB 10
1-2TAB-1
INITIAL AVIATION MISHAP NOTIFICATIONFAA NOTIFICATION........................................................TAB 11INITIAL MISHAP DATA REPORT (MDR)...........................TAB 12MISCELLANEOUS REPORTS / DUTIES.............................TAB 13CLASS C AVIATION MISHAPS...................................TAB 14SECTION II: GENERAL (NON-AVIATION) MISHAPSSECTION II: GENERAL (NON-AVIATION) MISHAPS
NOTIFICATION...............................................TAB 1INJURY REPORT..............................................TAB 2NON-AVIATION MISHAP REPORTING FLOWCHART.................................TAB 3SECTION III: OPREP-3 OR SPECIAL INCIDENTSSECTION III: OPREP-3 OR SPECIAL INCIDENTS
SPECIAL INCIDENT REPORT DETERMINATION......................TAB 1OPREP-3 VOICE REPORT.......................................TAB 2OPREP-3 MESSAGE.........................................................TAB 3UNIT SITREP PROCEDURES.....................................TAB 4
START HERE
1-3TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
SECTION 1
AVIATION MISHAP PROCEDURES
INITIAL AVIATION MISHAP NOTIFICATION.......................TAB 1SAR ININIATION / ODO PHONE REPORT..........................TAB 2MISHAP CATEGORY and CLASSIFICATION.........................TAB 3OPREP-3 VOICE REPORT.......................................TAB 4SQUADRON RECALL............................................TAB 5COMMODORE / CAG PHONE REPORTS..............................TAB 6OPREP-3 MESSAGE............................................TAB 7COLLECTION OF MISHAP RELATED RECORDS.......................TAB 860 MINUTE VOICE REPORTS....................................TAB 9PAO DRAFT PRESS RELEASE....................................TAB 10FAA NOTIFICATION...........................................TAB 11INITIAL MISHAP DATA REPORT (MDR)...........................TAB 12MISCELLANEOUS REPORTS / DUTIES.............................TAB 13CLASS C AVIATION MISHAPS...................................TAB 14
1-4TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
SECTION 2
GENERAL / NON-AVIATION
MISHAP PROCEDURESNOTIFICATION...............................................TAB 1INJURY REPORT..............................................TAB 2NON-AVIATION MISHAP REPORTING FLOWCHART....................TAB 3
1-5TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
SECTION 3
OPREP-3 OR SPECIAL
INCIDENT REPORT
PROCEDURES
SPECIAL INCIDENT REPORT DETERMINATION......................TAB 1OPREP-3 VOICE REPORT.......................................TAB 2OPREP-3 MESSAGE............................................TAB 3UNIT SITREP PROCEDRUES.....................................TAB 4
CSFWPACINST 3750.1A
N45
COMSTRKFIGHTWINGPAC INSTRUCTION 3750.1A
Subj: MISHAP/INCIDENT RESPONSE PLAN (M.R.P.)
Ref: (a) OPNAVINST 3750.6 Series (Naval Aviation Safety Program)
(b) OPNAVINST 3100.6 Series (Special Incident Reporting Procedures)
(c) NAVAIR 00-80T-116-1,2,3,4 (Safety Investigation
Technical Manual, Vols I-IV)
(d) OPNAVINST 4790.2 Series (Naval Aviation Maintenance Program)
(e) COMNAVAIRPACINST 3750.16 Series (Aviation Safety Program)
(f) CINCPACFLT OPORD 201, Annex F (Public Affairs
Guidance for Disasters/Accidents/Incidents)
(g) JAGINST 5800.7 Series (JAG Manual)
(h) NAVMILPERSMAN, 421011-4210260, 5030240
(i) SECNAVINST 5720.44 Series (DON Public Affairs Policy & Regulations)
(j) OPNAVINST 5102.1 Series (Mishap Investigation and Reporting)
1-6TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
Encl: (1) COMSTRKFIGHTWINGPAC Mishap/Incident Response Plan
1. Purpose. This instruction provides a standardized guide for initial reporting, investigation procedures, and subsequent action required in the event of an aviation mishap, non-aviation mishap or event requiring special incident reporting involving aircraft or personnel under the cognizance of Commander, Strike Fighter Wing Pacific. This instruction has been extensively revised to reflect current safety programs and mishap reporting requirements.
2. Cancellation. COMSTRKFIGHTWINGPAC 3750.1
3. Background. References (a) through (j) set forth the requirements, conditions, and general procedures to follow in the submission of reports, conduct of investigations, and promulgation of other administrative correspondence associated with aircraft mishaps, non-aircraft mishaps, special incident reporting, personal injuries, and identified hazardous conditions.
4. Action
a. To ensure timely, accurate, and uniform reporting of mishaps, Lemoore based STRKFIGHTWINGPAC commands will not generate their own parallel pre-mishap plans. Forward deployed STRKFIGHTWINGPAC commands stationed at NAF Atsugi shall make appropriate modifications for their theater of operations.
b. The following training items, checklists, message formats, and tabs have been designed to serve as guides for all
STRKFIGHTWINGPAC commands, operating in all possible locations, under extremely diverse condition. There may be selected procedures, personnel and organizations cited for action or notification that would be applicable to one command but not necessarily to another.
c. The senior member of the AMB, squadron safety officer and senior watch officer shall review the pre-mishap plan contents upon a change in the location or operating environment for the command. He/she shall delineate those specific items that may be disregarded, but not deleted, from the Mishap/Incident Response Plan. Use of preformatted messages tailored to the individual command reporting criteria are desirable and encouraged.
d. Commanding Officers/Officers-in-Charge/Department Heads shall ensure that concerned personnel are familiar with enclosure (1) and that all individuals within the command comply with the following procedures.
(1) General. Any person who has knowledge of a mishap involving injury to personnel or damage to government property shall immediately report the facts to the nearest squadron or squadron duty officer, as appropriate. Except as outlined in this instruction, personnel shall not divulge information, either officially or unofficially, to any other party.
(2) Specific. Nothing in this instruction shall preclude logical and warranted actions. In the event of a mishap, the respective duty officer (ASDO, ODO or SDO) is responsible for immediate implementation of enclosure (1) and retains responsibility until relieved by proper authority. The duty officer should delegate authority to NAS/squadron members to satisfy necessary reporting and administrative requirements in the most timely and efficient manner possible. In the event of a death or serious injury, personnel shall not discuss the matter with sources outside the command until information has been released by proper authority. Any injured
1-7TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
or deceased individual’s name shall not be released, except to authorized Naval authorities, without the express permission of the respective Commanding Officer.
(3) Reference (g) provides guidelines to determine if a JAG Manual investigation of an aircraft mishap is necessary. If a JAG Manual investigation is required it must be conducted separately from the AMB investigation. No individual shall be assigned to both investigations. Both investigations shall have access to all real evidence but may not share witness statements or deliberations. The privileged character of the AMB investigation must be protected.
(4) The Concept of Privilege. Use of privileged information is critical to timely and complete investigation of aircraft mishaps. The protection of privileged information is essential to ensure complete and candid responses in witness statements and AMB deliberations. Commanding Officers, Officers-in-Charge, and Department Heads shall ensure that all individuals within the command are familiar with the use and restrictions of privileged information as specified in reference (a).
5. Changes. Proposed changes or updates to this instruction shall be forwarded to the
COMSTRKFIGHTWINGPAC Safety Officer (N45) via email or phone at x1033.
K. A. HOLMSTRUP
Chief Staff Officer
Distribution:
CSFWPACINST 5215.1G
(Lists I and II)
This Mishap Response Plan is divided into three sections
covering different types of mishaps.
Refer to the appropriate section based on the mishap
descriptions below.
-----------------------------------------------------------------------------
，SECTION I: AVIATION MISHAPS SECTION I: AVIATION MISHAPS
DESCRIPTION
•NAVAL AIRCRAFT INVOLVED and one or more of the following:NAVAL AIRCRAFT INVOLVED
•A FATALITY occurred (DOD or Civilian).
•Aircraft and/or property DAMAGE is $20,000 or more.
•INJURY to DOD personnel results in
•Permanent total disability
•Permanent partial disability
•5 or more lost workdays (not including day of injury).
Note: In addition to flying or taxiing aircraft, this includes
personal injuries that occur “on” an aircraft that is parked or
1-8TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
not operating. Examples: PC falls off wing, tow tractor runs
into parked aircraft.
-----------------------------------------------------------------------------，SECTION II: GENERAL (NON-AVIATION) MISHAPSNON-AVIATIONSECTION II: GENERAL () MISHAPS
DESCRIPTION
•NAVAL AIRCRAFT NOT involved.NAVAL AIRCRAFT NOT involved
•Any of the following whether on or off-duty:
•Personnel injury, death, occupational illness.
•Material (property) damage in excess of $10,000.
•Explosive mishap or conventional ordnance deficiencies.
•Motor Vehicle fatality, injury, or damage.
•Diving mishap, hyperbaric treatment, death.
NOTE: This includes any automobile or recreational mishaps, injuries
in workshops or hangars (not involving aircraft).-----------------------------------------------------------------------------，SECTION III: OPREP-3 SPECIAL INCIDENTS
DESCRIPTION
•OPREP-3 reporting required for Aviation Mishaps is covered in Part OPREP-3 reporting required for Aviation Mishaps is covered in Part •
I.I.
•Events and special incidents that may attract…
•National level interest (OPREP-3 PINNACLE Series).
•High U.S. Navy interest (OPREP-3 NAVY BLUE Series).
•Local higher authority interest (UNIT SITREP).
NATIONAL LEVEL HIGHER NAVAL HIGH LEVEL NAVY INTERESTINTERESTAUTHORITY INTEREST
OPREP-3 PINNACLEOPREP-3 NAVY BLUEUNIT SITREP
Events not requiring ，War risk attacks, ，Any Class A or B OPREP-3 reporting.aircraft mishap not a harassment, PINNANCLE.，Hoax bomb threathostile acts
，Aircraft crash on ，Minor racial against U.S.government land or at incidents，Major nuclear sea.，Minor fraud, waste, weapons incidentsand abuse，Bomb threat thought
，Territorial to be valid，Violent crimeviolations，Civilian or military •Assaultdisorder，Defections•Aggravated assault
，Request for •Sexual assault，Sabotage
1-9TAB-1
INITIAL AVIATION MISHAP NOTIFICATION
assistance after •Robbery，Hijackingnatural disaster•Armed robbery，High-level ，Major racial incident•Spousal abusemilitary ops •Child abuse，Nuclear reactor/ resulting in radiological ，Incidents of damage to accidentssuicide or aircraft, ships, ，Minor nuclear weapons attempted suicideequipment, etc.accidents
，Injury to ，Minor collisions at
civilianssea
，Widespread ，Oil spills
civilian property ，Labor strikes
damage，Naval accidents
(fire, flood, etc.)，SAR initiation in
foreign country，SAR
，Abrupt foreign ，Major fraud, waste
and abusegovernment changes
，INCSEA violations，Reconnaissance
，Discrimination and incidents
sexual harassment，Attacks against
nuclear site
，Receipt of
critical
intelligence
--------------------------------------------------------------------------
---
* YOU HAVE JUST BEEN INFORMED OF A POSSIBLE AVIATION
MISHAP INVOLVING A SQUADRON AIRCRAFT. *
AVIATION MISHAP DESCRIPTIONAVIATION MISHAP DESCRIPTION
•NAVAL AIRCRAFT INVOLVED and one or more of the NAVAL AIRCRAFT INVOLVED
following:
•A FATALITY occurred (DOD or Civilian).
•Aircraft and/or property DAMAGE is $20,000 or more.
•INJURY to DOD personnel results in
•Permanent total disability
•Permanent partial disability
•5 or more lost workdays (not including day of injury).
1-10TAB-1
INITIAL AVIATION MISHAP NOTIFICATIONINITIAL NOTIFICATION
STEP 1-1:First, , everything you will need is here in this RELAXRELAX
binder.
STEP 1-2:Remove a blank Initial Notification Worksheet from Appendix 1A
of this section and record as much information as possible.For the ASDO, immediately after hanging up -
STEP 1-3:Notify the Operations Duty Officer (ODO) or the Squadron Duty
Officer (SDO) immediately and continue as many of the following
steps as possible until relieved by the SDO.
Continued Next Page
1-11TAB-1
INITIAL AVIATION MISHAP NOTIFICATIONGET ORGANIZED and GET HELP!
For the ODO, SDO, or ASDO while awaiting relief -
STEP 1-4:If possible, grab 3 people and assign the following duties:
•DUTY OFFICER: Coordinates the Mishap Plan of Action.
•PHONE TALKER: Answers the phone and initiates the recall when
tasked.
•LOG KEEPER: Keeps a log of all actions/events.
•RUNNER: Collects required information and assists as needed.For the DUTY OFFICER -
STEP 1-5:Remove a blank Duty Officer Mishap Action Checklist from
Appendix 1B of this section to keep you on track and to record
completed action items.
For the LOG KEEPER (if assigned) -
STEP 1-6:Remove several blank Mishap Log Worksheets from Appendix 1C of
this section and record pertinent actions/events as they occur.
INITIAL ACTION ITEM
STEP 1-7:GO TO TAB 2 for SAR initiation and/or NAS Lemoore ODO GO TO TAB 2
notification.
1-12TAB-1
INITIAL NOTIFICATION WORKSHEET
** Gain as much of the following information as possible! **Time of Call: ____________
Caller’s Initial Description of Mishap:
_________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Caller’s Name: _______________________(Rank): _________________Phone Number: _______________________(Organization): _________Time of mishap (Local): ______________(Zulu):
_________________
Location: (nearest crossroads, be as specific as possible)__________________________________________________________________________________________________________________________________
_________________________________________________________________Did caller witness mishap?， YES ， NO
Do you know the type aircraft? __________________________________Did you see parachute(s)? ， YES ， NO ， UNKNOWN
How many? __________________________________________________Are there survivor(s)? ， YES ， NO ， UNKNOWN
Condition:
_________________________________________________
Were people injured on the ground? ， YES ， NO ， UNKNOWN
Condition: _________________________________________________Is/was there a fire/explosion?， YES ， NO ， UNKNOWN
Description: _______________________________________________Are any of the following on scene/have they been contacted:
Police， ONSCENE ， CONTACTED ， UNKNOWN
1A-1APPENDIX 1A
INITIAL AVIATION MISHAP NOTIFICATION
Fire Department， ONSCENE ， CONTACTED ， UNKNOWN
An ambulance， ONSCENE ， CONTACTED ， UNKNOWN
Is helo landing site available?， YES ， NO ， UNKNOWN
Location: __________________________________________________Weather at scene:_________________________________________________________________________________________________________________Will caller remain on site?， YES ， NO
If no, caller’s destination: _______________________________Caller’s home address:________________________________________
________________________________________Caller’s home phone:________________________________________Were there any other witnesses? ， YES ， NO
Name___________________________________________________Address___________________________________________________
___________________________________________________Phone___________________________________________________Name___________________________________________________Address___________________________________________________
___________________________________________________Phone___________________________________________________ADVICE TO CALLER
•Ask caller if he/she can direct fire, police, or ambulance
personnel to the mishap scene (if required).
•Advise the caller of potential explosive hazards and hazardous
materials and of need to warn others.
1-2TAB-1
INITIAL AVIATION MISHAP NOTIFICATION•Ask caller to attempt to keep people out of the area. •Ask caller to preserve wreckage until military/civilian law
enforcement personnel arrive, if possible.
1-3TAB-1
Duty Officer MISHAP ACTION CHECKLIST
** DO NOT RELEASE NAMES OF PERSONNEL INVOLVED **
ACTIONTABDEADLINETIME1ASAPInitial Notification
2ASAPInitiate/Verify SAR Launched
Determine Mishap Category/Class
Aviation Mishap Category
，Flight Mishap3ASAP
Class，Flight-Related Mishap
，Class A，Aircraft Ground Mishap
，Class BFor Aviation MishapsABC
，Class COPREP-3 Voice Report
45-MIN，PinnacleNA,,
，Navy Blue
5ASAPInitiate Squadron Recall,,,6< 20-MINCommodore/CAG Phone Reports,,,720-MINOPREP-3 MESSAGENA,,8ASAPCollect mishap related records,,,
60-Minute Phone Reports
960-MINCOMNAVSAFECEN Phone ReportNANA,
COMNAVAIRPAC Phone Report1060-MINPAO Draft Press ReleaseNANA,
Civil a/c 114-HRFAA Phone Report involved
Initial Mishap Data Report (MDR)124-HRNA,,(Class A & B)
Miscellaneous Reports/Duties
•Fluid Samples & 72 hr history
•PNOK/SNOK Notification
•Imminent Death Retirement13As req’dAs req’d•X-ray/Equipment Loss Report
•Engine transition report
•Loss of COMSEC equipment letter1424-HRClass C Aviation MishapsNANA,
1B-1APPENDIX 1B
MISHAP CATEGORY and CLASSIFICATION (cont)For the Log Keeper –
Record all pertinent actions/events as they occur.TIMACTION/EVENT
E
3-5TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)TIMACTION/EVENT
E
3-6TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)TIMACTION/EVENT
E
3-7TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)
If you were notified of the mishap by the NAS Lemoore
Operations Duty Officer (ODO) and/ or a SAR
effort has
3-8TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)
already been
initiated –
STEP 2-1:GO TO TAB-3 GO TO TAB-3
to determine
Mishap
Category
and
3-9TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)
Classificatio
n.
-----------------------------------------------------------------
** If a SAR effort has not been initiated,** If a SAR effort has not been initiated,
this is your FIRST PRIORITY! **this is your FIRST PRIORITY! **
STEP 2-1:Contact the appropriate SAR facility.
OUTSIDE THE LOCAL (CA Central Valley) AREA –
3-10TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)
•All CONUS SAR
efforts are coordinated out of Langley AFB. Contact the Air Force Rescue Control
Center (AFRCC) at DSN: 574-8112 or 800-851-3051
•Inform the NAS
Lemoore ODO at
x1023 of the out of
3-11TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)
area mishap and that
you have already
called the AFRCC. INSIDE THE LOCAL (CA Central Valley) AREA –
•Call the NAS Lemoore ODO immediately at x1023. He will initiate
the NAS Lemoore SAR effort, contact AFRCC and will notify the
appropriate on base agencies (numbers listed in Table 2-1 for
reference).
•For follow-up
purposes, regional
agencies are listed in
Table 2-2 below.NAS Lemoore AgenciesDSNCOMMERCIAL
Base CO949-3345/6(559)998-3345/6
Base PAO949-3394/5(559)998-3394/5
Crash/Fire949-4749/50(559)998-4749/50(Security Dispatch)
CDO Beeper--(559)587-8278
EOD949-3542(559)998-3542
Hospital949-4391 (559)998-4391
Photo Lab949-1125(559)998-1125
3-12TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)Weather Office949-1020(559)998-1020
Numbers unverified 9 July 2001.
Table 2-1. NAS
Lemoore Agencies
Continued Next Page
SAR FacilityDSNCOMMERCIAL
Central Valley, Sierras (Owens Valley and West)NAS Lemoore BASE OPS949-1023(559) 998-1023NAS Lemoore SAR949-1565/69(559) 998-1565/69“Skylife” Dispatch--(559)456-7800(Kings & Fresno Counties)
R-2508 (East of Sierras)
NAS China Lake BASE OPS437-5475(760)939-5475
437-5222 (duty)(760)939-5222NAS China Lake SAR437-3529 (ops)(760)939-3529
W-283/285
(510)437-3701Coast Guard Alameda730-3821(800)246-7236
Fallon Ranges
NAS Fallon BASE OPS890-2419/2458(775)426-2419/2458NAS Fallon SAR890-3485(775)426-3485
San Diego
NAS North Island BASE OPS735-8233/34(619)545-8233/34MCAS Miramar BASE OPS267-4277/79(858)577-4277/79FACSFAC San Diego 735-1775(619)545-1777
El Centro / Yuma
NAF El Centro BASE OPS658-8601/8507(760)339-2601/2507MCAS Yuma BASE OPS269-2326/2077(928)269-2326/2077MCAS Yuma SAR269-2300/2533(928)269-2300/2533
Numbers verified 9 July 2001.
Table 2-2. Regional SAR Facilities
3-13TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)---------------------------------
--------------------------------
Once contacted, the ODO nearest the mishap site will normally provide the following:
•Follow-up on a missing aircraft’s flight plan.
•SAR coordination
•Initial on-site security
•Transportation and medical requirements
•Coordination with local FAA representatives (if required).
•Once initial phone calls and messages are sent, the ODO will normally
turn over coordination efforts to your command.
Following SAR initiation/ NASL ODO notification -
STEP 2-2:GO TO TAB-3 to determine Mishap Category and GO TO TAB-3
Classification.
，AVIATION MISHAPS AVIATION MISHAPS
STEP 3-1:Go to Appendix 3A and determine Aviation Mishap Category and
Classification:
，Class A，Flight Mishap (FM) Mishap Mishap，Class B，Flight-Related Mishap (FRM)Category: Class:，Class C，Aircraft Ground Mishap (AGM)
** If unsure of damage cost, OVER-ESTIMATE to the next Class! Mishap ** If unsure of damage cost, OVER-ESTIMATE to the next Class! Mishap
severity can always be downgraded later. ** severity can always be downgraded later. **
For Class A or B AVIATION MISHAPS only -
STEP 3-2:, for the OPREP-3 Voice Report.GO TO TAB 4GO TO TAB 4
3-14TAB-3
MISHAP CATEGORY and CLASSIFICATION (cont)For Class C AVIATION MISHAPS –
STEP 3-2:GO TO TAB 14, for Class C Mishap Reporting procedures.GO TO TAB 14
3-15TAB-3
OPREP-3 VOICE REPORT (cont)
Mishap SeverityMishap CategoryClass AClass BClass CFlight Mishap (FM)•Aircraft destroyed.
AND/OR
•Intent for flight •Any fatality (DOD or
existed. (*)Civ).
ANDAND/OR
•Aircraft damage •Total damage cost is
exceeds $20,000.$1,000,000 or more.
AND/OR
•Injury to DOD
personnel resulted in
•Total damage •Total damage permanent total
cost is $200,000 cost is $20,000 disability.
4-16TAB-4
OPREP-3 VOICE REPORT (cont)
but less than but less than •Any fatality (DOD or
$1,000,000.$200,000.Civ).
AND/ORAND/ORAND/OR
•Injury to DOD •Injury to DOD •Total damage cost is Flighpersonnel personnel $1,000,000 or more.
resulted in resulted in AND/ORpermanent five or more •Injury to DOD partial lost workdays.personnel resulted in disability.permanent total
AND/ORdisability.t-•Three or more
DOD personnel
were
hospitalized.
Relat
ed
Mish
ap
(FR
M)(**)
4-17TAB-4
OPREP-3 VOICE REPORT (cont)
•Aircraft destroyed.
AND/OR
•Any fatality (DOD or Aircraft
Civ).
AND/OR
•Total damage cost is
Ground $1,000,000 or more.
AND/OR
•Injury to DOD
personnel resulted in Mishap permanent total
disability.
(AGM)
•Intent for flight did
not exist. (*)
(*) Intent for flight exists when
•Brakes are release or takeoff power is applied to begin an authorized flight.
•At first motion of the catapult after pilot has signaled readiness for launch.
And continues until the aircraft taxies clear of the runway or landing area.(**) An example of a FRM would be a fastener falling off an airplane and killing a civilian on the ground. NOTE: For details on Mishap and Injury Classification, refer to
OPNAVINST 3750.6R, CHAPTER 3.
GENERAL INFO
•The main purpose of the OPREP-3 voice report is immediate
notification of a mishap to the highest levels, not to provide them
details for a CNN news brief. Keep it simple and make it quick.
• DUE WITHIN 5 MINUTES of notification of an OPREP-3 level incident.
•Required for all Class A & B AVIATION MISHAPS (not Class C).
•Ensure a reasonable effort has been made to contact the CO, XO, or
ASO in STEP 4-2 below, prior to making the call.
•Do not unduly delay the call while waiting for further information.
• When embarked, Strike OPS or CAG Safety will normally make this call
(back them up!)
-----------------------------------------------------------------STEP 4-1:Go to Appendix 4A and determine the TYPE of OPREP-3 REPORT
required.
，Pinnacle
4-18TAB-4
OPREP-3 VOICE REPORT (cont)
，Navy Blue
STEP 4-2:CO Confirmation: Contact the CO as the first person in the
squadron recall (which will start in TAB 5).
•Notify him of the incident.
•Ask him to confirm your determination of Pinnacle vs Navy
Blue.
•Ask him for
his estimate
of the impact
of the mishap
on the
squadron’s
4-19TAB-4
OPREP-3 VOICE REPORT (cont)
ability to operate (this will be used in the
OPREP-3 20-minute
message).
，NONE
，MINIMAL
，MODERATE
，SEVERE
4-20TAB-4
OPREP-3 VOICE REPORT (cont)
NOTE: Contact the XO if CO cannot be reached. Contact the ASO if CO/XO cannot be reached. If none of the above individuals are available, make the determinations using your best judgement.
STEP 4-3:Go to Appendix 4B and determine the OPREP-3/SITREP SERIAL
NUMBER for this voice report.
Continued Next Page
4-21TAB-4
OPREP-3 VOICE REPORT (cont)DELEGATE THE REMAINING TAB-4 STEPS, IF ABLE.STEP 4-4:Go to Appendix 4C and fill in the details of the OPREP-3 VOICE
REPORT TEMPLATE.
•NOTE: Examples of OPREP-3 Pinnacle and Navy Blue Voice
Reports are also contained in Appendix 4C.
STEP 4-5:Make the call! Contact the following agencies in order until
someone is reached.
PRIORITYAGENCYPHONE NUMBER
COMM: (808)471-3201/2/3FIRSTCINCPACFLTSTU-III: (808)471-5208/9SECONDNAVY COMMAND CENTER (NCC)COMM: (703)695-0231/0232
COMM: (703)697-6340NATIONAL MILITARY COMMAND THIRD•Request they relay or CENTER (NMCC)conference call to NCC.
Numbers verified 04 Feb 2002.
•Read the filled-in OPREP-3 VOICE REPORT TEMPLATE
•EXACTLY AS WRITTEN and
•IN A CHALLENGE AND REPLY FORMAT.
•Speak clearly and don’t read too quickly.
•** DO NOT RELEASE NAMES OF PERSONNEL INVOLVED **
4-22TAB-4
OPREP-3 VOICE REPORT (cont)
STEP 4-6:Write
down the time of the call and
any
information/in
structions
from the
4-23TAB-4
OPREP-3 VOICE REPORT (cont)
contacted
agency.
STEP 4-7:Write
down the
incident
description and DTG for
4-24TAB-4
OPREP-3 VOICE REPORT (cont)
the receipt of
this report in
Appendix
4B.
As soon as the voice report has been given to one of the listed agencies
you are done with this task -
STEP 4-8:GO TO TAB 5 for the Squadron Recall. GO TO TAB 5
4-25TAB-4
TYPE of OPREP-3 REPORT
OPREP-3 PINNACLEOPREP-3 PINNACLE
Used to provide the National Command Authority (NCA) with immediate notification of any incident or event where NATIONAL LEVEL INTEREST is
indicated.
If doubt exists as to whether
an incident could possibly
develop into a matter of NCA ，War risk attacks, interest, submit an OPREP-3 harassment, hostile acts PINNACLE report.against U.S.
，Major nuclear weapons
incidents
，Territorial violations
，Defections
，Sabotage
，Hijacking
，High-level military ops
resulting in damage to
aircraft, ships, equipment,
etc.
，Fatalities/Injury to
civilians
，Widespread civilian property
damage
，SAR initiation in foreign
country
，Abrupt foreign government
changes
，Reconnaissance incidents
，Attacks against nuclear site
，Receipt of critical
intelligence
4A-1APPENDIX 4A
TYPE of OPREP-3 REPORT
OPREP-3 NAVY BLUEOPREP-3 NAVY BLUEIf in doubt between PINNACLE
or NAVY BLUE, submit an OPREP-Used to provide the CNO and 3 PINNACLE report.other Naval Commanders with immediate notification of incidents of military,
political or press interest that is of HIGH NAVY RATHER
THAN NATIONAL LEVEL INTEREST.
The reports are submitted to provide “as it happens” information.
，Any Class A or B aircraft mishap
not a PINNANCLE.
，Aircraft crash on government land
or at sea.
，Bomb threat thought to be valid，Civilian or military disorder，Request for assistance after
natural disaster
，Major racial incident
，Nuclear reactor/ radiological
accidents
，Minor nuclear weapons accidents，Minor collisions at sea
，Oil spills
，Labor strikes
，Naval accidents (fire, flood,
etc.)
，SAR
，Major fraud, waste and abuse，INCSEA violations
，Discrimination and sexual
harassment
4A-2APPENDIX 4A
OPREP-3/SITREP SERIAL NUMBER LOG
GENERAL INFO
•SERIALIZE EACH INCIDENT WITH ITS OWN 3-DIGIT CODE, STARTING WITH 001 FOR THE FIRST INCIDENT EACH CALENDAR YEAR.
•SERIALIZE SUBSEQUENT REPORTS CONCERNING THE SAME INCIDENT WITH
A LETTER SUFFIX (I.E., 001, 001A, 001B, ETC.).
Calendar Year
20____
Seria
lDate-Time-Incident DescriptionType ReportNumbeGroup
r
，Pinnacle
，Navy 001Blue
，SITREP
，Pinnacle
，Navy
Blue
，SITREP
，Pinnacle
，Navy
Blue
，SITREP
，Pinnacle
，Navy
Blue
，SITREP
，Pinnacle
，Navy
Blue
，SITREP
，Pinnacle
，Navy
4B-1APPENDIX 4B
OPREP-3/SITREP SERIAL NUMBER LOG
Blue
，SITREP
，Pinnacle
，Navy
Blue
，SITREP
，Pinnacle
，Navy
Blue
，SITREP
4B-2APPENDIX 4B
SQUADRON RECALL
GENERAL INSTRUCTIONS
•In each column, check the appropriate box.
•Fill in any blanks.
•Text in parentheses is for amplification and should not be read.•In each row, read text VERBATIM to include only checked boxes and filled
in blanks.
OPREP-3 Voice Report Template
，“CINCPACFLT，PINNACLETHIS IS STRIKE FIGHTER ，NAVY COMMAND CENTERYou Say:OVER.”OPREP-3,SQUADRON ______,，NATIONAL MILITARY ，NAVY BLUE
COMMAND CENTER
THIS IS
，CINCPACFLT，PINNACLEThey “STRIKE FIGHTER ，NAVY COMMAND CENTEROVER.”SEND OPREP-3Respond:SQUADRON ______,，NAVY BLUE，NATIONAL MILITARY
COMMAND CENTER
，UNCLASSIFIED，FLASH，“CINCPACFLTOPREP-3 (No crypto)THIS IS STRIKE FIGHTER (for pinnacle)，NAVY COMMAND CENTER，，CONFIDENTIALSQUADRON ______,，IMMEDIATE，NATIONAL MILITARY ，SECRET， (for navy blue)COMMAND CENTER，TOP SECRET
_________.SERIAL “LINE ONE(Number from Table 4-2)
(Type Incident)__________________________________
_________________________________________________
(Location)_______________________________________You Say:INCIDENT“LINE TWO_________________________________________________
(Zulu Time)______________________________________
(Brief description of mishap. Do
not speculate!)___________________
__________________________________
NARRATIVE__________________________________OVER.”“LINE THREE
__________________________________
__________________________________
“MY NAME IS(Rank, Name)
You Say:“YOU CAN REACH MY UNIT AT(Give ready room phone number.)
OVER.”“REQUEST THE DATE TIME GROUP FOR YOUR RECEIPT OF THIS REPORT
OPREP-3 PINNACLE EXAMPLE:
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, OPREP-3,
PINNACLE, OVER.”
“STRIKE FIGHTER SQUADRON ONE TWO THREE, THIS IS CINCPACFLT, SEND OPREP-3,
PINNACLE, OVER.”
5-3TAB-5
SQUADRON RECALL
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, FLASH,
UNCLASSIFIED, OPREP-3, PINNACLE,
LINE ONE, SERIAL, ZERO ZERO ONE.
LINE TWO, INCIDENT, AIRCRAFT ACCIDENT, LAS VEGAS, NEVADA, ONE EIGHT
ZERO ZERO ZULU.
LINE THREE, NARRATIVE, PILOT EJECTED FROM FA-18 AIRCRAFT FOLLOWING
INFLIGHT FIRE, PERIOD. AIRCRAFT CRASHED INTO CAESARS PALACE CASINO
KILLING NUMEROUS CIVILIANS, PERIOD. EMERGENCY RESPONSE IN PROGRESS,
PERIOD. OVER.”
OPREP-3 NAVY BLUE EXAMPLE:
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, OPREP-3, NAVY
BLUE, OVER.”
“STRIKE FIGHTER SQUADRON ONE TWO THREE, THIS IS CINCPACFLT, SEND OPREP-3,
NAVY BLUE, OVER.”
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, IMMEDIATE,
UNCLASSIFIED, OPREP-3, NAVY BLUE,
LINE ONE, SERIAL, ZERO ZERO TWO.
LINE TWO, INCIDENT, AIRCRAFT ACCIDENT, USS LEXINGTON, SOUTHERN
CALIFORNIA OPERATING AREA, ZERO TWO THREE ZERO ZULU.
LINE THREE, NARRATIVE, FA-18 RAMP STRIKE DURING NIGHT APPROACH TO USS
LEXINGTON, PERIOD. PILOT EJECTED AND AIRCRAFT LOST AT SEA, PERIOD.
SAR IN PROGRESS, INJURIES UNKNOWN, PERIOD. OVER.”
GENERAL INFO
•DO NOT RELEASE NAMES OF PERSONNEL INVOLVED OVER THE TELEPHONE TO ANYONE
EXCEPT THE CO AND XO OR AS DIRECTED BY THE CO.
•Do not discuss ANY aspects of the incident with wives or other non-
squadron personnel.
•Do not linger on the phone. Tell the officer you are reaching that the
squadron is implementing the Mishap Response Plan and that they are to
report to the Ready Room as soon as possible.
DELEGATE THIS TAB (IF POSSIBLE). USE A PHONE IN ANOTHER OFFICE. KEEP THE DUTY OFFICE AND
ITS PHONE LINES FREE!
STEP 5-1:Contact the personnel listed in Table 5-1 below using
5-4TAB-5
SQUADRON RECALL
•Appendix 5A, Standing Aircraft Mishap Board (AMB)•Appendix 5B, Squadron Phone List
•Appendix 5C, Squadron Recall Roster
•Table 5-2, List of Non-Squadron Recall Numbers•If you cannot contact someone, continue down the list.
AVIATION MISHAPTIME POSITIONNOTIFIEDCLASS A/BCLASS C
CO,(Tab-3),
XO,,
ASO,,
Duty YN,
OPSO,,
MO,,
ADMIN-0,
FLT SURGEON,,
Squadron PAO,
BASE PAO (*),
CMC,
(fatality)CHAPLAIN
CACO(fatality)
OTHER AMB ,MEMBERS
Table 5-1. Squadron Recall Priorities
Continued Next
Page
5-5TAB-5
SQUADRON RECALL
5-6TAB-5
SQUADRON RECALL
IndiviConta
dualct
Numb
ers
NAS DurinLemog
ore Norma
5-7TAB-5
SQUADRON RECALL
BASE l
PAOWorki
Mr. ng
Dennis HoursMcGraWork:
th559-(availa998-ble 24-3393/3
5-8TAB-5
SQUADRON RECALL
7)398
DSN:
949-
3393/3
398
After
Hours
Home:
5-9TAB-5
SQUADRON RECALL
559-
924-
0147
Pager:
559-
971-
0944
Cell: 5-10TAB-5
SQUADRON RECALL
559-
381-
0592
CAG Work: Flight 559-Surge998-
onDSN:
949-
5-11TAB-5
SQUADRON RECALL
Home:
Beepe
r:
Cell:
Deploy
ed: NAS Via
LemoHospit
5-12TAB-5
SQUADRON RECALL
ore al Info
Duty DeskFlight Work: Surge559-
on 998-
4481
DSN:
949-
5-13TAB-5
SQUADRON RECALL
4481Directl
y
Beepe
r:
559-
585-
60075-14TAB-5
SQUADRON RECALL
Cell:
559-
696-
2621
Table 5-2. List
of Non-Squadron
5-15TAB-5
SQUADRON RECALL
Recall Numbers
5-16TAB-5
SQUADRON RECALL
For Class A or
B AVIATION
MISHAPS –
STEP 5-2:GO TO TAB 6, for Commodore/CAG Phone Reports.GO TO TAB 6
5-17TAB-5
STANDING AIRCRAFT MISHAP BOARD (AMB)
For the Squadron ASO –
Fill in the table as required.
AMB POSITIONUNITPHONEEMAIL
DSNSENIOR MEMBER
NAME/POSITIONCOMM
DSNAIRCRAFT
OPERATIONS
NAME/POSITIONCOMM
DSNAIRCRAFT
MAINTENANCE
NAME/POSITIONCOMM
DSNAVIATION SAFETY
NAME/POSITIONCOMM
DSNFLIGHT SURGEON
NAME/POSITIONCOMM
DSNOTHER
COMM
•This information will be required during submission of the
initial Mishap Data Report (MDR) in TAB 12.
5A-1APPENDIX 5A
SQUADRON (WORK) PHONE LISTFor the Squadron ASO –
Reference or replace Appendix 5B with a current Squadron Phone List for NAS Lemoore, for USS Ship, or a specific detachment site, as appropriate.
5B-1APPENDIX 5B
OPREP-3 MESSAGE
For the Squadron ASO –
Reference or replace Appendix 5C with a current Squadron Recall Roster for NAS Lemoore, for USS Ship, or a specific detachment site, as appropriate.
GENERAL
•Make these calls ASAP after the OPREP-3 5-minute voice report.•Delegate this tab if able.
•The CO may desire to make these calls, if available.-----------------------------------------------------------------STEP 6-1:Fill in the following template:
•“This is _______________________________“ (name, rank)
•“Calling from VFA-___________” (squadron)
，Class A Aircraft Mishap”•“We have had a ，Class B Aircraft Mishap”
•“…
involving________________________________________________________
___________________________” (# aircraft/# personnel)
•(Give a brief description of incident, including injury, aircraft damage, and
SAR status. Do not speculate!)
________________________________________________________________
________________________________________________________________
____________________________________________________
Example: “Aircraft ran off runway 32L at NAS Lemoore following an
aborted takeoff. Aircrew sustained minor injuries, probable class B aircraft
damage.”
•“For further information, you may reach our squadron at
______________________” (phone number)
-----------------------------------------------------------------
7-2TAB-7
OPREP-3 MESSAGE
COMMODORE NOTIFICATION
STEP 6-2:Contact the following individuals in the Commodore’s office and
read the filled in template. If someone cannot be reached,
continue down the list.
** DO NOT RELEASE NAMES OF PERSONNEL INVOLVED EXCEPT TO THE
COMMODORE OR CHIEF STAFF OFFICER (CSO) **
Continue Next Page
7-3TAB-7
OPREP-3 MESSAGE
PRIORITYPERSONPHONE NUMBER
Between 0730 and 1630 PST Monday thru Friday -
Commodore/CSO's OFFICE (If neither is in, Comm: 559-998-1040leave the info with their FIRSTDSN: 949-1040Secretary and she will
track them down)
At all other times -
Home: 559-924-2979FIRSTCOMMODORECell: 559-779-9778
Home: 559-583-6599SECONDCHIEF STAFF OFFICER (CS0)Cell: 559-240-0175
Beeper: 559-587-8994
(leave your ph# at the beep.
He will call back. Let him THIRDWING CDOknow that you have already
spoken to/left a message for
the Commodore/ CSO)
Comm: 559-998-1033FOURTHWING SAFETY (leave msg)DSN: 949-1033
Numbers verified 04 Feb 2002CAG NOTIFICATION
STEP 6-3:Contact the following individuals in the CAG’s office and read
the filled in template. If someone cannot be reached, continue
down the list.
** DO NOT RELEASE NAMES OF PERSONNEL INVOLVED **PRIORITYPERSONPHONE NUMBER
During normal working hours -
Comm: 559-998-
FIRSTDSN: 949-CAGDeployed:
Comm: 559-998-
SECONDCAG OPSDSN: 949-
Deployed:
Comm: 559-998-
THIRDCAG SAFETY OFFICERDSN: 949-
Deployed:
At all other times -
Comm: 559-998-
FIRSTCAG DUTY OFFICEDSN: 949-
Deployed:
7-4TAB-7
OPREP-3 MESSAGE
When Commodore and CAG notification is complete –STEP 6-4:GO TO TAB 7, for the OPREP-3 20-Minute Message.GO TO TAB 7
GENERAL INFO
• DUE WITHIN 20 MINUTES of notification of an OPREP-3 level incident.•Required for all Class A & B AVIATION MISHAPS.
•If all the information is not available, DO NOT WAIT. Release the
message with what you have and send a follow-on message later with more
information.
----------------------------------------------------------------If you haven’t already done so -
STEP 7-1:Recall the Duty YN/PN or grab someone from ADMIN who can use
the Message System.
STEP 7-2:Go to Appendix 7A and fill in a blank OPREP-3 MESSAGE TEMPLATE
with the required information.
STEP 7-3:Give the filled in template to the Duty YN/PN, and have them
prepare the message.
Most CO's will want to know the text of the message prior to it going out. Ensure a
reasonable effort has been made to reach the CO or XO with the text of the
message if you were unable to reach him prior to the 5 minute voice report -
STEP 7-4:Release the message.
Reference:OPNAVINST 3100.6G, SPECIAL INCIDENT REPORTING
(OPREP-3, NAVY BLUE AND UNIT SITREP)
7-5TAB-7
OPREP-3 MESSAGE
7-6TAB-7
COLLECTION OF MISHAP RELATED RECORDS
“X” appropriate addresses and fill in blanks as appropriate.
--------------------------------------------------------------------------
---
Message Precedence: FLASH for Pinnacle – IMMEDIATE for Navy BlueFM STRKFITRON _____________
Addressees for OPREP-3 Pinnacle
TO
JOINT STAFF WASHINGTON DC//J3 NMCC//
USCINCPAC HONOLULU HI...................(or unified commander)
CNO WASHINGTON DC//NCC//
CMC WASHINGTON DC...........................(if involves USMC)
CINCPACFLT PEARL HARBOR HI//FCC//................(or flt cinc)
COMNAVAIRSYSCOM WASHINGTON DC//9F//.....(if aircraft accident)INFO (Chain of Command)
COMTHIRDFLT ........................(current fleet - deployed)
CTF ____________............................(current task force - deployed)
COMNAVAIRPAC SAN DIEGO CA//N00/N01/N012/N32/N36/N45/N73//...........(tycom)
COMCRUDESGRU ____________...................................(battle group)
COMCARAIRWING ____________ .......................................(airwing)
COMSTRKFIGHTWINGPAC LEMOORE CA//N00/N01/N30/N42/N45//(type wing)(Info Others As Appropriate)
ONI WASHINGTON DC
NAS LEMOORE CA....................(or incident shore station)
USS ____________.....................(current ship – deployed)
NAVSURFWARCEN INDIAN HEAD MD....(if ordnance related accident)
NAVY JAG ALEXANDRIA VA...............................(note 1)
DIRNAVCRIMINVSERV WASHINGTON DC//22D/23/02/21/24//....(note 2)
Addressees for Navy Blue
TO
CNO WASHINGTON DC//NCC//
CINCPACFLT PEARL HARBOR HI//FCC//................(or flt cinc)(Immediate Operational and Administrative Commanders)
COMTHIRDFLT ........................(current fleet - deployed)
CTF ____________............................(current task force - deployed)
COMNAVAIRPAC SAN DIEGO CA//N00/N01/N012/N32/N36/N45/73//............(tycom)
COMCRUDESGRU ____________...................................(battle group)
COMCARAIRWING ____________ .......................................(airwing)
COMNAVAIRSYSCOM WASHINGTON DC//09F//....(if aircraft accident)INFO (Remaining Chain of Command As Appropriate)
USCINCPAC HONOLULU HI...................(or unified commander)
COMSTRKFIGHTWINGPAC LEMOORE CA//N00/N01/N30/N42/N45//(type wing)(Info Others As Appropriate)
ONI WASHINGTON DC
NAS LEMOORE CA.......................(incident shore station)
USS ____________.....................(current ship – deployed)
NAVSURFWARCEN INDIAN HEAD MD....(if ordnance related accident)
NAVY JAG ALEXANDRIA VA ...............................(note 1)
DIRNAVCRIMINVSERV WASHINGTON DC//22D/23/02/21/24//....(note 2)
COMNAVSAFECEN NORFOLK VA//00/10/11/541//..............(note 3)
8-7TAB-8
COLLECTION OF MISHAP RELATED RECORDS
Note 1:(injury to civilians, damage to civilian property, violations of law of war)
Note 2:(for actual, suspected or threatened major violations of law or
good order and discipline; for counter intelligence matters; for
incidents resulting in the loss of life; and for those other
situations in which the Naval Criminal Investigative Service
participation is required by SECNAVINST 5520.3B)
Note 3:(when reporting
fires, flooding,
grounding, explosions,
collisions, or other
accidents to U.S. Navy
units)
8-8TAB-8
COLLECTION OF MISHAP RELATED RECORDSBT
UNCLAS ...................................(classify if necessary)
MSGID/OPREP-3P or OPREP-3NB/VFA-___/001/_____//(Squadron/SN from App-
4B/Month)
REF/A/OPREP-3P or OPREP-3NB/VFA-___/ddttttZmmmyy/-/NOTAL//(DTG of voice
report)
AMPN/INITIAL VOICE REPORT TO _____________//.........(agency for voice report)
FLAGWORD/PINNACLE or NAVY BLUE/-//
TIMELOC/ddttttZ/_______________________________________
/________________//
(incident dtg) /(location:lat-long, or geo
<20char) /(init,folup,final)
GENTEXT/INCIDENT IDENTIFICATION AND
DETAILS/__________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//
•Clearly identify the incident being reported within the first two
sentences.
•For aircraft accidents, include
•Aircraft model, buno, reporting custodian, custodian location.
•Pilot’s name, rank, injury code (if known), and number of other
persons on board and their injuries.
•Mission and phase of flight, sar status, and aircraft damage.
8-9TAB-8
COLLECTION OF MISHAP RELATED RECORDS
•Provide an account of the personnel and/or unit losses or damages
which were incurred as a result of the incident; report unknowns.
When reporting the death or serious injury of U.S. military
personnel, names will be withheld pending notification of next of kin.
•Provide an assessment of the public affairs impact of any incident
likely to generate significant public interest and provide data on
any proposed news release (e.g. No press interest expected or Press
interest likely.
RMKS/
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//
•Include CO’s assessment of situation, impact of the incident on the
reporting unit, and the ability of the unit to operate.
•Enter additional information about the incident, if necessary.•The final message report for the incident will include: “MISHAP REPORT
NOT REQUIRED / SUBMITTED / TO FOLLOW.”
•The status of NCIS notification/participation, if any.
BT
OPREP-3 PINNACLE EXAMPLE
UNCLAS
MSGID/OPREP-3P/PATRON FOUR ZERO/001A/MAY//
FLAGWORD/PINNACLE/-//
TIMELOC/041715Z/KAESONG KN/FOLUP//
GENTEXT/INCIDENT IDENTIFICATION AND DETAILS/P3C ORION ACFT
EXPERIENCED NAVAID TROUBLE AND APPEARS TO HAVE UNINTENTIONALLYVIOLATED NORTH KOREAN AIR SPACE. ACFT RTB.//
RMKS/COMMANDERS ESTIMATE: NO DAMAGES OR CASUALTIES.
WILL CHECK NAVAID GEAR ON ALL SQDN ACFT. EXPECT ADVERSE
PUBLIC REACTION FROM N. KOREAN GOVT. ACCUMULATING DATA
FROM FLIGHT CREW FOR POSSIBLE PRESS RELEASE.//
8-10TAB-8
COLLECTION OF MISHAP RELATED RECORDSFor all AVIATION MISHAPS (Class A, B, or C) –
STEP 8-1:At a minimum, impound the following records/ information for
submission to the AMB Senior Member or the Squadron ASO.Delegate this TAB to the RUNNER (if possible).
----------------------------------------------------------------
8-11TAB-8
PAO DRAFT PRESS RELEASEOPERATIONS
，Original Flight Schedule (working copy with all annotated changes)
，Aircrew Logbook(s)
，Aircrew Training Record(s)
，MAC Flight Briefing Materials
，Briefing Guides
，Weather Brief (DD-175-1)
，Flight Plan (DD-175)
，Copy of relevant NOTAMS
，Copy of current SOP
WEATHER OFFICE
，Forecast Weather Conditions at the mishap site，Actual Weather Conditions at the mishap siteMAINTENANCE
，MA logbooks
，MA ADB
，Other pertinent maintenance records/documents，Direct lock-down and back-up of NALCOMIS to capture all pertinent
maintenance data.
When completed or inwork by Runner –STEP 8-2:GO TO TAB 9, for 60-Minute Voice ReportsGO TO TAB 9
10-12TAB-10
PAO DRAFT PRESS RELEASESAFETY
，Aircrew NATOPS Jacket(s)
，Current copies of NATOPS Manual & PCL
，Copy of NATOPS Performance Charts (if applicable)，Current copy of OPNAVINST 3750.6R
ADMIN
，Aircrew Emergency Data Form(s) to CO/CACO.，Personnel Service Record(s).
FLIGHT SURGEON
，Aircrew Health Record(s)
OTHERS
，CVRS Tapes, MU, Memory Cards
，ATC Tapes (radar, IFF, and/or voice)
，Other items deemed appropriate.
GENERAL INFO
•For Class A AVIATION MISHAPS only.
•Due within 60 minutes of a Class A mishap.
•Do not delay the call if details are not available.•** Do not release names of personnel involved over the telephone. **
-----------------------------------------------------------------
STEP 9-1:Fill in the following information:
•REPORTING CUSTODIAN(S):_______________________
•AIRCRAFT TYPE:_______________________
•BUREAU NUMBER:_______________________
•MISHAP LOCATION:_______________________
•TIME OF MISHAP:________(L)_________(Z)
•BRIEF NARRATIVE:_______________________
________________________________________________
________________________________________________
10-13TAB-10
PAO DRAFT PRESS RELEASE
•DAMAGE:_______________________
•INJURIES/FATALITIES:_______________________
POINTS OF CONTACT: _______________________
COMNAVSAFCEN PHONE REPORTSTEP 9-2:Call the NAVAL SAFETY CENTER and read the above report.
MISHAP TELEPHONE REPORT LINE (Manned 24 hr)
DSN: 564-2929
COMM:(757)444-2929 (Collect)
NOTE: Additional information in subsequent calls is encouraged, as it becomes
available including requests for investigative assistance. COMNAVAIRPAC PHONE REPORT
STEP 9-3:Call COMNAVAIRPAC and read the above report.
AIRPAC SAFETY OFFICE (During Working Hours)
DSN: 735-2788/2845
COMM:(619)545-2788/2845
AIRPAC DUTY OFFICE (After Hours)
DSN: 735-2017
COMM:(619)545-2017
GENERAL INFO
•REQUIRED
anytime an
10-14TAB-10
PAO DRAFT PRESS RELEASE
OPREP-3
Report is made.
• DUE WITHIN
60 MINUTES of
mishap/incident
occurrence.
•** DO NOT RELEASE AIRCREW NAMES until confirmation of both Primary &
Secondary Next of Kin Notification. Include the statement “NAME(S)
WITHHELD PENDING NOTIFICATION OF NEXT OF KIN” if required.•Message Precedence shall be “IMMEDIATE.”
-----------------------------------------------------------------
STEP 10-1:Remove a blank PAO MESSAGE TEMPLATE from Appendix 10A and fill in as
much of the required information as possible.
STEP 10-2:Contact the NAS Lemoore BASE PAO, Mr. Dennis McGrath. He is available
24 hours a day.
10-15TAB-10
PAO DRAFT PRESS RELEASE
Work: 559-
998-
3393/3398
DSN:
949-
3393/3398
10-16TAB-10
PAO DRAFT PRESS RELEASE
Pager: 559-
971-0944
Cell: 559-381-0592
Home: 559-924-0147
Email: mcgrath.dennis@lemoore.navy.mil
•He will help you draft/edit the final message.
•Depending on his whereabouts, he may ask you to read and/or email the
proposed text.
Once the final message is prepared -
STEP 10-3:Pass the draft to the duty YN or ADMIN for message generation and
transmission to COMSTRKFIGHTWINGPAC.
Once the message is received at COMSTRKFIGHTWINGPAC -
STEP 10-4:The NAS Lemoore BASE PAO will
•Inform the Commodore and WING CSO of its contents
•Generate the actual Press release
•Handle all questions from the Press
** If the Press contacts the squadron directly, politely direct them to contact the NAS
10-17TAB-10
PAO DRAFT PRESS RELEASE
Lemoore BASE PAO at the above numbers.**
10-18TAB-10
FAA NOTIFICATION
FM STRKFITRON ____________
TO COMSTRKFIGHTWINGPAC LEMOORE CA//N012//
INFO CINCPACFLT PEARL HARBOR HI//013//
COMNAVAIRPAC SAN DIEGO CA//012//
CHINFO WASHINGTON DC//JJJ//
NAS LEMOORE CA//N09L//
COMCARAIRWING _____
BT
UNCLASS//NO5720//
MSGID/GENADMIN/VFA-_____//
SUBJ/PUBLIC AFFAIRS-PROPOSED PRESS RELEASE//
RMKS/1. ________________________________________________________
(aircraft model/squadron/local time of mishap)________________________________________________________________
(location of mishap in plain english)
________________________________________________________________
(fate of aircrew and whether ejected)
________________________________________________________________
(names withheld pending NOK notification)
2. ____________________________________________________________
(narrative account of mishap/phase of flight)
________________________________________________________________________________________________________________________________
(Any other newsworthy information, especially ordnance)______________________________________________________________________________________________________________________________//** Draft this report using civilian/plain language terminology.**GENERAL INFO
•Submit this report only if FAA and/or civil aircraft are involved.• DUE WITHIN 4 HOURS of the mishap.
11-19TAB 11
FAA NOTIFICATION
-----------------------------------------------------------------STEP 11-1:Take a blank FAA NOTIFICATION TEMPLATE from Appendix 11A and fill out
the required information.
STEP 11-2:Make a voice report to the FAA via the local flight service station within four hours of the mishap.
During normal working hours (M-F 0830-1700) call:
FRESNO FSS DISTRICT OFFICE
(559) 487-5306 x239 when prompted (or ask the operator for the
District Office MGR. Leave a voice mail if no
answer.)
After hours or during a holiday call:
FAA WESTERN PACIFIC REGION DUTY OFFICER
(310) 725-3300
•The telephone report should contain all information
required in the message.
•Get the name of the recipient at the FSS, as it is required
for the message.
STEP 11-3:Send the FAA message via priority precedence within 24 hours of the mishap.
STEP 11-4:Fax a copy of the message to the Fresno FSS at (559)454-8808.
11-20TAB 11
INITIAL MISHAP DATA REPORT (MDR)PRIORITY UNCLASSIFIED
FM STRKFITRON _____________
TO FAA WESTERN RGN HQ LOS ANGELES CA
INFO CNO WASHINGTON DC
CINCPACFLT PEARL HARBOR HI
COMNAVAIRPAC SAN DIEGO CA
COMNAVSAFECEN NORFOLK VA//00/10/11/541//
COMSTRKFIGHTWINGPAC LEMOORE CA
NAS LEMOORE CA
UNCLASS FOUO //N03750//
MSGID/GENADMIN/STRKFITRON _____//
SUBJ/AIRCRAFT (INCIDINT/ACCIDENT) INVOLVING (FAA FACILITY/ CIVILIAN AIRCRAFT)//
REF/A/DOC/OPNAVINST 3750.16B//
REF/B/TEL/VFA-_____/(dtg)//
AMPN/REF B IS TELCON BETWEEN FRESNO FSS/(faa recipient) AND VFA-___/
(caller’s name)//
RMKS/1. DATE/LOCAL TIME/TIME ZONE OF MISHAP.
2.LOCATION OF MISHAP (distance and bearing from nearest military base/prominent geographic location or use lat long) .
3.AIRCRAFT TYPE/MODEL/BUNO.
4.(squadron).
5.LAST BASE OF DEPARTURE.
6.AIRCRAFT DESTINATION.
8.LAST KNOWN POSITION AND/OR RADIO CONTACT WITH PILOT.9.SECURITY CLASSIFICATION OF ACCIDENT.
10.RADIOACTIVE MATERIALS ONBOARD? (YES/NO)
11.DESCRIPTION OF MISHAP. (DO NOT INCLUDE NAMES OF INDIVIDUALS INVOLVED IN THE MISHAP OR ANY PRIVILEGED INFORMATION).
12.IDENTIFY FAA FUNCTIONS INVOLVED. (State if FAA/NTSB participation in mishap investigation is desired).
13.STATE WHETHER OTHER INVESTIGATIONS WELL BE CONDUCTED.14.POINT OF CONTACT. (Name, rank, comm telephone number, address).//
GENERAL INFO
• DUE WITHIN 4 HOURS for Class A and B mishaps.
• DUE WITHIN 24 HOURS for Class C mishaps.
•If all the information is not available, use “TBD” and DO NOT WAIT.
Release the message and send a follow-on message later.•Submit a first amended message MDR for Class A and B mishaps, if
necessary, within 24 hours.
•Submit additional amended MDRs as needed to update or correct data in
the previous MDR. Amended MDRs help inform the endorsing chain of the
progress of the investigation. Include only new or corrected
information. Always repeat heading and summary paragraphs.
12-21TAB-12
INITIAL MISHAP DATA REPORT (MDR)•MDRs are NON-PRIVILEGED!! Do not include the privilege statement in the
text (change to instruction forthcoming).
----------------------------------------------------------------If you haven’t already done so -
STEP 12-1:Recall the Duty YN/PN or grab someone from ADMIN who can use
the Message System.
STEP 12-2:Go to Appendix 12A and fill in a blank MDR MESSAGE TEMPLATE
with the required information.
STEP 12-3:Give the filled in template to the Duty YN/PN, and have them
prepare the message in TurboPrep.
Once the message has been QA’d and approved -
STEP 12-4:Release the message.
Reference:OPNAVINST 3750.6, NAVAL AVIATION SAFETY PROGRAM, Chapter 5
12-22TAB-12
MDR MESSAGE TEMPLATEPRE-FORMATTED IAW 3750.6R
“X” appropriate addresses and fill in blanks.----------------------------------------------------------------
-------------
MESSAGE ADDRESSEES
P XXYYYYZ MON YY
FM STRKFITRON ______________........................Your SquadronTO
CNO WASHINGTON DC//N88F//...............................Always
CMC WASHINGTON DC//A/SD//...............................Always
COMNAVSAFECEN NORFOLK VA//00/10/11/FILE//...............Always
ALL HORNET AIRCRAFT ACTIVITIES............................CAD Other Commands in Endorsing Chain of
Command to First Flag Levelif not contained in CAD – MOST ARE!!
_________________________....(See Appendix 12B for Hornet CAD)
_________________________
_________________________
Activities from whom aid was requested in para 7 must be action
addressees!
_________________________
_________________________
_________________________
INFO
CINCPACFLT PEARL HARBOR HI.......Wide public interest expected
NAS LEMOORE CA ...............................................
Shore station if involved
USS _____________________ ....................Ship if involved
_________________________....Command of other aircrew/aircraft involved
LSO SCHOOL NAS OCEANA VA//JJJ//........Carrier landing mishaps
HELSUPPRON EIGHT ..........Helo shipboard mishap involving LSE
HELSUPPRON THREE ..........Helo shipboard mishap involving LSE
ARMED FORCES INSTITUTE OF PATHOLOGY..........Fatality involved
WASHINGTON DC//CME-0//
HELANTISUBRON ONE//60//...........Mishap involves a SAR effort
COMNAVAIRWARCENWPNDIV CHINA LAKE CA//JJJ//..............Note 1
NAVAIRWARCENACDIV PATUXENT RIVER MD//JJJ//..............Note 1
ALL AEROMEDICAL ACTIVITIES .............................Note 1
HQ AFSC KIRTLAND AFB NM//SEF//.........USAF Involved - Note 2
CDRUSASC FT RUCKER AL//PESC-Z//..........USA Involved - Note 2
COMDT COGARD WASHINGTON DC//G-KSE//....USCG Involved - Note 2
NAVY JAG ALEXANDRIA VA//JJJ//Non-DOD acft, personnel, property involved
12A-1TAB-12A
MDR MESSAGE TEMPLATE
NAVSURFWARCENDIV INDIAN HEAD MD//5320//.CAD and AEPS devices of
aircrew
escape systems are
involved
OTHER INFORMATION OR ACTION ADDRESSEES..as directed or considered appropriate
__________________________
__________________________
__________________________
Note 1: Aeromedical matters or aviation life support systems (ALSS)
involved.
Note 2: Aircraft, personnel, or facilities of that service
involved (as appropriate) or mishap aircraft/engine is
common with those of that service (see Appendix H of
3750.6R).
12A-2TAB-12A
MDR MESSAGE TEMPLATE
MDR GUIDELINES
•Include only the information shown in the format below.•Check boxes and fill in blanks where appropriate.•Use “NA” for any information required by the format, which is
obviously inappropriate (such as altitude for a ground
mishap).
•Use “TBA, TBD, or UNK” for any information that is unavailable
when the message is released.
•Use the term “ESTIMATED” when appropriate.
•Submit amended reports whenever new or corrected information
becomes available. Include paragraph 1 as initially reported
plus only those other paragraphs that have changed. Precede
and follow all new or corrected material in the text by the
symbol ”XXX.”
-------------------------------------------------------------------------
BODY OF MESSAGE
BT
UNCLAS FOUO //N03750// THIS IS AN INITIAL GENERAL USE NAVAL
FIRST AMENDED
SECOND AMENDED
AVIATION MISHAP DATA REPORT VFA-____, CLASS A FM, ____-
____,
(sqdn) B FRM (SN: ##-FY)
C AGM
___________, FA-18__, ________/REPORT SYMBOL OPNAV 3750-20.(dd mmm yy) (mod/ser) (buno)
(occurred)
MSGID/GENADMIN/VFA-___/____________/_______//......(sqdn, msg SN,
month)
SUBJ/AVIATION MDR/-//
REF/A/DOC/OPNAVINST/3750.6R//
REF/B/DOC/JAGINST/5800.7C//
REF/C/____________________________//.(other refs as appropriate)
NARR/REF A IS THE NAVAL AVIATION SAFETY PROGRAM. REF B IS THE JAG MANUAL. REF C IS
___________________________________//
POC/________________________/______/_____________________________________/
(name) (rank) (code/billet)____________________________/TEL:_DSN_____________COMM__________
_________/
(location) (phone or “deployed”)
EMAIL:_______________________________________________//
12A-3TAB-12A
MDR MESSAGE TEMPLATE
RMKS/1.
SUMMARY.____________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________ (Brief, factual statement to describe mishap, e.g., AIRCRAFT DEPARTED RUNWAY AFTER LEFT MAIN MOUNT COLLASPED ON LANDING ROLLOUT.)
2.DATA
A.REPORTING ACTIVITY
(1) VFA-_____..................................short title
(2) _________.........................................UIC
(3) NA..................................parent squadron
(4) NA............................parent squadron's UIC
B.AIRCRAFT
(1) FA-18____................................model/series
(2) _________.........................................buno
(3) _________.................................modex & side
(4) VFA-_____..........................reporting custodian
(5) _________.........................................UIC
12A-4TAB-12A
MDR MESSAGE TEMPLATE
(6) OFP-_____..................................OFP version
(7) _________________.................FCC software version(8) F404-GE-400 F404-GE-402 F414-GE-400.....engine
t/m/s
(9) ____________,____________........engine serial numbers(10) GPWS
- INSTALLED/OPERATIVE
COLLISION AVOIDANCE SYSTEM
- NOT INSTALLED
PREDICTIVE MATERIAL FAILURE WARNING SYSTEM
- INSTALLED/OPERATIVE
SURVIVABLE FLIGHT INFORMATION COLLECTION SYSTEM
- INSTALLED/OPERATIVE ...............dfirs aircraft
NAVIGATION SYSTEM INTEGRATED GPS
- INSTALLED/OPERATIVE..................magr aircraft(11) NA.................................................
parent sqdn/reporting cust of composite sqdns(12) NA.................................................
UIC of parent sqdn/reporting cust of composite sqdns
C.INVOLVED EQUIPMENT......parts/equipment involved in mishap, e.g. EFTs
(1) _____________ (1) _____________.................model
(2) _____________ (2) _____________.................make
(3) _____________ (3) _____________...................P/N
(4) _____________ (4) _____________........equipment code(5) _____________ (5) _____________........configuration
(6) _____________ (6) _____________..work unit code (wuc)(7) _____________ (7) _____________.remarks for clarity
D.ENVIRONMENT
(1) DATE:__________.......................date – dd mmm yy(2) TIME:_________L.............................local time
(3) ZONE:__________........................local time zone(4) CONDN:......................................__________
day or night
(5) LOCN:
___________________________________________________________
(location: name of geog area, body of water,
nearest town, or signif landmark. DO NOT provide
a vessel name.)
(A) LATD: ________________ ..........DDMMSS N/S format
(fill leftmost digits with zeros and rightmost
digits with X’s if req’d due to an imprecise
location.)
(B) LONG: ________________.....................DDDMMSS E/W format
(C) STATE: ________________...........state or province
(D) COUNTRY: _____________.....................country
(E) FACILITY: _____________ ............ship or station
12A-5TAB-12A
MDR MESSAGE TEMPLATE
(if a ship, state as e.g., USS STENNIS/CVN-
74)
(F) NAVAID: _______________.......ICAO ident of nearest
afld,navaid,ship
(G) BRG: _______________.........mag brg from navaid
(H) DIST: _______________............dist from navaid
(I) AIRSPACE: _____________ .......Select from and give
number:
CLASS A, CLASS B, CLASS C, CLASS D, CLASS
E, CLASS G, VICTOR AIRWAY, JET ROUTE, IR,
VR, ALERT AREA, MOA, WARNING AREA,
RESTRICTED AREA, CARRIER CONTROL AREA,
CARRIER CONTROL ZONE, N/A, ON DECK,
UNKNOWN.
(J) MISHAP SITE ELEVATION: __________ MSL....in ft msl
(K) MISHAP/EMERGENCY ALTITUDE: _________ MSL AGL
altitude
(if mishap occurred above the surface or
altitude of initial emergency onset.)
12A-6TAB-12A
MDR MESSAGE TEMPLATE
(6) WX AS BRIEFED
(A) BRIEFED BY:........................................
select one
FORECASTER BRIEFER PILOT
UNKNOWN
OTHER: __________(describe) NA
(NA applies only when a briefing was not
available and for events for which no
weather brief was expected or required.)
(B) BRIEFING UTILIZATION:..............................
select one
USED NOT USED NOT AVAILABLE
UNKNOWN NA
(NA only applies to events for which a
weather briefing would not normally be
required.)
(C) AIR TEMP: __________.......................in deg F
(D) RELATIVE HUMIDITY: __________in % relative humidity
(E) DEWPOINT: __________.......................in deg F
(F) WATER TEMP: __________.............in deg F or “NA”
(G) WIND DIRECTION: _________..........in deg or “0” if light/variable
(H) WIND VELOCITY: __________..........in kts or “0” if light/variable
(I) WIND GUSTS: __________..velocity or “NONE FORECAST”
(J) CEILING: __________.first BKN or OVC layer or “NONE FORECAST”
(K) SKY CONDITION: _________________________......in wx sequence format
(e.g., 20 BKN 50 OVC 350 SCT)
(L) HORIZON:.................................select one
VISIBLE OBSCURED PARTIALLY
OBSCURED
UNKNOWN NA
(M) VISIBILITY: __________....... in sm; state “99” if CAVU/unrestricted
(N) OBSTRUCTIONS TO VISION:.......select all that apply
DUST FOG ICE FOG GROUND FOG
HAZE
SMOKE PRECIPITATION BLOWING DUST
BLOWING SAND BLOWING SPRAY
BLOWING SNOW
CLOUDS OTHER: _________(specify)
NA
(O) ALTIMETER SETTING: __________.......in inch mercury
(for the time and location of mishap or nearest wx
facility)
12A-7TAB-12A
MDR MESSAGE TEMPLATE
(P) ICING: __________....as forecast or “NONE FORECAST”
(Q) PRECIPITATION:................select all that apply
DRIZZLE LIGHT RAIN HEAVY RAIN HAIL
SLEET LIGHT SNOW HEAVY SNOW
FREEZING RAIN FREEZING DRIZZLE
OTHER: __________(specify) NA
(R) EXTREME WX:........................................
select all that apply
TURBULENCE (IMC) CLEAR AIR TURBULENCE
GUSTY WINDS TORNADO/WATERSPOUT WIND SHEAR
HURRICANE/TYPHOON THUNDERSTORM
SEVERE THUNDERSTORM LIGHTNING
OTHER: __________(specify) NA
(S) BRIEFING ACCURACY:.......................select one
SUBSTANTIALLY CORRECT CONSIDERABLY BETTER
THAN FORECAST CONSIDERABLY WORSE THAN FORECAST
UNKNOWN NA
12A-8TAB-12A
MDR MESSAGE TEMPLATE
(7)WX - PREVAILING
(A) AIR TEMP: __________.......................in deg F
(B) RELATIVE HUMIDITY: __________in % relative humidity
(C) DEWPOINT: __________.......................in deg F
(D) WATER TEMP: __________.............in deg F or “NA”
(E) WIND DIRECTION: __________.........in deg or “0” if light/variable
(F) WIND VELOCITY: __________..........in kts or “0” if light/variable
(G) WIND GUSTS: __________...velocity or “NONE PRESENT”
(H) CEILING: __________.first BKN or OVC layer or “NONE PRESENT”
(I) SKY CONDITION: ________________________ ......in wx sequence format
(e.g., 20 BKN 50 OVC 350 SCT)
(J) HORIZON:.................................select one
VISIBLE OBSCURED PARTIALLY OBSCURED
OBSCURED UNKNOWN NA
(K) VISIBILITY: __________.............in sm or “99” if CAVU/unrestricted
(L) OBSTRUCTIONS TO VISION:.......select all that apply
DUST FOG ICE FOG GROUND FOG
HAZE
SMOKE PRECIPITATION BLOWING DUST
BLOWING SAND BLOWING SPRAY
BLOWING SNOW
CLOUDS OTHER: _________(specify) NA
(M) ALTIMETER SETTING: __________......in inch mercury
(N) ICING: __________......as present or “NONE PRESENT”
(O) PRECIPITATION:................select all that apply
DRIZZLE LIGHT RAIN HEAVY RAIN HAIL
SLEET LIGHT SNOW HEAVY SNOW
FREEZING RAIN FREEZING DRIZZLE
OTHER: __________(specify) NA
(P) EXTREME WX:........................................
select all that apply
TURBULENCE (IMC) CLEAR AIR TURBULENCE
GUSTY WINDS TORNADO/WATERSPOUT WIND SHEAR
HURRICANE/TYPHOON THUNDERSTORM
SEVERE THUNDERSTORM LIGHTNING
OTHER: __________(specify) NA
(Q) RUNWAY CONDITION:.............select all that apply
12A-9TAB-12A
MDR MESSAGE TEMPLATE
DRY WET SLUSH LOOSE SNOW
PACKED SNOW
ICE PATCHY SANDED OILY
UNPREPARED
OTHER: __________(specify) UNKNOWN
NA (event not in the rwy envrnmnt)
(R) METEOROLOGICAL COMMENTS:
_____________________________________
____________________________________________________________________________________________________________________________
(Briefly describe any additional
environmental/meteorological information deemed
pertinent to the mishap.)
E.SAFETY PROGRAMS
(1) __________....date CO attended Aviation Command Safety Course
(2) __________date Aviation Safety Officer (ASO) attended
Aviation Safety Officers Course
(if CO or ASO have not attended either course, state “HAS NOT
ATTENDED.”)
(3) __________.......date of last NAVSAFECEN safety survey
12A-10TAB-12A
MDR MESSAGE TEMPLATE
3.CIRCUMSTANCES
(1) ORIGIN: __________.....departure ship/afld; else lat/long
(2) MISSION: __________.............mission in plain language
(3) TOTAL MISSION REQUIREMENT CODE: __________.....use 3710.7
codes
(4) TYPE OF FLIGHT PLAN: __________......VFR, IFR, DVFR, etc.
_____________________________________________________________________
(if known, state if pilot was or was not in IMC at time of
mishap)
(5) DESTINATION: __________.........intended point of landing
(6) AIRCRAFT EVOLUTION: ________________________________
(activity in which
acft was involved, e.g., catapult launch, climb, cruise,
30-degree dive, flight deck respot, maintenance, etc.)4.MISHAP CLASSIFICATION. _______________________________________________________________________________________________________________________________
_____________________________________________________________________________
(State that information upon which mishap classification is based. Copy info from Appendix 3A of TAB 3, e.g., for a CLASS A FM: “INTENT FOR FLIGHT EXISTED AND AIRCRAFT WAS DESTROYED.”5. DAMAGE AND COSTS.itemize aircraft/equipment/property damage & costs
A.AIRCRAFT
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
•If aircraft was destroyed, so state.
•If not, describe all aircraft damage and list cost.
Itemize costs, including hours to repair.
•If items/costs unknown, state “TBD.”
•If more than one aircraft was damaged, list model,
bureau number, hours to repair, and cost each
separately.
B.DOD PROPERTY DAMAGE
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12A-11TAB-12A
MDR MESSAGE TEMPLATE
_____________________________________________________________________•Per major item, describe all DOD property damage and list cost.
•Describe property damage, and itemize costs, including hours to repair.
•Use cost figures provided by the cognizant aviation depot, if available, else state “TBD.”
C.NON-DOD PROPERTY DAMAGE
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________•Describe all non-DOD property damage itemizing cost.•Information about the actual cost of damage to non-DOD property shall be provided by a representative from the claims section of the nearest naval activity or a representative from the nearest naval legal service office.
•Use their best estimates until this information is available.
12A-12TAB-12A
MDR MESSAGE TEMPLATE
6.PERSONNEL INFORMATION, INJURIES, AND COSTS
A.SOULS ON BOARD: __________....total for each acft involved
B.CREW: __________...total num of aircrew aboard each mishap acft
(1)
___________________________________________________________________________________________________________________________________________________________________________________________________
(2)
___________________________________________________________________________________________________________________________________________________________________________________________________
For each crewmember, state –
•Crew duty assigned, e.g., PIC, WSO, COPILOT, etc.
•Designate who was at the controls at the time of the
mishap.
•Rank/rate, designator, service, parent organization.
•Duty status (on or off duty).
•Injury classification: fatal injury, permanent total
disability, permanent partial disability, lost workday
injury, first aid injury, no injury, lost at sea,
missing, or unknown.
•Describe the most significant injuries, days
hospitalized and additional days away from work,
describe the body part injury and diagnosis, and pre-
existing diseases/defects that contributed to the
mishap. State whether male or female.
•State if NVDs were being used.
For the pilot, copilot and NFOs -
•State total flight hours, hours in model, and flight
hours last 30, 60 and 90 days.
C.TOTAL NUMBER OF PASSENGERS: NA.....or total # paxs in each
aircraft
(1)INJURED PASSENGERS: NA..........or total # injured paxs
12A-13TAB-12A
MDR MESSAGE TEMPLATE
•Give rank/rate, NEC/designator, service.
•Specify DOD or non-DOD, parent organization, duty
status, injury.
•Describe the most significant injuries, days
hospitalized and additional days away from work.
(2) UNINJURED PASSENGERS: NA..or total # uninjured paxs in
each acft
D.INJURED NONOCCUPANTS: __________...........total # injured
nonoccupants
(1)
___________________________________________________________________________________________________________________________________________________________________________________________________
(2)
___________________________________________________________________________________________________________________________________________________________________________________________________
•List all injured nonoccupants.
•State the NEC/designator, service.
•Specify if DOD or non-DOD, duty status, civilian or
military, injury.
•Describe the most significant injuries, days
hospitalized, and additional days away from work.
E.AEROMEDICAL ANALYSIS WILL WILL NOT BE SENT.
____________________
___________________________________________________(if
not, state why)
12A-14TAB-12A
MDR MESSAGE TEMPLATE
7.MISHAP INVESTIGATION.
________________________________________________________________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Include the following if applicable -
•NON-PRIVILIGED information on progress of the mishap
investigation.
•Location of wreckage, if different from mishap location.
•Requests for assistance. State the nature of help needed,
when and where, and the source of the aid, if known. When
requesting assistance from the controlling custodian or
from an activity external to the command, begin the
request with the phrase “FOR (controlling custodian),
REQUEST....” Our controlling custodian is COMNAVAIRPAC!!
Requests for help from activities subordinate to the
controlling custodian should be similarly addressed. Be
sure the activity from whom you are requesting aid is an
action addressee on the message.
•Requests for relief from investigative and reporting
responsibilities. See chapter 6 of 3750.6R for details.
•Requests for extensions of SIR deadlines. See chapter 7 of
3750.6R.
•Requests for salvage of submerged wreckage. See para 609c
of 3750.6R.
•FAA notification required/date/time notified.
•Flight Data Recorder: recovered/activity where
sent/date/which traceable means used.
•PLAT Tape obtained /activity where sent/date/which
traceable means used.
•Tower Tapes or recordings of air control transmissions
obtained/date.
•Status of all previously requested EIs.
•Justification for upgrading, downgrading or category
changes.
12A-15TAB-12A
MDR MESSAGE TEMPLATE8.JAG MANUAL INVESTIGATION. THIS MISHAP DOES DOES NOT MEET THE
REQUIREMENTS IN REF B FOR A JAG MANUAL INVESTIGATION. If appropriate, include INVESTIGATION BEGUN, __________ (date), BY CO VFA-______(convening authority).
9.AVIATION MISHAP BOARD
- SENIOR MEMBER: _________________________.rank, name, command
DSN_____________________,COMM__________________,CELL___________________
FAX_____________________,EMAIL_________________________________________
(List DSN, commercial, cell phone and fax numbers for the
senior member or the member designated as point of contact
to answer telephone inquiries in the POC line above the
RMKS line. If embarked, so state and provide an INMARSAT
phone number.)
- AIRCRAFT OPERATIONS: _________________________.rank, name, command
- AIRCRAFT MAINTENANCE: _________________________.rank, name, command
- AVIATION SAFETY: _________________________.rank, name, command
- FLIGHT SURGEON: _________________________.rank, name, command
- ____________________: _________________________//.....rank, name, command
(other board members)
BT
XXXX
NNNN
12A-16TAB-12A
HORNET COLLECTIVE ADDRESS DESIGNATOR
R 091515Z MAR 00 PSN 856407S30COMCRUDESGRU TWELVE
COMCRUDESGRU TWOFM COMNAVSAFECEN NORFOLK
VA//10/15D/FILE//COMFAIRWESTPAC ATSUGI JA//N312//
COMMARFORLANT
TO AIRTEVRON NINECOMMARFORLANT
AIRTEVRON NINE DET PT MUGU CACOMMARFORPAC
CDRUSASC FT RUCKER AL//CSSC-Z//COMMARFORPAC
CG FIRST MAWCOMNAVAIRESFOR NEW ORLEANS LACG FOURTH MAWCOMNAVAIRLANT NORFOLK CG I MEFVA//N45/N42//
CG II MEFCOMNAVAIRPAC SAN DIEGO CACG SECOND MAWCOMNAVAIRSYSCOM PATUXENT CG THIRD MAWRIVER MD//5.0D/5.0F//CMC WASHINGTON DC//SD//COMNAVAIRWARCENACDIV CMC WASHINGTON DC//SD//PATUXENT RIVER MDCNATRA CORPUS CHRISTI TXCOMNAVAIRWARCENWPNDIV CHINA CNO WASHINGTON DC//N88F//LAKE CA//44K100D//
COMNAVSAFECEN NORFOLK
AirwingsVA//10/11/15D/FILE//COMCARAIRWING EIGHTCOMOPTEVFOR NORFOLK VACOMCARAIRWING ELEVENCOMSTRKFIGHTWINGLANT OCEANA COMCARAIRWING FIVEVA
COMCARAIRWING FOURTEENCOMSTRKFIGHTWINGPAC DET COMCARAIRWING NINEFALLON NV
COMCARAIRWING ONECOMSTRKFIGHTWINGPAC COMCARAIRWING SEVENFLTINTROTM LEMOORE CACOMCARAIRWING SEVENTEENCOMSTRKFIGHTWINGPAC LEMOORE COMCARAIRWING THREECA
COMCARAIRWING TWODCMC BOEING ST LOUIS MO//RDF//COMCARAIRWINGRES TWO ZEROFITRON COMP THIRTEEN
FITRON COMP TWELVE
Battle GroupsHQ AFSC KIRTLAND AFB
NM//SEF/SEP/SE//COMCARGRU EIGHT
LSO SCHOOL NAS OCEANA VACOMCARGRU FIVE
COMCARGRU FOURMAGsCOMCARGRU ONE
MAG ELEVENCOMCARGRU SEVEN
MAG FOUR NINECOMCARGRU SIX
MAG FOUR NINE DET ALFACOMCARGRU THREE
MAG FOUR ONECOMCARGRU TWO
MAG FOUR SIXCOMCRUDESGRU EIGHT
MAG FOUR TWOCOMCRUDESGRU FIVE
MAG FOUR TWO DET ALFACOMCRUDESGRU ONE
MAG THREE ONECOMCRUDESGRU THREE
MAG TWELVECOMCRUDESGRU THREE
MAG TWELVE
12B-1TAB-12B
HORNET COLLECTIVE ADDRESS DESIGNATOR
STRKFITRON ONE ONE FIVEMAWTS ONE YUMA AZSTRKFITRON ONE ONE THREENAVAIRWARCENTRASYSDIV STRKFITRON ONE THREE ONEORLANDO FL//10A//STRKFITRON ONE THREE SEVENNAVAIRWARCENWPNDIV PT MUGU CASTRKFITRON ONE THREE SIXNAVAIRWPNSTA CHINA LAKE STRKFITRON ONE TWO FIVECA//C0811/C087//STRKFITRON ONE TWO TWONAVAVNDEPOT JACKSONVILLE FLSTRKFITRON ONE ZERO FIVENAVAVNDEPOT NORTH ISLAND CASTRKFITRON ONE ZERO SIXNAVCOMTELSTA WASHINGTON STRKFITRON THREE FOURDC//N3/N353//STRKFITRON THREE SEVENNAVCSRF HONOLULU HI//W33//STRKFITRON TWO FIVENAVFLIGHTDEMRONSTRKFITRON TWO SEVENNAVPGSCOL MONTEREY CA//10//STRKFITRON TWO TWONAVSTKAIRTESTRON PATUXENT STRKFITRON TWO ZERO FOURRIVER MD//55SA90A/55SA10A F18//STRKFITRON TWO ZERO ONENAVSTKAIRWARCEN FALLON NVSTRKFITRON TWO ZERO THREENAVTESTPILOTSCH PATUXENT RIVER SWATSLANT OCEANA VAMD//55TP90A//
NAVTESTWINGLANT PATUXENT
RIVER MD//55TW90A/55IM90A//
NAVTESTWINGPAC PT MUGU
CA//562000D//
NAVWPNTESTRON CHINA LAKE
CA//562000D/562100D//
NCTAMS EURCENT NAPLES IT//JJJ//
NCTAMS EURCENT NAPLES IT//JJJ//
NCTAMS LANT NOVA NORFOLK VA
Weapon Schools
SFWSLANT OCEANA VA
SFWSPAC LEMOORE CA
Navy Squadrons
STRKFITRON EIGHT ONE
STRKFITRON EIGHT SEVEN
STRKFITRON EIGHT SIX
STRKFITRON EIGHT THREE
STRKFITRON EIGHT TWO
STRKFITRON FIFTEEN
STRKFITRON NINE FOUR
STRKFITRON NINE SEVEN
STRKFITRON ONE FIVE ONE
STRKFITRON ONE FOUR SEVEN
STRKFITRON ONE FOUR SIX
STRKFITRON ONE NINE FIVE
STRKFITRON ONE NINE TWO
12B-2TAB-12B
HORNET COLLECTIVE ADDRESS DESIGNATOR
Carriers
USS ABRAHAM LINCOLNUSS CARL VINSON
USS CONSTELLATION
USS DWIGHT D EISENHOWERUSS ENTERPRISE
USS GEORGE WASHINGTONUSS HARRY S TRUMANUSS JOHN C STENNISUSS JOHN F KENNEDYUSS KITTY HAWK
USS NIMITZ
USS THEODORE ROOSEVELT
Marine SquadronsVMFA AW FIVE THREE THREEVMFA AW ONE TWO ONEVMFA AW THREE THREE TWOVMFA AW TWO FOUR TWOVMFA AW TWO TWO FIVEVMFA AW TWO TWO FOURVMFA ONE FOUR TWO
VMFA ONE ONE FIVE
VMFA ONE ONE TWO
VMFA ONE THREE FOURVMFA ONE TWO TWO
VMFA THREE ONE FOURVMFA THREE ONE TWOVMFA THREE TWO ONEVMFA THREE TWO THREEVMFA TWO FIVE ONE
VMFA TWO ONE TWO
VMFA TWO ONE TWO
VMFA TWO THREE TWOVMFAT ONE ZERO ONEVMFT FOUR ZERO ONE
12B-3TAB-12B
UNIT SITREP
UNCLAS //N02342//
MSGID/GENADMIN/COMNAVSAFECEN/15-059/MAR//
SUBJ/ALL HORNET AIRCRAFT
ACTIVITIES COLLECTIVE ADDRESS DESIGNATOR (CAD)
/1 RECAPITULATION//POC/T. LARKIN/CIV/PRIPHN:DSN 564-3520 EXT 7283/-/COMNAVSAFECEN/SECPHN:757-444-3520 EXT 7283/ FAX: 757-444-7049/ DSN 564-7049/E-MAIL: TLARKIN@SAFETYCENTER.NAVY.MIL//RMKS/1. EFFECTIVE 22 MARCH 2000 THE ACTION ADDRESSEES OF THIS MESSAGE LESS CNO WASHINGTON DC, NAVCSRF HONOLULU HI, NCTAMS LANT NOVA NORFOLK VA, NCTAMS EURCENT NAPLES IT AND NAVCOMTELSTA WASHINGTON DC CONSTITUTE THE ALL HORNET AIRCRAFT ACTIVITIES COLLECTIVE ADDRESS DESIGNATOR.
2. THE FOLLOWING PARTICULARS PERTAIN TO THE ALL HORNET AIRCRAFT ACTIVITIES CAD:
A. COGNIZANT AUTHORITY: COMNAVSAFECEN NORFOLK VA.
B. PURPOSE: TO BE USED SOLELY FOR DISSEMINATION OF HAZARDS, MISHAP REPORTS, MISHAP INVESTIGATION REPORTS AND THEIR ENDORSEMENTS AS ADDRESSED IN OPNAVINST 3750.6Q.
C. CLASSIFICATION: THE PURPOSE AND COMPOSITION OF THIS CAD ARE UNCLASSIFIED; HOWEVER, SIGNIFICANT PORTIONS OF THE REPORTS TRANSMITTED HEREUNDER CONTAIN PRIVILEGED INFORMATION AS DEFINED IN OPNAVINST 3750.6Q. SUCH INFORMATION REQUIRES SPECIAL HANDLING TO ENSURE THAT IT IS USED ONLY FOR SAFETY PURPOSES, AND UNAUTHORIZED DISCLOSURE IS A CRIMINAL OFFENSE PUNISHABLE UNDER ARTICLE 92 OF THE
UCMJ. THEREFORE, DISTRIBUTION OF ALL INFORMATION SENT UNDER THIS CAD MUST BE CLOSELY MONITORED AND CONTROLLED.
D. AUTHORIZED USERS: ALL CAD ADDEES; ORIGINATORS AND ENDORSERS OF HAZARD REPORTS, MISHAP REPORTS, AND MISHAP INVESTIGATION REPORTS PERTAINING TO ALL HORNET AIRCRAFT; AND CNO WASHINGTON DC.
3. ADDEES INFORM YOUR SERVING TELECOMMUNICATIONS FACILITIES/TERMINALS OF THIS PROMULGATION SO THEY MAY CONFIRM THEIR GUARDLISTS.//
BT
GENERAL INFO - The following should be considered for possible action.
14A-1APPENDIX 14A
UNIT SITREP
•Obtain a 72-hour history for all personnel involved. For all Class A &
B mishaps (and if necessary for Class C mishaps) send individuals
directly involved in the mishap to medical to have blood samples drawn.
Consult your flight surgeon with questions.
•If a squadron fatality has occurred, contact the command CACO to
initiate PNOK and SNOK notification.
•If death is imminent for a military member, contact the Admin Officer
immediately to initiate Imminent Death Retirement procedures.•If a loss of COMSEC equipment has occurred, alert the squadron CMS
Custodian and Security Manger so they can initiate a "Loss of COMSEC
Equipment Letter."
•Query the maintenance department as to whether they will need to
initiate an X-ray / Equipment Loss Report.
•Distribute the Mishap Responsibility checklists to appropriate members
of the squadron (located in the Safety Officer’s Turnover Binder).If the aircraft mishap as determined in TAB 3 is Class “C” (less than $200,000 damage and/or
no permanent disability) there are no immediate reports required. The first report deadline
is 24 hours from the mishap occurrence.
GENERAL INFO
•Initiate squadron notification referencing TAB 5.
•With a Class “C” aircraft mishap, the CO may want to send a Unit
SITREP. If a Unit SITREP is to be sent, go to APPENDIX 14A.
•Blood samples are not required for Class C mishaps unless it is
suspected that drugs/alcohol or other physical impairments may be a
factor. If necessary, send appropriate individuals directly involved
in the mishap to medical to have blood samples drawn, and a 72-hour
history taken. Consult your flight surgeon with questions.
•When the above steps are complete, collect all relevant materials
relating to the mishap and ensure they are given to the Safety
Officer. The Safety Officer, or an alternate designated by the CO
will be responsible for following through on required mishap messages.
•Distribute the Mishap Responsibility checklists to appropriate
members of the squadron (located in the Safety Officer’s Turnover
Binder).
14A-1APPENDIX 14A
UNIT SITREP
•The Unit SITREP is used by CO's to tell appropriate operational
commanders about any incident not meeting OPREP-3 reporting criteria.
•If the CO desires to send a Unit SITREP, refer to the message format
on the next page (APPENDIX 14A).
•Unit SITREP messages are due within 20 minutes - no voice report is
required. Message precedence and classification is as appropriate.
•A Unit SITREP shall be submitted when:
(a) Directed
(b) Considered appropriate by the CO.
(c) A bomb threat is evaluated as a hoax.
•A Unit SITREP will contain the following information:
(a) Status of situations/events not requiring an OPREP-3.
(b) Progress of special operations/events.
(c) Information concerning specific events/operations.
(d) Type of event being reported.
(e) Brief account of event (who, what, where, when, why, action
taken).
(f) Do not release sensitive or personal information. Use general
identification of individuals (i.e. PO1 or 20 yr old E-3).
•For RMKS, include CO’s assessment of the situation, impact of the
incident on the unit, unit’s ability to conduct operations and
anticipated press interest. The final message report for the
incident will include “mishap report to follow, submitted or not
required.”
14A-1APPENDIX 14A
OPREP-3 VOICE REPORT (cont)
UNCLASSIFIED
01 000000Z XXX XX PP
UUUU XXXXXX
FM STRKFITRON___________________
TO COMSTRKFIGHTWINPAC LEMOORE CA//NOO/NO1/N30/N80//
INFO COMNAVAIRPAC SAN DIEGO CA//00/01/30/80//
CNO WASHINGTON DC//JJJ//
CINCPACFLT PEARL HARBOR HI//JJJ//
COMNISCOM WASHINGTON DC//22D// (HOAX BOMB THREATS)UNCLASS
MSGID//UNITSITREP/STRKFITRON____/____/_____//(SERIALNUMBER/MONTH)FLAGWORD/-/UNITSITREP//
TIMELOC/________/_________/__________//
(INCIDENT DTG/LAT-LONG/INIT,FOLUP,FINAL)
GENTEXT/INCIDENT IDENTIFICATION AND
DETAILS/__________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//RMKS/_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//X. X. XXXXX, XXXX, XXXX
X.X. XXXXX, CO, XXXX
UNCLASSIFIED 000000Z XXX 00
2-7TAB-2
OPREP-3 VOICE REPORT (cont)
* USE THIS TAB ONLY IF AN INDIVIDUAL HAS BEEN INJURED IN ANY WAY IN A MISHAP OR THAT IS NOT DIRECTLY RELATED TO A NAVAL
ACIRCRAFT.*
INITIAL NOTIFICATION
STEP 1-1:Record all available information on the Initial Notification
Worksheet (appendix 1A).
STEP 1-2:Notify the Operations Duty Officer (ODO) or the Squadron Duty
Officer (SDO) immediately. In the event of death or serious
injury ensure the CO, XO, and CACO are notified to initiate
primary and secondary next of kin notification. Do not release
victim’s names to anyone outside the chain of command.Note:If the CO is fatally or critically injured or missing, an
OPREP-3 PINNACLE report is required (see SECTION 3).STEP 1-3:For non-fatal, non-serious mishaps, notify the Safety Officer
and have the victim’s supervisor fill out a “SUPERVISOR’S
REPORT OF MISHAP/OCCUPATIONAL ILLNESS INCIDENT” worksheet from
Tab 2.
STEP 1-4:FAX the report to the NAS Lemoore Base Safety office at x2328.STEP 1-5:Make a follow-up phone call to NAS Lemoore Base Safety at x3936
or x3932 and request their assistance in fulfilling the
investigation and reporting requirements. Reference Tab 3 to
determine the governing instruction.
STEP 1-6:Give the original Report and all other information associated
with the mishap to the Safety Officer.
** Gain as much of the following information as possible! **Time of Call: ____________
Caller’s Name: _______________________(Rank): _________________Phone Number: _______________________(Organization): _________Time of mishap (Local): ______________
2-8TAB-2
OPREP-3 VOICE REPORT (cont)
Location: (nearest crossroads, be as specific as possible)
__________________________________________________________________________________________________________________________________
_________________________________________________________________Caller’s Initial Description of Mishap (Find out who, what, where, when and why): ___________________________________________
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
If anyone has gone to hospital, find out which hospital:
____________________________________
What are the estimated injuries?， YES ， NO ， UNKNOWN
Condition: _________________________________________________ How many injured?， UNKNOWN
Condition: _________________________________________________Are any of the following on scene/have they been contacted:
Police， ONSCENE ， CONTACTED ， UNKNOWN
Fire Department， ONSCENE ， CONTACTED ， UNKNOWN
An ambulance， ONSCENE ， CONTACTED ， UNKNOWN
Were there any other witnesses? ， YES ， NO
Name___________________________________________________
Address___________________________________________________
2-9TAB-2
OPREP-3 VOICE REPORT (cont)
___________________________________________________Phone___________________________________________________Name___________________________________________________Address___________________________________________________
___________________________________________________Phone___________________________________________________
SUPERVISOR'S REPORT OF MISHAP/OCCUPATIONAL ILLNESS INCIDENTUTILIZING PAGE (1), SUPERVISORS SHALL, WITHIN 24 HOURS OF FIRST NOTICE, REPORT ALL MISHAPS AND
OCCUPATIONAL ILLNESSES TO THE SITE SAFETY OFFICE BY TELEPHONE (X3936)! INCIDENTS OCCURING ON
WEEKENDS OR HOLIDAYS SHALL BE REPORTED ON THE NEXT WORKDAY FOLLOWING. WITHIN 5 WORKING DAYS FOLLOWING FIRST NOTICE OF THE INCIDENT, COMPLETE PAGE (2) AND FORWARD THE ENTIRE REPORT, INCLUDING
SUPPORTING DOCUMENTS AND DOCUMENTED CORRECTIVE ACTIONS, TO THE SITE SAFETY OFFICE BY FAX (EXT. 2328), GUARDMAIL, OR IN PERSON. THE FOLLOWING INFORMATION IS REQUIRED TO COMPLETE THIS REPORT.
FOR SAFETY OFFICE USE ONLY!
DATE REPORT RECVD: / / RECVD BY: DATE IN OSHMAP: / /
REPORTER'S NAME: SUPVR: YES / NO
ACTIVITY/DEPARTMENT: PHONE: ( ) -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------EMPLOYEE INFORMATION
NAME OF EMPLOYEE: ______. (Last First MI) (SSN) RANK/RATE/SERIES & GRADE : DOB: / / SEX:
AIR STATION: __________. COMMAND/ACTIVITY: ___ UIC: PM/DEPARTMENT: WC / SHOP CODE: JOB TITLE:
PERSONNEL TYPE (CIRCLE ONE): CIVIL SERVICE NON-APPROPRIATED FUND CIVILIAN MILITARY
WORK SHIFT: (CIRCLE ONE): 1ST 2ND 3RD ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------SELECT TYPE OF INCIDENT (CIRCLE ONE): PERSONAL INJURY OCCUPATIONAL ILLNESS MOTOR VEHICLE PROPERTY DAMAGE------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------PERSONAL INJURY MISHAP OR OCCUPATIONAL ILLNESS INCIDENT INFORMATION (CIRCLE OR FILL IN THE APPLICABLE DATA)1. INCIDENT DATE: / / 2. INCIDENT TIME: 3. DID INCIDENT OCCUR: ON DUTY OR OFF DUTY
4. INCIDENT OCCUR ON BASE: NO YES - OCCURANCE LOCATION: FAC #
5. ACTIVITY/TASK ENGAGED IN: (WELDING, MATERIAL HANDLING, USING COMPUTER, DRIVING VEHICLE, JOGGING, BASKETBALL, ETC.) 6. SOURCE OF INJURY: (WELDER, CIRCULAR SAW, DOOR, STAIRS, VEHICLE, BASKETBALL, RACQUET BALL, KNIFE, ETC.) 7. TYPE OF INJURY/ ILLNESS: 8. ACCIDENT TYPE: (FRACTURE, CUT, BURN, ETC.) (FALL FROM, STRUCK BY, CONTACT WITH, ETC.)9. BODY PART INJURED:
2-10TAB-2
OPREP-3 VOICE REPORT (cont)
(HEAD, LEG, LEG, FOOT, FINGER, HAND, ARM, NOSE, ETC.) (INDICATE LEFT OR RIGHT WHERE NECESSARY)10. MEDICAL TREATMENT REQUIRED: NO YES - DATE: WHERE: 11. HOSPITIALIZATION REQUIRED: NO YES - # OF DAYS: WHERE: 12. LOST WORKDAYS ASSIGNED: NO YES - # OF DAYS: 13. LIGHT DUTY DAYS ASSIGNED: NO YES - # OF DAYS: 14. DID THE INCIDENT INVOLVE ANY OF THE FOLLOWING: RECREATION ATHLETICS HOME SIGHT CHEMICAL
HEARING LOSS (STS) ERGONOMICS BLOODBORNE PATHOGEN EXPOSURE BIOHAZARD MOTOR VEHICLE
IF CHEMICAL, LIST MSDS#(s) AND CHEMICAL NAME(S):
15. SHORT NARRATIVE (How Incident Occurred): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 16. RECORDED WITH BASE DISPENSARY: YES NO 17. CA-1 OR CA-2 OR LS-202 FILED FOR CIVILIAN EMPLOYEES
18. GENERAL CAUSE OF MISHAP: PERSONNEL ERROR MATERIAL FAILURE ENVIRONMENTAL EXTREMES UNSAFE ACT INADEQUATE PRECAUTIONS INADEQUATE PROCEDURES UNSAFE CONDITION LACK OF TRAINING
OTHER (specify:) EXPLAIN:
19. SPECIFIC CAUSE OF MISHAP: FAILURE TO SUPERVISE NO "SOP" EMPLOYEE DID NOT FOLLOW "SOP" HORSEPLAY
EMPLOYEE DISTRACTED EMPLOYEE IN HURRY PPE NOT PROVIDED PPE PROVIDED BUT NOT WORN UNSAFE DRIVING
SUPERVISOR INATTENTION TO WORKPLACE HAZARDS EMPLOYEE INATTENTION TO WORKPLACE HAZARDS
VIOLATING SAFE SPORTS PRACTICES ASSUMING UNSAFE POSTURE WARNINGS NOT POSTED
OTHER (SPECIFY): EXPLAIN:
20. CORRECTIVE ACTION(S) TAKEN (COUNSELLING, TRAINING, SOP DEVELOPMENT, HAZARD ABATEMENT, ETC.):
(DESCRIBE):
DATE COUNSELING CONDUCTED: / / CONDUCTED BY: (SIGN AND DATE) DATE TRAINING CONDUCTED / / CONDUCTED BY: (SIGN AND DATE)NOTE: IT IS RECOMMENDED THAT COUNSELING AND TRAINING CONDUCTED AS A CORRECTIVE ACTION BE DOCUMENTED AND THE DOCUMENTATION BE RETAINED WITH THE DEPARTMENT/PM/DIVISION COPY OF THIS REPORT.
SUPPLEMENTAL MOTOR VEHICLE MISHAP INFORMATION
21. TYPE OF MOTOR VEHICLE: PMV GMV MC ATV OTHER
22. DRIVER(S) INVOLVED : (1) (NAME & ADDRESS OR COMMAND)
2-11TAB-2
OPREP-3 VOICE REPORT (cont)
(2) (NAME & ADDRESS OR COMMAND)
23. MOTOR VEHICLE(S) INVOLVED: (1) (YEAR, MAKE, MODEL, ETC.)
(2) (YEAR, MAKE, MODEL, ETC.) 24. TYPE OF PPE USED (CIRCLE APPROPRIATE PPE): SEAT BELTS HELMET GLOVES BOOTS LEATHERS GOGGLES
SUPPLEMENTAL GOVERNMENT MOTOR VEHICLE/PROPERTY DAMAGE INFORMATION
25. DESCRIPTION OF GOVERNMENT PROPERTY: (NOMENCLATURE) (SERIAL #)26. DESCRIPTION OF DAMAGE:
27. DAMAGE COST:
ROUTING: SUPVR/LCPO/LPO: DATE: __________________________ (SIGN & DATE) DIVISION OFFICER: ________________________________________________ DATE: __________________________ DEPT HEAD/PROGRAM MANAGER: _________________________________________________ DATE: __________________________ SITE SAFETY OFFICE: _____________________________________________________ DATE: __________________________
2-12TAB-2
OPREP-3 VOICE REPORT (cont)
TAB
3
2-13TAB-2
OPREP-3 VOICE REPORT (cont)
DESCRIPTION
•You have arrived at this section if you are responding to a special You have arrived at this section if you are responding to a special •
incident or event that may generate high-level interest.incident or event that may generate high-level interest.
•From the table below determine the reporting requirement for the
special incident in question. Go to the tab listed at the bottom of
the appropriate column. If an event or special incident may
attract…
•National level interest - OPREP-3 PINNACLE Series.
•High U.S. Navy interest - OPREP-3 NAVY BLUE Series.
•Local higher authority interest - Unit SITREP.
NATIONAL LEVEL HIGHER NAVAL HIGH LEVEL NAVY INTERESTINTERESTAUTHORITY INTEREST
OPREP-3 PINNACLEOPREP-3 NAVY BLUEUNIT SITREP
Events not requiring ，War risk attacks, ，Any Class A or B OPREP-3 reporting.aircraft mishap not a harassment, PINNANCLE.，Hoax bomb threathostile acts
，Aircraft crash on ，Minor racial incidentsagainst U.S.government land or at ，Minor fraud, waste, ，Major nuclear sea.and abuseweapons incidents，Bomb threat thought to ，Violent crime，Territorial be valid•Assaultviolations，Civilian or military •Aggravated assaultdisorder，Defections•Sexual assault
，Request for assistance ，Sabotage•Robberyafter natural disaster•Armed robbery，Hijacking，Major racial incident•Spousal abuse，High-level ，Nuclear reactor/ •Child abusemilitary ops radiological accidents，Incidents of resulting in ，Minor nuclear weapons suicide or damage to accidentsattempted suicideaircraft, ships, ，Minor collisions at equipment, etc.sea
，Injury to ，Oil spillscivilians，Labor strikes
，Widespread ，Naval accidents (fire, civilian property flood, etc.)
damage，SAR
，SAR initiation in ，Major fraud, waste and foreign countryabuse
，Abrupt foreign ，INCSEA violations
government changes，Discrimination and
，Reconnaissance sexual harassment
incidents
，Attacks against GO TO TAB 2GO TO TAB 2nuclear site
2-14TAB-2
OPREP-3 VOICE REPORT (cont)
，Receipt of GO TO TAB 4GO TO TAB 4
critical
intelligence
GO TO TAB 2GO TO TAB 2
DESCRIPTION
•You have arrived at this section if you are responding to a special You have arrived at this section if you are responding to a special •
incident or event that may generate high-level interest.incident or event that may generate high-level interest.•From the table below determine the reporting requirement for the
special incident in question. Go to the tab listed at the bottom of
the appropriate column. If an event or special incident may
attract…
•National level interest - OPREP-3 PINNACLE Series.
•High U.S. Navy interest - OPREP-3 NAVY BLUE Series.
•Local higher authority interest - Unit SITREP.NATIONAL LEVEL HIGHER NAVAL HIGH LEVEL NAVY INTERESTINTERESTAUTHORITY INTEREST
OPREP-3 PINNACLEOPREP-3 NAVY BLUEUNIT SITREP
2-15TAB-2
OPREP-3 VOICE REPORT (cont)
Events not requiring ，War risk attacks, ，Any Class A or B OPREP-3 reporting.aircraft mishap not a harassment, PINNANCLE.，Hoax bomb threathostile acts
，Aircraft crash on ，Minor racial incidentsagainst U.S.government land or at ，Minor fraud, waste, ，Major nuclear sea.and abuseweapons incidents，Bomb threat thought to ，Violent crime，Territorial be valid•Assaultviolations，Civilian or military •Aggravated assaultdisorder，Defections•Sexual assault
，Request for assistance ，Sabotage•Robberyafter natural disaster•Armed robbery，Hijacking，Major racial incident•Spousal abuse，High-level ，Nuclear reactor/ •Child abusemilitary ops radiological accidents，Incidents of resulting in ，Minor nuclear weapons suicide or damage to accidentsattempted suicideaircraft, ships, ，Minor collisions at equipment, etc.sea
，Injury to ，Oil spillscivilians，Labor strikes
，Widespread ，Naval accidents (fire, civilian property flood, etc.)
damage，SAR
，SAR initiation in ，Major fraud, waste and foreign countryabuse
，Abrupt foreign ，INCSEA violations
government changes，Discrimination and
，Reconnaissance sexual harassment
incidents
，Attacks against GO TO TAB 2GO TO TAB 2nuclear site
GO TO TAB 4GO TO TAB 4，Receipt of
critical
intelligence
GO TO TAB 2GO TO TAB 2
GENERAL INFO
•There are two parts to an OPREP-3 Report. The OPREP-3 Voice Report
and the OPREP-3 Message.
•The main purpose of the OPREP-3 voice report is immediate
notification of a special incident to the highest levels of the Navy
2-16TAB-2
OPREP-3 VOICE REPORT (cont)
and/or Federal Government. It is not intended to provide details for
a CNN news brief. Keep it simple and make it quick.
• DUE WITHIN 5 MINUTES of notification of an OPREP-3 level incident.•Ensure every reasonable effort has been made to contact the CO, XO,
or ASO in STEP 2-2 below, prior to making this phone call.•Do not unduly delay the call while waiting for further information.
-----------------------------------------------------------------
STEP 2-1:Go to Appendix 2A and determine the TYPE of OPREP-3 REPORT
required.
，Pinnacle
，Navy Blue
STEP 2-2:CO Confirmation: Contact the CO using the squadron recall.
•Notify him of the incident.
•Ask him to confirm your determination of Pinnacle vs Navy
Blue.
•Ask him for
his estimate
of the impact
of the
2-17TAB-2
OPREP-3 VOICE REPORT (cont)
incident on the
squadron’s ability to operate (this will be used in the
OPREP-3 20-
2-18TAB-2
OPREP-3 VOICE REPORT (cont)
minute
message).
，NONE
，MINIMAL
，MODERATE
，SEVERE
NOTE: Contact the XO if CO cannot be reached. Contact the OPS-O if CO/XO cannot be reached. If none of the above individuals are available, make the determinations using your best judgement.
STEP 2-3:Go to Appendix 2B and determine the OPREP-3/SITREP SERIAL
NUMBER for this voice report.
Continued Next Page
2-19TAB-2
OPREP-3 VOICE REPORT (cont)DELEGATE THE REMAINING TAB-4 STEPS, IF ABLE.STEP 2-4:Go to Appendix 2C and fill in the details of the OPREP-3 VOICE
REPORT TEMPLATE.
•NOTE: Examples of OPREP-3 Pinnacle and Navy Blue Voice
Reports are also contained in Appendix 2C.
STEP 2-5:Make the call! Contact the following agencies in order until
someone is reached.
PRIORITYAGENCYPHONE NUMBER
COMM: (808)471-3201/2/3FIRSTCINCPACFLTSTU-III: (808)471-5208/9SECONDNAVY COMMAND CENTER (NCC)COMM: (703)695-0231/0232
COMM: (703)697-6340NATIONAL MILITARY COMMAND THIRD•Request they relay or CENTER (NMCC)conference call to NCC.
Numbers verified 10 July 2001.
•Read the filled-in OPREP-3 VOICE REPORT TEMPLATE
•EXACTLY AS WRITTEN and
•IN A CHALLENGE AND REPLY FORMAT.
•Speak clearly and don’t read too quickly.
•** DO NOT RELEASE NAMES OF PERSONNEL INVOLVED **
2-20TAB-2
OPREP-3 VOICE REPORT (cont)
STEP 2-6:Write
down the time of the call and
any
information/in
structions
from the
2-21TAB-2
OPREP-3 VOICE REPORT (cont)
contacted
agency.
STEP 2-7:Write
down the
incident
description and DTG for
2-22TAB-2
OPREP-3 VOICE REPORT (cont)
the receipt of
this report in
Appendix
2B.
As soon as the voice report has been given to one of the listed agencies
you are done with this task -
STEP 2-8:GO TO TAB 3 for the OPREP-3 Message. GO TO TAB 3
2-23TAB-2
TYPE of OPREP-3 REPORT
OPREP-3 PINNACLEOPREP-3 PINNACLE
Used to provide the National Command Authority (NCA) with immediate notification of any incident or event where NATIONAL LEVEL INTEREST is
indicated.
If doubt exists as to whether
an incident could possibly
develop into a matter of NCA ，War risk attacks, interest, submit an OPREP-3 harassment, hostile acts PINNACLE report.against U.S.
，Major nuclear weapons
incidents
，Territorial violations
，Defections
，Sabotage
，Highjacking
，High level military ops
resulting in damage to
aircraft, ships, equipment,
etc.
，Fatalities/Injury to
civilians
，Widespread civilian property
damage
，SAR initiation in foreign
country
，Abrupt foreign government
changes
，Reconnaissance incidents
，Attacks against nuclear site
，Receipt of critical
intelligence
2A-1APPENDIX 2A
TYPE of OPREP-3 REPORT
OPREP-3 NAVY BLUEOPREP-3 NAVY BLUEIf in doubt between PINNACLE
or NAVY BLUE, submit an OPREP-Used to provide the CNO and 3 PINNACLE report.other Naval Commanders with immediate notification of incidents of military,
political or press interest that is of HIGH NAVY RATHER
THAN NATIONAL LEVEL INTEREST.
The reports are submitted to provide “as it happens” information.
，Any Class A or B aircraft mishap
not a PINNANCLE.
，Aircraft crash on government land
or at sea.
，Bomb threat thought to be valid，Civilian or military disorder，Request for assistance after
natural disaster
，Major racial incident
，Nuclear reactor/ radiological
accidents
，Minor nuclear weapons accidents，Minor collisions at sea
，Oil spills
，Labor strikes
，Naval accidents (fire, flood,
etc.)
，SAR
，Major fraud, waste and abuse，INCSEA violations
，Discrimination and sexual
harassment
2A-2APPENDIX 2A
OPREP-3/SITREP SERIAL NUMBER LOG
GENERAL INFO
•SERIALIZE EACH INCIDENT WITH ITS OWN 3-DIGIT CODE, STARTING
WITH 001 FOR THE FIRST INCIDENT EACH CALENDAR YEAR. SEE
APPENDIX 4A OF SECTION 1 TO GET OBTAIN THE LATEST OPREP SERIAL
NUMBER.
•SERIALIZE SUBSEQUENT REPORTS CONCERNING THE SAME INCIDENT WITH
A LETTER SUFFIX (I.E., 001, 001A, 001B, ETC.).
2B-1APPENDIX 2B
OPREP-3 MESSAGE
GENERAL INSTRUCTIONS
•In each column, check the appropriate box.
•Fill in any blanks.
•Text in parentheses is for amplification and should not be read.•In each row, read text VERBATIM to include only checked boxes and filled
in blanks.
OPREP-3 Voice Report Template
，“CINCPACFLT，PINNACLETHIS IS STRIKE FIGHTER ，NAVY COMMAND CENTERYou Say:OVER.”OPREP-3,SQUADRON ______,，NATIONAL MILITARY ，NAVY BLUE
COMMAND CENTER
THIS IS
，CINCPACFLT，PINNACLEThey “STRIKE FIGHTER ，NAVY COMMAND CENTEROVER.”SEND OPREP-3Respond:SQUADRON ______,，NAVY BLUE，NATIONAL MILITARY
COMMAND CENTER
，UNCLASSIFIED，FLASH，“CINCPACFLTOPREP-3 (No crypto)THIS IS STRIKE FIGHTER (for pinnacle)，NAVY COMMAND CENTER，，CONFIDENTIALSQUADRON ______,，IMMEDIATE，NATIONAL MILITARY ，SECRET， (for navy blue)COMMAND CENTER，TOP SECRET
_________.SERIAL “LINE ONE(Number from Table 4-2)
(Type Incident)__________________________________
_________________________________________________
(Location)_______________________________________You Say:INCIDENT“LINE TWO_________________________________________________
(Zulu Time)______________________________________
(Brief description of mishap. Do
not speculate!)___________________
__________________________________
NARRATIVE__________________________________OVER.”“LINE THREE
__________________________________
__________________________________
“MY NAME IS(Rank, Name)
You Say:“YOU CAN REACH MY UNIT AT(Give ready room phone number.)
OVER.”“REQUEST THE DATE TIME GROUP FOR YOUR RECEIPT OF THIS REPORT
OPREP-3 PINNACLE EXAMPLE:
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, OPREP-3,
PINNACLE, OVER.”
“STRIKE FIGHTER SQUADRON ONE TWO THREE, THIS IS CINCPACFLT, SEND OPREP-3,
PINNACLE, OVER.”
3-2TAB-3
OPREP-3 MESSAGE
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, FLASH,
UNCLASSIFIED, OPREP-3, PINNACLE,
LINE ONE, SERIAL, ZERO ZERO ONE.
LINE TWO, INCIDENT, AIRCRAFT ACCIDENT, LAS VEGAS, NEVADA, ONE EIGHT
ZERO ZERO ZULU.
LINE THREE, NARRATIVE, PILOT EJECTED FROM FA-18 AIRCRAFT FOLLOWING
INFLIGHT FIRE, PERIOD. AIRCRAFT CRASHED INTO CAESARS PALACE CASINO
KILLING NUMEROUS CIVILIANS, PERIOD. EMERGENCY RESPONSE IN PROGRESS,
PERIOD. OVER.”
OPREP-3 NAVY BLUE EXAMPLE:
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, OPREP-3, NAVY
BLUE, OVER.”
“STRIKE FIGHTER SQUADRON ONE TWO THREE, THIS IS CINCPACFLT, SEND OPREP-3,
NAVY BLUE, OVER.”
“CINCPACFLT, THIS IS STRIKE FIGHTER SQUADRON ONE TWO THREE, IMMEDIATE,
UNCLASSIFIED, OPREP-3, NAVY BLUE,
LINE ONE, SERIAL, ZERO ZERO TWO.
LINE TWO, INCIDENT, AIRCRAFT ACCIDENT, USS LEXINGTON, SOUTHERN
CALIFORNIA OPERATING AREA, ZERO TWO THREE ZERO ZULU.
LINE THREE, NARRATIVE, FA-18 RAMP STRIKE DURING NIGHT APPROACH TO USS
LEXINGTON, PERIOD. PILOT EJECTED AND AIRCRAFT LOST AT SEA, PERIOD.
SAR IN PROGRESS, INJURIES UNKNOWN, PERIOD. OVER.”
GENERAL INFO
• DUE WITHIN 20 MINUTES of notification of an OPREP-3 level incident.•If all the information is not available, DO NOT WAIT. Release the
message with what you have and send a follow-on message later with more
information.
----------------------------------------------------------------If you haven’t already done so -
STEP 3-1:Recall the Duty YN/PN or grab someone from ADMIN who can use
the Message System.
3-3TAB-3
OPREP-3 MESSAGE
STEP 3-2:Go to Appendix 3A and fill in a blank OPREP-3 MESSAGE TEMPLATE
with the required information.
STEP 3-3:Give the filled in template to the Duty YN/PN, and have them
prepare the message.
Most CO's will want to know the text of the message prior to it going out. Ensure a
reasonable effort has been made to reach the CO or XO with the text of the
message if you were unable to reach him prior to the 5 minute voice report -STEP 3-4:Release the message.
Reference:OPNAVINST 3100.6G, SPECIAL INCIDENT REPORTING
(OPREP-3, NAVY BLUE AND UNIT SITREP)
3-4TAB-3
UNIT SITREP
“X” appropriate addresses and fill in blanks as appropriate.
--------------------------------------------------------------------------
---
Message Precedence: FLASH for Pinnacle – IMMEDIATE for Navy BlueFM STRKFITRON _____________
Addressees for OPREP-3 Pinnacle
TO
JOINT STAFF WASHINGTON DC//J3 NMCC//
USCINCPAC HONOLULU HI...................(or unified commander)
CNO WASHINGTON DC//NCC//
CMC WASHINGTON DC...........................(if involves USMC)
CINCPACFLT PEARL HARBOR HI//FCC//................(or flt cinc)
COMNAVAIRSYSCOM WASHINGTON DC//9F//.....(if aircraft accident)INFO (Chain of Command)
COMTHIRDFLT ........................(current fleet - deployed)
CTF ____________............................(current task force - deployed)
COMNAVAIRPAC SAN DIEGO CA//N00/N01/N012/N32/N36/N45/N73//...........(tycom)
COMCRUDESGRU ____________...................................(battle group)
COMCARAIRWING ____________ .......................................(airwing)
COMSTRKFIGHTWINGPAC LEMOORE CA//N00/N01/N30/N42/N45//(type wing)(Info Others As Appropriate)
ONI WASHINGTON DC
NAS LEMOORE CA....................(or incident shore station)
USS ____________.....................(current ship – deployed)
NAVSURFWARCEN INDIAN HEAD MD....(if ordnance related accident)
NAVY JAG ALEXANDRIA VA...............................(note 1)
DIRNAVCRIMINVSERV WASHINGTON DC//22D/23/02/21/24//....(note 2)
Addressees for Navy Blue
TO
CNO WASHINGTON DC//NCC//
CINCPACFLT PEARL HARBOR HI//FCC//................(or flt cinc)(Immediate Operational and Administrative Commanders)
COMTHIRDFLT ........................(current fleet - deployed)
CTF ____________............................(current task force - deployed)
COMNAVAIRPAC SAN DIEGO CA//N00/N01/N012/N32/N36/N45/73//............(tycom)
COMCRUDESGRU ____________...................................(battle group)
COMCARAIRWING ____________ .......................................(airwing)
COMNAVAIRSYSCOM WASHINGTON DC//09F//....(if aircraft accident)INFO (Remaining Chain of Command As Appropriate)
USCINCPAC HONOLULU HI...................(or unified commander)
COMSTRKFIGHTWINGPAC LEMOORE CA//N00/N01/N30/N42/N45//(type wing)(Info Others As Appropriate)
ONI WASHINGTON DC
NAS LEMOORE CA.......................(incident shore station)
USS ____________.....................(current ship – deployed)
NAVSURFWARCEN INDIAN HEAD MD....(if ordnance related accident)
NAVY JAG ALEXANDRIA VA ...............................(note 1)
DIRNAVCRIMINVSERV WASHINGTON DC//22D/23/02/21/24//....(note 2)
4A-1APPENDIX 4A
UNIT SITREP
COMNAVSAFECEN NORFOLK VA//00/10/11/541//..............(note 3)
Note 1:(injury to civilians, damage to civilian property, violations of law of war)
Note 2:(for actual, suspected or threatened major violations of law or
good order and discipline; for counter intelligence matters; for
incidents resulting in the loss of life; and for those other
situations in which the Naval Criminal Investigative Service
participation is required by SECNAVINST 5520.3B)
Note 3:(when reporting
fires, flooding,
grounding, explosions,
collisions, or other
accidents to U.S. Navy
units)
4A-1APPENDIX 4A
UNIT SITREP
BT
UNCLAS ...................................(classify if necessary)
MSGID/OPREP-3P or OPREP-3NB/VFA-___/001/_____//(Squadron/SN from App-
4B/Month)
REF/A/OPREP-3P or OPREP-3NB/VFA-___/ddttttZmmmyy/-/NOTAL//(DTG of voice
report)
AMPN/INITIAL VOICE REPORT TO _____________//.........(agency for voice report)
FLAGWORD/PINNACLE or NAVY BLUE/-//
TIMELOC/ddttttZ/_______________________________________
/________________//
(incident dtg) /(location:lat-long, or geo
<20char) /(init,folup,final)
GENTEXT/INCIDENT IDENTIFICATION AND
DETAILS/__________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//
•Clearly identify the incident being reported within the first two
sentences.
•For aircraft accidents, include
•Aircraft model, buno, reporting custodian, custodian location.
•Pilot’s name, rank, injury code (if known), and number of other
persons on board and their injuries.
•Mission and phase of flight, sar status, and aircraft damage.
4A-1APPENDIX 4A
UNIT SITREP
•Provide an account of the personnel and/or unit losses or damages
which were incurred as a result of the incident; report unknowns.
When reporting the death or serious injury of U.S. military
personnel, names will be withheld pending notification of next of kin.
•Provide an assessment of the public affairs impact of any incident
likely to generate significant public interest and provide data on
any proposed news release (e.g. No press interest expected or Press
interest likely.
RMKS/
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//
•Include CO’s assessment of situation, impact of the incident on the
reporting unit, and the ability of the unit to operate.
•Enter additional information about the incident, if necessary.•The final message report for the incident will include: “MISHAP REPORT
NOT REQUIRED / SUBMITTED / TO FOLLOW.”
•The status of NCIS notification/participation, if any.
BT
OPREP-3 PINNACLE EXAMPLE
UNCLAS
MSGID/OPREP-3P/PATRON FOUR ZERO/001A/MAY//
FLAGWORD/PINNACLE/-//
TIMELOC/041715Z/KAESONG KN/FOLUP//
GENTEXT/INCIDENT IDENTIFICATION AND DETAILS/P3C ORION ACFT
EXPERIENCED NAVAID TROUBLE AND APPEARS TO HAVE UNINTENTIONALLYVIOLATED NORTH KOREAN AIR SPACE. ACFT RTB.//
RMKS/COMMANDERS ESTIMATE: NO DAMAGES OR CASUALTIES.
WILL CHECK NAVAID GEAR ON ALL SQDN ACFT. EXPECT ADVERSE
PUBLIC REACTION FROM N. KOREAN GOVT. ACCUMULATING DATA
4A-1APPENDIX 4A
UNIT SITREP
FROM FLIGHT CREW FOR POSSIBLE PRESS RELEASE.//
•The Unit Situation Report (STIREP) is used by CO's to tell
appropriate operational commanders about any reportable special
incident not meeting OPREP-3 reporting criteria.
•If the CO desires to send a Unit SITREP, refer to the message format
on the next page (APPENDIX 4A).
•Unit SITREP messages are due within 20 minutes - no voice report is
required. Message precedence and classification is as appropriate.
•A Unit SITREP shall be submitted when:
(a) Directed
(b) Considered appropriate by the CO.
(c) A bomb threat is evaluated as a hoax.
•A Unit SITREP will contain the following information:
(a) Status of situations/events not requiring an OPREP-3.
(b) Progress of special operations/events.
(c) Information concerning specific events/operations.
(d) Type of event being reported.
(e) Brief account of event (who, what, where, when, why, action
taken).
(f) Do not release sensitive or personal information. Use general
identification of individuals (i.e. PO1 or 20 yr old E-3).
•For RMKS, include CO’s assessment of the situation, impact of the
incident on the unit, unit’s ability to conduct operations and
anticipated press interest.
4A-1APPENDIX 4A
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
UNCLASSIFIED
01 000000Z XXX XX PP
UUUU XXXXXX
FM STRKFITRON___________________
TO COMSTRKFIGHTWINPAC LEMOORE CA//NOO/NO1/N30/N80//
INFO COMNAVAIRPAC SAN DIEGO CA//00/01/30/80//
CNO WASHINGTON DC//JJJ//
CINCPACFLT PEARL HARBOR HI//JJJ//
COMNISCOM WASHINGTON DC//22D// (HOAX BOMB THREATS)UNCLASS
MSGID//UNITSITREP/STRKFITRON____/____/_____//(SERIALNUMBER/MONTH)FLAGWORD/-/UNITSITREP//
TIMELOC/________/_________/__________//
(INCIDENT DTG/LAT-LONG/INIT,FOLUP,FINAL)
GENTEXT/INCIDENT IDENTIFICATION AND
DETAILS/__________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//RMKS/_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________//X. X. XXXXX, XXXX, XXXX
X.X. XXXXX, CO, XXXX
UNCLASSIFIED 000000Z XXX 00
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
SqdnO 3750.1A
24 OCT 2001
BAT PRE-MISHAP PLAN
Someone has just told you one of our aircraft has been, or possibly was, involved in a mishap or one of our Marines has been seriously injured. If yes, pull out Step 1 worksheet, and start
filling this out. Then, immediately, find someone senior to you, and ask for help! If you are all alone, press with the rest of the
checklist, get a hold of the SDO and GDO, and notify the chain of command, ASAP!
If a Marine has sustained a minor injury, ensure the Marine has received care and consult a safety officer, the SDO or the GDO. You may only need to call and e-mail/fax a flash report (Step 7) to the MAG-11 GDO (7-1666), fax (7-6808). In all cases contact the Marine's OIC and NCOIC. During working hours contact MAG DOSS at 7-1381.
Carry out all the steps in this checklist. A non-laminated copy of this checklist is provided in the back of this notebook. Use this, and divide out the pages among the Marines helping you. On the next page, write down whom you gave these to, so you can ensure they get completed. Work quickly. All steps are time critical. Write as much as you need on this checklist, and have your scribe take notes on the pad provided in the 5th sleeve. Start by turning the page and proceed through each step.
Time now is:_____
Name:__________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Take a deep breath. Use this checklist to ensure completion of all
required steps.
MISHAP COMPLETION CHECKLIST
(Circle One) WHO TIME
STEP 1 "Mishap Information Sheet Complete?" YESNON/A STEP 2 "Page SDO" YES NON/A
STEP 3 "Notification of Emergency Personnel" YESNON/ASTEP 4 "Start a log of events"YES NON/A
STEP 5 "Verify Bat involvement in the mishap"YESNON/A
STEP 6 "Immediate Notification of Key Personnel" YESNON/ASTEP 7 "Flash Report" to Group (within 5 minutes) YESNON/A
STEP 8a-8e "Notification of Key Personnel" and shop checklists YES NON/ASTEP 9 "Navy Safety Center telephone report” (within 60 min) YESNON/A
STEP 10 "OPREP-3 Confirmation" (within 20 minutes) YESNON/A
STEP 11 CACO Duties – Family Member Notification YES NO N/ASTEP 12 "Weather at Mishap site" YESNON/ASTEP 13 "Federal Aviation Administration (FAA) phone call"
(if required, within 4 hours) YESNON/A
STEP 14 "Initial Mishap Report" (Class A or B within 4 hours)YESNON/A
(Class C within 24 hours)
STEP 15 "Death Imminent processing"YESNON/A
STEP 16 “Department Head Checklists”YESNON/A
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 1
Do this step IF someone is on the phone and has told you an
aircraft or Marine has been in an accident. Fill out the information quickly and skip any line that the caller does not immediately know.
If it is NOT a phone call ... go to Step 2!
MISHAP INFORMATION SHEET
1. Date:______________ Time:____________
2.Caller's Name: Address:
3.Caller's Phone Number:
4.Did the Caller see the mishap? (Circle one) YES NO
5.Mishap Location/Time of Mishap:
6.Description of Aircraft:
(markings, bureau #, side #, etc)
7.Aircrew name(s):What Squadron:
Marine's name: What Workcenter:
8.Mishap description/Extent of Damage to Aircraft:
9. Is there a fire at the scene? (Circle one) YES NO UNKNOWN
10.Number of persons and the extent of injury:
11. Extent of damage to property:
12.Where can the caller stand by to direct emergency personnel?
13.Name of other Witnesses:
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 2
If you are not the SDO, page him/her immediately at #
__9620__ . KEEP GOING WITH THE CHECKLIST !!! DO NOT STOP!!! YOU MUST COMPLETE ALL THE STEPS IN THIS
MISHAP PLAN!!! If it is very serious such as a Marine seriously
injured, or a serious aircraft emergency, contact the GDO (7-1666)
immediately, as well.
Step 3
ENSURE EMERGENCY PERSONNEL ARE ON THE WAY TO PREVENT FURTHER INJURY OR DAMAGE!
If an aircraft has crashed, call Miramar Base Operations, 7-4277/4279, and say:
This is the VMFA(AW) -242 Duty Officer/SDC: (Rank, Name)
A VMFA(AW)-242 aircraft has been reported crashed at: (Location)
Activate the crash alarm. My telephone number is: (duty phone #)_7-9127______
If a Marine is injured on base call 911 !More helpful numbers below: GO TO STEP 4 . NOW
EMERGENCY NUMBERS
Ambulance: 911 Fire/Paramedics: 911
Crash Crew: 7-6912 Drugs: 7-9849
Explosive Ordnance Disposal: 7-7800/ 7802 Suicide: 7-9849
Fuels/Val Line: 7-4284/4285 Poison Center: 7-9849
Security (PMO): 7-4059
North Island Search and Rescue: 253-4515
Yuma Search and Rescue: 264-3803 / 3118
Fire (Structural): 7-4059
Station Environmental- 7-1108
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 4
Start a log of everything that occurs. Use the notes packet provided in the next sleeve (sleeve #5) of this binder. Write down all information you receive regarding the mishap. Get a Marine to act as scribe, writing down all info. This includes callers' names,
phone numbers, and times.
Step 5
Verify that the Bats were involved in the mishap. Was a Bat aircraft or any 242 Marine involved in the accident/mishap?
-If Yes go to Step 6. If you are in doubt go to
Step 6 and assume the Bats were involved.
-If No, contact the Bat Safety Office for appropriate action. If it is a weekend or after-hours, call the Group Duty Officer at 7-1666.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 6
-This is a time critical step, work quickly.
IMMEDIATE NOTIFICATION OF KEY PERSONNEL
1. Notify the personnel in the order listed below and brief them on the following information from STEP
#1:
a. Time and location of the mishap.
b. Mishap Description.
c. Injuries, if known.
d. Damage to aircraft/property, if known.
e. Aircraft side number/bureau number/type.
Work # Home # Time / Initials
(1) Squadron CO: LtCol Kemper9242 858-549-1812
858-967-7435
(2) Squadron DOSS:Maj Kline 9126 760-741-6709
(3) Squadron ASO:Capt Baggs9126 858-621-4943
858-442-4832
(4) Group ASO:Maj Towey 1394 619-282-4466
(5) Flight Surgeon:Lt Rasmussen 877-752-2757 (pager) 858-780-0986 (home)
(GDO ): x 7-1666 Group ADJ 7-1666/1778 Fax 7-68082. Have your phone watch/assistant perform Step No. 8 (notification of the AMB).
3. The Autovon/DSN extension for Miramar is 267- . To access DSN, dial 94, and then the 7-digit number. The commercial area code and prefix is (858) 577-xxxx. To access local commercial lines, dial 99,
and then the 7-digit number. For long distance commercial, dial 99-1, and then the 10-digit number.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 7
Fill out a Flash report. The computerized flash report generator is located on the ready room computer desktop. If not found there, it is also located in the C: drive, as well as the D: drive. Additionally, it is located in the same locations of the desktop computer in the Safety office (key 6). The first step of
this process is to call MAG-11 GDO (7-1666) and inform them of the event/incoming flash report. Follow the instructions found
on the next page, or posted above the computer in the safety office.
If unable to access this program, a backup disc is in the front of the Pre-Mishap Plan Binder. If e-mail is down, fax it. If all computer/email assets are down, pull out the blank flash report example, and write it out by hand. Fax this to the GDO, and if the fax is down - give it to them by phone call.
FLASH REPORT
Use the 3MAW Interactive Flash Report format on the desktop. E-mail the Flash report to the appropriate addresses(posted in RR) , cc it to Capt Baggs, print a hard copy to give back to the ODO, print a hard copy to put in the DOSS’s in-box.
FAX #: 7-6808
GDO/VOICE #: 7-1666/1778.
Call to ensure the e-mail/Fax made it to the group.
If you are not in Miramar, fill out a paper Flash Report and fax or call MAG-11.
After e-mailing the FLASH REPORT, save it on the desktop of the computer.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 8
The AMB phone list is on this page, inform all members.
Department Head checklists are included in step 15, attached
to this page. Notify them and distribute checklists
NOTIFICATION OF AMB and OTHER PERSONNEL
1. Notify the personnel in the order listed below of the following information from STEP #1:
a. Time and location of mishap.
b. Mishap description.
c. Injuries, if known (no names until Next-of-Kin are notified)
d. Damage to aircraft/property, if known.
e. Aircraft side and bureau number/type.
NAME WORK# HOME#______CELL#_____
(1) Squadron XO Maj Kurth 9124858-455-5518 858-723-5630 (2) Operations Officer Maj Miles 9134949-498-9025 949-235-2501(3) Maintenance Officer Maj Arnold 9109858-780-9932 858-395-8018(4) Administrative O/CACO Maj Gribble 9119858-538-9686 (5)Logistics Officer Capt Leighton 9140858-792-4144 858-395-6609(6) SgtMaj SgtMaj Oldham 9122760-724-0718
(7) Aircraft Mishap Board Members (Based on availability)
(PHONE LIST ON FOLLOWING PAGE)
PRIMARYSECONDARY
Senior Member Maj Kurth Maj Kline
858-455-5518 / 723-5630760-741-6709 / 760-533-6709
Safety Capt Baggs Capt Straub
858-621-4943 / 422-4832760-787-9712
Operations Capt KeenanCapt Smay
858-449-4011 619-640-7299
Maintenance Maj Lang Capt Earles
858-271-1297858-272-5786
Flight Surgeon LT Rasmussen
858-780-0986
IF THIS MISHAP OCCURRED AT OR NEAR ANOTHER BASE, REFER TO THE EMERGENCY PHONE LISTS FOR
ALL LOCAL BASES AT THE BACK OF THIS BINDER
Time Initials
(7) Photo Lab: 7-4719 (or contact PMO after hours)
(8) Explosive Ordnance Disposal (CADS and Ordnance): 7-7800/ 7802
(9) Station Environmental: 7-1108
(10) Chaplain (Fatal/Serious Injury): 7-1333 (11) Public Affairs Officer: 7-6000
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
NOTE: HOW TO DEAL WITH THE MEDIA:
1.If anyone in the media or anyone not known to you calls asking questions about the mishap, tell them the following statement:
"I am not able to comment, please call Public Affairs at (858) 577-6000."
If any family member of ANYONE in the squadron calls regarding the mishap and the status of their loved ones, tell them:
"I'm sorry, we don't have any information yet, we will call you as soon as we find out anything."DON'T tell them the status good or bad of anyone if possible, if the family member is insistent, get a phone
number and tell them the CO or his representative will call them back.
2.Military personnel must cooperate with the press to a certain extent. A story will be written regardless of your cooperation, and if uncooperative, it is possible that a story might be written that would have a decidedly detrimental effect upon the Service. Under no circumstances will the names of the aircrew be given. However, a general statement such as the fact that it was a routine training flight is permissible.3.Do not attempt to stop news photographers from taking pictures unless classified equipment or human remains are involved. In that case warn the photographers that these type of pictures are not allowed, and if they persists after warning, inform them that the authorities must be notified of their actions. Get their name, address, and the organization for which they work and give this information to the Public Affairs Officer and Senior Member of the AMB.
4.In the past, news photographers have been cooperative in refraining from taking pictures of an objectionable nature. If, however, this is violated, report the individual's name and newspaper to the Joint Public Affairs Officer and Senior Member of the AMB or Mishap Board, along with the subject matter of the photograph.
5.Use the following format for releasing information to PAO:
* Mishap Data:
a. Type Aircraft: F/A-l8D
b. Squadron: VMFA (AW) -242
c. Accident Date/Time:
d. Location:
e. Mission:
f. Casualties: * DO NOT release without CO/XO approval.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 9
NAVAL SAFETY CENTER PHONE REPORT
FOR CLASS A MISHAPS ONLY
(Class A is a death or loss of aircraft)
A telephone report to the Naval Safety Center is required. This telephone report is not to be delayed for lack of information. Make the call giving all information presently available. The call should be made as soon as possible but not later than 60 minutes after the mishap. The form below should be filled out and read off over
the phone. The phone call will be taped at the center so speak slowly and concisely. The Safety Center DSN number is 564-2929, Commercial
(757) 444-2929 (Collect calls accepted).
A message mishap report is required within 4 hours for all Class A and Class B mishaps. A message
mishap report for Class C mishaps is required within 24 hours (see the ASO).
USE THE FOLLOWING FORMAT
1. Identification
a. Person Calling
b. Activity VMFA(AW)-242
c. Telephone numbers (DSN) ODO 267-9127
ASO267-9126
CO267-9242
Commercial (858) 577-9127
2. The Mishap
a. Reporting Custodian: VMFA(AW)-242
b. A/C Type & Bureau Number:
c. Mishap Location:
d. Brief Narrative:
e. Damage:
f. Injuries/Fatalities:
g. Points of Contact: Capt Baggs ASO, DSN # 267-9126
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 10 OPREP-3 PACKET
Verify a member of the Aircraft Mishap Board or the S-3 is coordinating an OPREP-3 message. Additionally, hand them this OPREP-3 packet of 5 pages. In Miramar, MAG-11 send this message. In Iwakuni, the squadron is responsible for sending this message. See the AMB notification list in step #8.
OPREP-3 REPORT
1. OPREP-3 reports are released by 242; however, THEY MUST BE PASSED THROUGH MAG DOSS, MAG CO, AND, 3MAWCG before release.
2. All incidents that may necessitate release of an OPREP-3 report will be reported from Squadron to Group to Wing as a FLASH Report.
3. This is a time critical message.
4. The format and guidance for OPREP-3 messages is attached to this page. Give it along with the oprep-3 disk to the person who will be drafting the report.
5. An initial OPREP-3 report is normally the first indication to senior authorities that an incident has occurred. These messages must be sent if high level Naval interest or National level interest is anticipated.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
OPREP-3 DETERMINATION
1. If the initial notification was from a military installation and an OPREP-3 has already been sent, then don't
send another one, go to step ten. Ensure that you get the Date/Time Group (Step one/line 16).2. An OPREP-3 report is required if the mishap is likely to generate national interest. There are three
categories:
a. OPREP-3 PINNACLE (Goes to the White House!)
Did the mishap:
- kill any civilians?
- cause widespread civilian property damage?
- involve territorial violations?
- occur because of sabotage by foreign nationals?
- involve the defection of US or foreign personnel?
- Is the mishap likely to generate national news or inquiries of high intensity?
b. OPREP-3 NAVY BLUE (Goes to the CNO)
Did the mishap:
- cause significant damage to civilian property?
- involve a near midair or an actual midair with civilian aircraft?
- involve a loss at sea of high technology equipment (e.g., a pod)?
- kill or critically injure the CO?
- involve a major spill of hazardous material?
- Any Class A or B Mishap that does not require a PINNACLE.
c. OPREP-3 UNIT SITREP or Special Incident Report(SIR)
Other conditions which higher commanders need to know about soon.
-SIR
- TFOA over non-populated areas (i.e. over water)
- Vehicle accidents on or off base involving Japanese Nationals.
*If any of these apply, go to TFOA/SIR Binder.
3. Fill out the appropriate voice report format.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
OPREP-3/TELEPHONE VOICE REPORTS
1. Voice reports are NOT required for UNIT SITREPs.2. Quickly fill in the blanks on the telephone report forms (next page). If you don't know something, just enter
"TBD".
3. For OPREP-3 PINNACLE reports only, call:
HEADQUARTERS AUTOVON COMMERCIAL
Natl Mil Cmd Ctr (NMCC) 851-3840/227-6340(703)697-63404. For OPREP-3 NAVY BLUE reports only, call:
HEADQUARTERS AUTOVON COMMERCIAL
Navy Cmd Ctr (NCC)225-0231(703)695-0231
5. Then, for both PINNACLE and NAVY BLUE reports call:
HEADQUARTERS AUTOVON COMMERCIAL
CINCPACFLT Cmd Ctr(FCC)315-471-3201/2/3(808)422-5944CMC225-7366/7/8 (703)695-7366
MAG-11 Adjutant/CO/XO 267-1666
MAG-11 GDO (after hours)267-1666/1778
Group Safety267-1628
Group OPS 267-1349/50
***** DO NOT RELEASE NAMES OF CREW MEMBERS *****
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
TELEPHONE REPORT WORK SHEET
1. "This is an OPREP-3 (PINNACLE)(NAVY BLUE) report of an aircraft mishap from VMFA(AW)-242 located at MCAS MIRAMAR. This is a conference call to Headquarters Marine Corps and the Command Center."
2. Flash(PINNACLE)/Immediate(NAVY BLUE) (circle one)
3. Top Secret/Secret/Confidential/Unclassified (circle one)
4. OPREP-3 PINNACLE or NAVY BLUE (circle one)
5. Serial Number. ___________ (Example 01-94)
6. Incident. (One sentence description) _______________________ ________________________________________________________________
7. Details:
a. Location (as precise as you can be with the information you have) ___________________________________________________________
b. Other details (significant) _____________________________
_________________________________________________________________
8. Remarks:
a.Aircraft Model: FA-18D
b. Bureau Number: ___________________
c. Reporting Custodian: VMFA(AW)-242
d. Custodian Location: MCAS Miramar
e. Aircrew names are withheld pending next of kin notification. (If applicable, ie. fatalities are involved)
9. Mission and phase of flight: _________________________________
_________________________________________________________________
10. Time (in ZULU) Miramar Local time +7 hours ____________
11. Name and Rank of Receiver. _________________________________
12. "This is the VMFA(AW)-242 SDO/ODO calling from AV 267-9127 OPREP-3 message report to follow. Press release will be coordinated with PAO, MCAS Miramar.”
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
OPREP-3 MESSAGE
1. The following pages contain the correct message formats for OPREP-3 PINNACLE, and OPREP-3 NAVY BLUE.
Fill in the information on the appropriate form.
2. Use a DTG on the message that is within 20 MINUTES of notification of the event. It must also be within 15 minutes of the initial phone call! If you have questions, call the Station Comm Center at 7-6080.3. MAG-11 will be the releasing authority for PINNACLE, NAVY BLUE and UNIT SITREP messages. For SIR messages 242 will be the releasing authority. All messages will be viewed and approved by the CO. 4. An example message is in MTF format on the disk located inside the front cover of this binder labeled oprep 3.
5. Access the appropriate message using MTF, fill in the necessary information and delete the unnecessary addressees, save the completed message, (get one of the OPS clerks or Admin personnel to help) and print out a rough for the CO to view. If no one is available to use a computer, just take the written messages. 6. When the CO and/or MAG-11 have OK'd the message find someone with release authority and have them take the disk to the Comm Center.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 11
CACO Duties – Family Member Notification
The purpose of this step is to get someone hot on pulling these Marines’ CACO forms, and laying the groundwork for notification of their next-of-kin in the immediate local area. Do not
by any means just pick up the phone and call their family. The Commanding Officer, a
Chaplain, and the CACO should be the ones to personally see the local area next-of-kin, unless briefed otherwise. The Commanding Officer will make this decision. In the meantime, get with the senior officer present from the S-1 department, determine who the immediate CACO is, and by all means, pull the forms immediately. Find out where their family live, work, etc… and how you plan to notify them. We want to have them notified in a timely manner, and not let them discover the bad news via the media. If there is a doubt as to whether or not a girlfriend or boyfriend should be told, this information is likely stated in the CACO forms, so again, the first thing you should be making sure happens is that the CACO forms are pulled, and read. The answers to any of your questions are likely found here.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Step 12.
Assign this step to another person.
WEATHER AT MISHAP SITE
Contact the Duty Forecaster, phone Extension_4028____, and obtain weather at the scene of the accident. If the mishap site is out of the local area, ask the duty weather forecaster to obtain exact weather from the closest weather facility to the scene of the mishap.
Location of Mishap: Nearest Airfield: .
STATION PRESSURE DEWPOINT RELATIVE HUMIDITY
INCHES MERCURY ? F. %
DRY BULB TEMPERATURE WET BULB TEMPERATURE ALTIMETER SETTING ? F
? F. .
RVR _______________ PRESSURE ALTITUDE ______ DENSITY ALTITUDE_______
CEILING AND SKY CONDITION
SURFACE WIND DIRECTION (in degrees magnetic) (Velocity-Knots) (Gusts)
VISIBILITY TO
NORTH: SOUTH: EAST: WEST: WEATHER AND/OR OBSTRUCTIONS TO VISION
STATE OF
RUNWAY
GENERAL WEATHER CONDITIONS FOR PAST HOUR
REMARKS Freezing
Level: Turbulence: Icing: Maximum Wind: Local weather warnings, MET:
Watch Advisories, Predominate Cloud Type:
DATE: TIME:
SQUADRON: TYPE OF AIRCRAFT: BUREAU NUMBER OF AIRCRAFT:
FORECASTER: NAME/RANK
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 13
This is only required if the FAA may have some involvement in the mishap, otherwise skip this step.
*Contact Miramar ATC to coordinate this 7-4277*
FEDERAL AVIATION ADMINISTRATION REPORT
1.If a function of the FAA is or may be involved in an aircraft mishap, or a civil aircraft is involved, a telephone call and message to the nearest FAA facility is required. The telephone report will include all available information and shall be made WITHIN FOUR HOURS of the time the mishap occurred. The nearest facility is SoCal Tracon located outside Miramar, telephone number (858)537-5800 or 5901 (after hrs). L.A.
Center: (DSN)312-640-1290, Military rep for L.A. Center: (661) 265-8287.
2.The determination of FAA involvement, possible or probable, rests with the military unit conducting the investigation. Basically, involvement will include any contributing factor to the mishap, which is controlled, supervised, accomplished or the responsibility of the FAA or its personnel. This would include erroneous chart information, minimum terrain criteria, and collisions with civilian aircraft and improper air traffic clearance. A follow-up message will be sent as soon as possible but not later than twenty-four hours after the mishap. For both the telephone report and the follow-up message, see OPNAVINST 3100.6E.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 14
Have an ASO trained Officer do this message if possible.
INITIAL MISHAP DATA REPORT MESSAGE
1. Seek the help of someone ASO trained. (Capt Baggs , Capt Straub)
2. Using the Mishap Data Report Generator checklist(NEXT PAGE), write the initial mishap report.3. For a Class A or B mishap, the message must be sent within 4 hours of the Mishap. For a class C mishap the message must be sent within 24 hours of the mishap.
4. The most important line in the message is the SUMMARY line. In the summary line, you will describe what happened without disclosing any cause. The summary is also important because it will be used to refer to the mishap from this point on. An example of a good summary is: Aircraft impacted the water during night close air support. A bad example is: Aircraft impacted the water due to a flight control malfunction. The causes of the mishap will be addressed in the investigation!
5. Anything in the report you do not know the answer to, simply put TBD. You must put something in all of the fields, even if it is TBD, do not leave any field blank. Do not delay the initial report because you do not know something.
6. Once written, bring the disk to the S-1 or Maintenance Admin to release the message.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
MISHAP DATA REPORT CHECKLIST
REMEMBER YOU HAVE ONLY 4 HOURS TO RELEASE THIS MESSAGE FOR A CLASS “A” OR “B” AND 24 HOURS FOR A CLASS “C”. IF YOU’RE NOT SURE, AIM
FOR 4 HOURS.
1.GO TO THE SAFETY OFFICE COMPUTER.
2.KINDLY ADVISE ANYONE CURRENTLY USING IT TO “GET THE @#*!
OFF.”
3.CLICK THE MISHAP GENERATOR ICON AND FOLLOW THE PROMPTS.
(as a last resort go to and click on “the gouge” then
click on “mishap report generator”)
4.BE SURE TO CLICK EVERY BOX OR THE PROGRAM WILL NOT
GENERATE THE REPORT.
IF YOU DON’T KNOW……PUT “TBD”.
5.WHEN ALL BOXES HAVE BEEN CHECKED CLICK “GENERATE”.6.AN ERROR MSG WILL APPEAR, CLICK “OK”.
7.AFTER ? 5 SECONDS A FILE WILL APPEAR ON THE DESKTOP CALLED
MR1.
8.OPEN AND THEN SAVE THE FILE AS “MR 01-01” TO THE DESKTOP AND
TO A BLANK DISK.
9.GIVE THE DISK TO THE S-1 CHIEF AND ASK HIM/HER TO CHECK IT FOR
“MTF” FORMAT AND TO ADD THE APPROPRIATE INFORMATION AT
THE TOP.
10.FIND AN ASO SCHOOL GRAD (CAPT STRAUB OR CAPT BAGGS) TO
CHECK THE CONTENT OR USE THE GUIDE IN CHAPTER 5 OF OPNAV
3750.6Q (IN SAFETY OFFICE ON BOOKSHELF).
11.ONCE THE MESSAGE HAS BEEN CORRECTED
FOR CONTENT AND FORMAT, GIVE THE DISK WITH THE .txt FILE TO
THE S-1 CHIEF OR ASO AND ENSURE THAT IT IS RELEASED.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 15
Do this step if a Marine is not expected to survive the next 72 hours. Have the S-1 Officer do this step if possible.
DEATH IMMINENT
Ref. CMC Washington DC msg 090616ZFeb99
1. If a Marine's death is expected within 72 hours, he or she should be processed for immediate medical retirement. This process can be initiated 24- hours a day 7-days a week.
2. This process is to increase the Marines survivor benefits.
3. A competent medical authority must submit a statement to the USMC Physical Evaluation Board (PEB). The statement must include medical evidence to support the claim that the Marine is expected to die within 72 hours.
4. Responsibilities of VMFA(AW)-242:
a. Immediately notify the HQMC Command Center at DSN 225-7366 or comm (703) 695-7366 and then release a personnel casualty report (PCR) (Form DD-3040-02) concerning the incident. DSN Fax: 227-2986
b. In the event the terminally ill Marine is receiving care in a treatment facility other than an MTF (i.e. civilian hospital):
1. Immediately notify the nearest MTF and ensure communication is established between the treatment facility and the MTF.
2. Notify the Military Medical Support Office (MMSO) in Great Lakes at 1-800-876-1131 so that MMSO can officially assign medical cognizance to the MTF closest to the treatment facility. Ask for the ODO. Tell them it is an imminent death situation – they have a checklist for this. MCAS Miramar is Tricare Area 9.
c. If required, ensure a line of duty determination or line of duty investigation is included with all necessary endorsements. The line of duty determination or line of duty investigation will be provided to the MTF to be forwarded with the medical evaluation board to the PEB. The PEB will adjudicate a case without the line of duty determination or line of duty investigation. However, the PEB preliminary findings will not be issued until receipt of the line of duty determination or investigation.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 16
DEPARTMENT HEADS’ POST-MISHAP CHECKLIST
The following list, while not all-
inclusive,
provides initial
guidance for
department
heads following
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
a mishap. If a
department
head is not available, any member of the
department can
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
get started on
this.
Administrative Officer
_____Imminent death retirement
_____CACO forms pulled, and looked at immediately for notification of next-of-kin information. Get hot on this. Don’t let this task slip by. The Commanding Officer will determine how and when notification will be, but this decision should be made quickly.
_____Provide record of Emergency Data (RED) to CO
_____Casualty report to CMC (step no. 14)
_____Draft notification letter/telegram to NOK
_____Draft condolence letter/telegram to NOK
_____Draft PAO release for submission to XO/CO
_____Prepare orders for AMB, CACO, JAG investigator
_____Prepare appointment letters for AMB (see safety office) , CACO (see S-1), and JAG Investigator_____Death gratuity paid
_____Provide administrative support for JAG investigation
_____JAG investigation complete
_____Personal Effect Inventory
Intelligence Officer
_____If applicable, submit preliminary inquiries and reports concerning the compromise of classified material in accordance with MCO P3040.4D
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Operations Officer
_____Ensure OPREP 3 reports and messages submitted correctly
_____Secure flight operations
_____Secure mishap pilot and WSO logbooks, NATOPS jackets, training jackets, etc._____Ensure SORTS message drafted for release
_____Remove AMB from flight schedule
Logistics Officer
_____Coordinate required logistics support for AMB, including,
a)transportation to the mishap site
b)billeting/messing at the mishap site
c)coordination of special equipment/gear for AMB
_____Personal effects inventory complete
_____Arrange for transportation of wreckage from mishap site to VMFA(AW)-242_____Arrange for salvage/disposal of wreckage
Maintenance Officer
_____Secure aircraft and engine logbooks, NALCOMIS data, FCF checklist, maintenance
records and any fluid samples of the mishap aircraft
_____Mobilize and task the Emergency Reclamation Team
_____Provide data to the ASO required to complete the Mishap Report message_____Prepare request for P & E inspection, if required
_____Be prepared to provide personnel to serve as a security force at the mishap site_____Ensure that qualified avionics personnel are assigned to remove and secure COMSEC equipment
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Director of Safety and Standardization
_____Ensure CO/XO notified
_____Verify mishap type/categorization
_____Verify all external agencies notified
_____Verify that photographer notified and enroute_____Proceed to mishap site and direct start of investigation
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
UNIT PHONE REPORT TO MILITARY FACILITY
CLOSEST TO MISHAP
THE NEAREST MILITARY FACILITY HAS RESPONSIBILITY
FOR SAR, INITIAL SITE SECURITY, ETC.PROVIDE THE FOLLOWING INFORMATION:
1. NAME/RANK-RATE: ___________________________________2. ORGANIZATION: VMFA(AW)-242_______________________3. PHONE NUMBER: _____________________________________4. TIME NOTIFIED OF MISHAP: ___________________________5. UNIT INVOLVED: _____________________________________6. TYPE AIRCRAFT INVOLVED: __________________________7. AIRCRAFT DAMAGE: _________________________________8. NUMBER OF AIRCREW INVOLVED: ____________________9. INJURIES: ___________________________________________10. LOCATION OF MISHAP: ______________________________11. CIVILIAN CASUALTIES: ______________________________12. PROPERTY DAMAGE: ________________________________13. SAR ASSISTANCE REQUIRED: ________________________14. CRASH/FIRE: (CALLED) (NEEDED)
15. MEDICAL AID: (CALLED) (NEEDED)
16. SECURITY: (CALLED) (NEEDED)
17. ODO'S NAME/TIME CONTACTED: _____________________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
MCAS YUMA dsn prefix 269
SAR.................................................................................................……… 3803/3118COMNAVFORJAPAN................................................................……………. 7666/7NAF ATSUGI COMMANDING OFFICER....................................………… 3111
Ambulance .....................................................................................……… 3113/(119)ATC .................................................................................................……………3274Base Operations ............................................................................…………… 3801/3Comm Center .................................................................................……………..3631Crash/Salvage .................................................................................………….. 3801/3Legal ...............................................................................................……………. 3161NCIS ...............................................................................................……………. 3223Photo lab .........................................................................................……………. 6227PWC (Transportation) .....................................................................……………. 3142Runway Support. ............................................................................…………….. 3749Safety (NAF). ..................................................................................……………. 3112Safety (CFWP) ...............................................................................……….. 3612/3544Security............................................................................................………. 3200/(119)Weapons ........................................................................................…………… 3216/7
Weather...........................................................................................…………….. 3208Off BaseOperator.........................................................................(DSN) 213 (COMM) 210CALL ATSUGI COMMERCIAL:
IN JAPAN 0467-78-5015
THE NUMBER
US 011-81-3160-64-LAST 4
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
NAS NORTH ISLAND dsn prefix 735
SAR (OVER WATER) (FASCFAC) .....................................…… 735-1775/1777SAR (OVER LAND) (US COAST GUARD) …………………….619-683-6470
MCAS IWAKUNI COMMANDING OFFICER ..............................xxxxxxxxx
Ambulance ...............................................................................…….3300ATC ..........................................................................................…….3006Base Operations .......................................................................…….8233Crash/Salvage ..........................................................................…….3211EOD...........................................................................................…….5274/3578Legal..........................................................................................…….5591NCIS .........................................................................................…….3139Photo lab ...................................................................................…….3043PWC (Transportation) ...............................................................……3860Safety (NAS)..............................................................................……5487Security......................................................................................……3245/(119)Weather.....................................................................................…….3005OUTSIDE LINE ACCESS:
COMMERCIAL:
DSN:
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
NAS EL CENTRO dsn prefix 658
Duty Office....................................................................................….2112 / 2113CVW-5 Det. OIC ..........................................................................….2001 / 2003ATC(SAR) ....................................................................................….3700 / 3523JMSDF ODO ...............................................................................…..(Japanese) 4002LSO Station .................................................................................…..3500 / 3502Medical .........................................................................................….3000 / 2025 / 2026Arresting Gear / Maint. Office. ......................................................…3510 / 3511Weather .......................................................................................…..4003OUTSIDE LINE ACCESS:
COMMERCIAL: 0 (then direct commercial dial to Japan)
DSN: Atsugi: 0-0468-21-5015 + 264-xxxx
0-0468-21-1944 / 1950 (Operator)
Yokosuka: 0-0468-21-1911 + 243-xxxx
CALLING TO IWO JIMA FROM MAINLAND:
0499-84-1119 + 4 digit extension (machine)
0499-84-1110 + 4 digit extension (operator)
0499-84-1121 + 4 digit extension (operator)
0499-84-1122 (direct line BEQ/BOQ office)
0499-84-1121 (direct line Det. OICs FAX)
KADENA AFB
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.SAR ................................................................................................…634-2492/2248COMNAVFORJAPAN......................................................................xxxxxxxxCOMMANDING OFFICER NAF KADENA ..................................xxxxxxxx
Ambulance .....................................................................................…119ATC ................................................................................................…634-1295Base Operations .............................................................................…634-8363Crash/Salvage ................................................................................…634-6407EOD...................................................................................................632-5141/5143Legal .................................................................................................634-8255/8241NCIS .................................................................................................645-3833Photo lab ........................................................................................…634-3813PWC (Transportation) .......................................................................634-1806Runway Support ................................................................................634-1366Safety (NAF)......................................................................................634-8398Security..............................................................................................634-0742Weather ..........................................................................................…634-3572Off Base Operator .............................................................................0Autovon Dial .....................................................................................191 FLASH
192 IMMEDIATE
193 PRIORITY
194 ROUTINE
OUTSIDE LINE ACCESS:
COMMERCIAL:
DSN:
NAF MISAWA
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.SAR...........................................................................................…….226-9254/2516COMNAVFORKOREA...............................................................….xxxxxxxxxMISAWA AFB COMMANDING OFFICER...............................….xxxxxxxxx
Ambulance ................................................................................…….226-3676ATC ...........................................................................................……226-4723Base Operations........................................................................…….226-4497Crash/Salvage ...........................................................................…….226-3454EOD...........................................................................................…….226-3942Legal .........................................................................................…….226-4022NCIS..........................................................................................…….226-3341/4358Photo lab ...................................................................................…….226-4096PWC (Transportation) ...............................................................……226-4682Safety (AFB)..............................................................................……226-3463Security......................................................................................……226-4359Weather.....................................................................................…….226-3900OUTSIDE LINE ACCESS:
COMMERCIAL:
DSN:
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
OSAN AB
SAR .......................................................................................………784-4831/4005COMNAVFORKOREA....................................................................xxxxxxxxOSAN AFB COMMANDING OFFICER ........................................xxxxxxxx
Ambulance ..................................................................................…..118ATC .............................................................................................…..784-2760/6957Base Operations ..........................................................................…..784-4222/6957Crash/Salvage ..............................................................................…..784-4710/6957EOD .............................................................................................…..784-6738Legal ............................................................................................…..784-4131NCIS ............................................................................................…..784-4437Photo lab ......................................................................................…..784-5800PWC (Transportation) ..................................................................….784-1843Runway Support. ..........................................................................….784-4222/6957Safety (AFB). ................................................................................…784-5515Security.........................................................................................….784-4571Weather .......................................................................................…..784-5474Off Base Operator .......................................................................…..784-1110Osan Switch Board ......................................................................….784-1110OUTSIDE LINE ACCESS:
COMMERCIAL:
DSN:
Supplement to CSFWPINST 3750.1A
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OTHER DET AIRFIELD:
BASE OPERATIONS ..................................................................………………..SAR .............................................................................................…………………COMMANDING OFFICER ...........................................................……………...Ambulance ..................................................................................…………………ATC .............................................................................................………………..Base Operations ..........................................................................…………………Crash/Salvage ..............................................................................………………..EOD .............................................................................................……………….Legal ............................................................................................………………NCIS ............................................................................................………………Photo lab ......................................................................................………………PWC (Transportation) ..................................................................……………..Runway Support. ..........................................................................……………..Safety (AFB). ................................................................................…………….Security.........................................................................................…………….Weather .......................................................................................……………..Off Base Operator........................................................................……………..Switch Board ...............................................................................…………….OUTSIDE LINE ACCESS:
COMMERCIAL:
DSN:
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Step 15
DEPARTMENT HEADS’ POST-MISHAP CHECKLIST
The following list, while not all
inclusive,
provides initial
guidance for
department
heads following
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
a mishap. If a
department
head is not available, any member of the
department can
Supplement to CSFWPINST 3750.1A
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get started on
this.
Administrative Officer
_____Imminent death retirement
_____Provide record of Emergency Data (RED) to CO
_____Casualty report to CMC
_____Draft notification letter/telegram to NOK
_____Draft condolence letter/telegram to NOK
_____Draft PAO release for submission to XO/CO
_____Prepare orders for AMB, CACO, JAG investigator
_____Prepare appointment letters for AMB, CACO, JAG investigator_____Death gratuity paid
_____Provide administrative support for JAG investigation
_____JAG investigation complete
Intelligence Officer
_____If applicable, submit preliminary inquiries and reports concerning the compromise of classified material
in accordance with MCO P3040.4D
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Operations Officer
_____Ensure OPREP 3 reports and messages submitted correctly
_____Secure flight operations
_____Secure mishap pilot and WSO logbook, NATOPS jacket, training jacket, etc._____Ensure SORTS message drafted for release
_____Remove AMB from flight schedule
Logistics Officer
_____Coordinate required logistics support for AMB, including,
d)transportation to the mishap site
e)billeting/messing at the mishap site
f)coordination of special equipment/gear for AMB
_____Personal effects inventory complete
_____Arrange for transportation of wreckage from mishap site to VMFA(AW)-242_____Arrange for salvage/disposal of wreckage
Maintenance Officer
_____Secure
aircraft and
engine
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logbooks,
NALCOMIS
data, FCF
checklist,
maintenance
records and any fluid samples of
Supplement to CSFWPINST 3750.1A
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the mishap
aircraft
_____Mobilize and task the Emergency Reclamation Team
_____Provide data to the ASO required to complete the Mishap Report message_____Prepare request for P & E inspection, if required
_____Be prepared to provide personnel to serve as a security force at the mishap site_____Ensure that qualified avionics personnel are assigned to remove and secure COMSEC equipmentDirector of Safety and Standardization
_____Ensure CO/XO notified
_____Verify mishap type/categorization
_____Verify all external agencies notified
_____Verify that photographer notified and enroute
_____Proceed to mishap site and direct start of investigation
Supplement to CSFWPINST 3750.1A
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UNITED STATES MARINE CORPS
Marine Medium Helicopter Squadron 163
Marine Aircraft Group 16
3d Marine Aircraft Wing, MarForPac
MCAS Miramar, P.O.Box 452117
San Diego, California 92145-2117
SqdnO P3750.2
DOSS
21 Jan 00
SQUADRON ORDER P3750.2
From:Commanding Officer
To: Distribution List
Subj: PRE-MISHAP PLAN
Ref: (a) OPNAVINST 3750.6Q
(b) OPNAVINST 3750.16B
(c) OPNAVINST 4790.2E
(d) NAVAIR 00-80T-67
(e) JAGINST 5800.7B
(f) MCO 3040.4C
(g) FMFPacO 3750.5J
(h) ASO P3750.6
(i) WgO 3750.17
(j) GruO 3750.7B
(k) SqdnO P5100.3B
Encl: (1) LOCATOR SHEET
1. Purpose. To establish a procedural method for the investigation and reporting of Aircraft Mishaps and Hazards involving squadron personnel, aircraft, and equipment.
2. Cancellation. SqdnO P3750.1F.
3. Discussion. References (a) through (k) set forth requirements for various types of reports concerned with aircraft mishaps and indicate procedures to be followed in the submission of these reports. References (a) and (d) provide detailed procedures for a thorough aircraft mishap investigation and guidance regarding the release of information concerning aircraft mishaps. Reference (b) provides requirements and procedures for FAA/ NTSB participation in military aircraft mishap investigations. References (a) and (c) provide criteria for the submission of reports in conjunction with combined safety reporting format. Reference (e) provides guidance with the legal requirements and criteria for JAG investigations. Reference (f) indicates how and when a report of personal injury will be forwarded to the next of kin and to official agencies. References (g) through (k) provide guidance and procedures for aircraft mishap investigation.
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.SqdnO P3750.2
21 Jan 00
4. Information. A well executed Pre-Mishap Plan may result in the difference between the success or failure of the subsequent investigation. This manual is intended to expedite a successful comprehensive investigation and ensure timely submission of required reports. This manual does not supersede or modify any existing order promulgated by higher headquarters for reporting and investigating mishaps and hazards.
5. Action
a. General. Any person having knowledge of a mishap involving damage to government property, injury to personnel, or a situation which could result in a mishap, shall report such facts to the Squadron Duty Officer immediately. Except as provided for in this instruction, personnel shall not divulge any information, either officially or unofficially, to any party.
b. Specific. Action officers will utilize this Order in the accomplishment of their responsibilities in the event of a mishap. Nothing in this Order shall preclude logical action, should the situation warrant. All personnel assigned responsibilities herein shall familiarize themselves thoroughly with this Order and with requirements of their post-mishap duties. In the event of death or serious injury, personnel shall not discuss the matter with sources outside the squadron until the information has been released by proper authorities. The individual names will not be released without the expressed permission of the Commanding Officer.
c. Aviation Safety Officer. The Aviation Safety Officer (ASO) shall periodically brief all squadron officers, shop supervisors, and enlisted watchstanders on the assigned responsibilities of the squadron Pre-Mishap Plan. The ASO shall ensure that this Order is maintained in a current status and reflects responsibilities assigned by the Commanding Officer. The ASO shall also assist the Senior Member of the standing mishap board in conducting training and drills for mishap board members and watchstanders.
d. Operations Duty Officer (ODO) and Squadron Duty Officer (SDO). The ODO, or SDO if an ODO is not
present or required, will generally be the first squadron person informed of an aircraft mishap or hazard. He or she is the key individual in initiating the appropriate chain of events. All ODO's/SDO's shall be familiar with the contents of this Order and the Pre-Mishap Plan Binder on the ODO's/SDO's desk. Upon assumption of the duty, the ODO/SDO shall review, at a minimum, the contents of Chapter 4 and Appendix A.
6. Certification. Reviewed and approved this date.
K. D. BEST
DISTRIBUTION: B
Copy To: AMB Turnover Jackets,
MAG-16 (ASO), MCAS Miramar (ASO)
SqdnO P3750.2
21 Jan 00
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
LOCATOR SHEET
Subj: PRE-MISHAP PLAN
Location: ______________________________________________________
(Indicate location(s) of copy(ies) of this Manual.)
Enclosure (1)
PRE-MISHAP PLAN
RECORD OF CHANGES
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Log completed change action as indicated.
______________________________________________________________________________Change Date of Date Signature of Person
Number Change Entered Incorporating Change
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
i
PRE-MISHAP PLAN
CONTENTS
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
CHAPTER
1 SCOPE
2 DEFINITIONS AND TERMS
3 AIRCRAFT MISHAP BOARD
4 MISHAP REPORTING
5 MISHAP INVESTIGATION
6 HAZARD REPORTING
APPENDIX
A INITIAL MISHAP CHECKLIST
B NEWS MEDIA MUTUAL COOPERATION STATEMENT
C DET OIC MISHAP CHECKLIST
D WITNESS STATEMENT
E ASO'S MASTER MISHAP CHECKLIST
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PRE-MISHAP PLAN
CHAPTER 1
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SCOPE
PARAGRAPH PAGE
GENERAL. . . . . . . . . . . . . .. . . . . . . . . . .1000 1-3SAFETY POLICY. . . . . . . . . . . . . . . . . . . . .1001 1-3AMB VS JAG MANUAL INVESTIGATIONS . . . . .1002 1-3
PRIVILEGED INFORMATION. . . . . . . . . . . . . . 1003 1-3
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CHAPTER 1
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SCOPE
1000. GENERAL. The purpose of the Pre-Mishap Plan is to delineate responsibilities required in the event of a mishap. Since all mishaps are different, no single document could possibly cover every possibility. This document provides an outline by which squadron personnel will guide themselves during the initial 24 hours following a mishap. Those initial 24 hours are critical in ensuring that a thorough investigation can be conducted. When unexpected problems are encountered, the success of the investigation will depend on the use of good judgment and initiative for areas not covered in this document. After the initial 24 hours, the Senior Member of the Aircraft Mishap Board (AMB) will direct the efforts of the board in accordance with all applicable references.
1001. SAFETY POLICY. There are no peace time missions, and very few combat missions, that preclude safety as our first priority in mission considerations. Safety is a prerequisite for successful combat readiness, training, and operations. If we cannot preserve our personnel and material assets we cannot attain a high state of personnel readiness. If, in the aftermath of a mishap, we fail to properly investigate and recommend solutions, we will be doomed to repeat it.
1002. AMB VERSUS JAG MANUAL INVESTIGATIONS. In the event of an aviation mishap involving
death, serious injury, extensive damage to government property or the possibility of a claim by or against the government, a JAG Manual Investigation will be initiated in addition to the AMB's Mishap Investigation. These two investigations are completely independent and separate. No information may be exchanged between them with the exception of the identity of witnesses and any real evidence not obtained through the use of a witness statement. Although the identity of witnesses will be passed, the topics discussed and information provided will not be. No portion of one report can be a part of the other. The ASO will screen the JAG Manual Investigation Report prior to submission to CO for signature/endorsement to ensure that no privileged information has been divulged.
1003. PRIVILEGED INFORMATION. All squadron personnel should be completely familiar with the
concept of safety privilege in order to ensure a free flow of all pertinent information necessary to the prevention of mishaps.
1. SAFETY PRIVILEGE. Individuals may be reluctant to reveal information pertinent to a mishap or the prevention of a mishap because they may believe that use of that information could be detrimental or embarrassing to themselves, their squadron mates, their squadron or others. They may also elect to withhold information to avoid self-incrimination. All personnel can be assured that they can reveal any information to any member of the AMB without fear of jeopardizing themselves or anyone else. That information can only be used for the prevention of mishaps and is inadmissible in any punitive or administrative action. AMB members are precluded from assignment to any other investigation or board relating to a mishap they investigated.
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1003 PRE-MISHAP PLAN
2. Protection of Privileged Information. All AMB members will take steps to ensure that all information
received by the AMB, the deliberations and recommendations of the AMB are safeguarded in accordance with the requirements of reference (a). Should privileged information be used for any purpose other than safety, credibility of all future assurances of privilege would be lost. All copies of MIR's and working papers of the
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.AMB should be secured in the Safety and Standardization Department safe or equivalent. No personal copies of the MIR/endorsement shall be held by any member of the AMB.
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PRE-MISHAP PLAN
CHAPTER 2
DEFINITIONS AND TERMS
PARAGRAPH PAGE
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.INTENT FOR FLIGHT. . . . . . . . . . . . . . . . . .2000 2-3NAVAL AIRCRAFT MISHAP. . . . . . . . . . . . . .2001 2-3INJURY CLASSIFICATION. . . . . . . . . . . . . . .2002 2-3NAVAL AIRCRAFT MISHAP CATEGORIES. . . . . 2003 2-3
NAVAL AIRCRAFT MISHAP SEVERITY CLASSES. 2004 2-3
DOD PERSONNEL . . . . . . . . . . . . . . . . . . . 2005 2-4NON-DOD PERSONNEL. . . . . . . . . . . . . . . .2006 2-4DUTY STATUS. . . . . . . . . . . . . . . . . . . . .2007 2-4LOST WORKDAYS. . . . . . . . . . . . . . . . . . . 2008 2-4FIRST AID. . . . . . . . . . . . . . . . . . . . . . . .2009 2-4HAZARD. . . . . . . . . . . . . . . . . . . . . . . . .2010 2-4RISK ASSESSMENT CODES. . . . . . . . . . . . . .2011 2-5
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PRE-MISHAP PLAN
CHAPTER 2
DEFINITIONS AND TERMS
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.2000. INTENT FOR FLIGHT. The following criteria apply to DOD aircraft involved in a single or multi-aircraft mishap. Intent for flight is a prerequisite for the classification of a naval mishap as a flight mishap or flight related mishap.
1. Intent for flight is considered to exist when the aircraft brakes are released and/or takeoff power is applied for the purpose of commencing an authorized flight.
2. Intent for flight continues until the aircraft has alighted and the aircraft weight is supported by the landing gear.
2001. NAVAL AIRCRAFT MISHAP is an unplanned event or series of events directly involving naval aircraft resulting in any of the following:
1. $10,000 or greater cumulative damage to naval aircraft or other aircraft (DOD or non-DOD). Property damage includes cost to repair or replace facilities, equipment or material.
2. An injury defined as traumatic bodily harm received while involved with naval aircraft, such as cut, fracture, burns or poisoning, resulting from single or 1-day exposure to an external force, toxic substance or physical agent, which results in:
a. Fatality, regardless of time between injury and death.
b. Permanent, Total Disability.
c. Permanent, Partial Disability.
d. Five or more lost work days (not including day of injury).
2002. INJURY CLASSIFICATION. See Tab 7 of Appendix A for injury Classification Codes.
2003. NAVAL AIRCRAFT MISHAP CATEGORIES. See Tab 7A of Appendix A for Naval Aircraft Mishap
Categories.
2004. NAVAL AIRCRAFT MISHAP SEVERITY CLASSES. See Tab 7B of Appendix A for Naval Aircraft
Mishap Severity Classifications.
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2005 PRE-MISHAP PLAN
2005. DOD PERSONNEL
1. Civilian on Duty. General schedule and wage grade employees (including National Guard and Reserve Technicians, unless in military duty status); non-appropriated fund employees (excluding part-time military);
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Corps of Engineers Civil Works Employees; Youth Student Assistance Program employees; Foreign Nationals employed by DOD components; and military exchange employees.
2. Military. All U.S. military personnel on active duty; U.S. Military Reserve or National Guard personnel on active duty or in drill status; service academy cadets; Reserve Officers Training Corps cadets when engaged in directed training activities; foreign national military personnel assigned to DOD components.2006. NON-DOD PERSONNEL. Off-duty DOD civilian personnel, persons employed by other Federal
agencies, and other civilians and Foreign Nationals not employed by DOD.
2007. DUTY STATUS. DOD personnel are on duty when:
1. Physically present at any location where they are to perform their officially assigned work. This includes those activities incidental to normal work activities which occur on DOD installations, such as lunch or coffee breaks and all activities aboard vessels.
2. Being transported by DOD or commercial conveyance for the purpose of performing officially assigned work. This includes reimbursable travel for temporary duty performed in private motor vehicles, but not routine travel to and from work.
3. Participating in compulsory sports or physical training activities.
2008. LOST WORKDAYS. Those workdays (consecutive or not) on which DOD personnel would have
worked, but could not because of injury. Excluded are the day of injury and the days that personnel did not work even though able to work.
2009. FIRST AID. An injury requiring minimal treatment(s) or no treatment and not resulting in a lost workday.
2010. HAZARD. A hazard is defined as a potential cause of damage or injury. See chapter 6 for examples.2-4
PRE-MISHAP PLAN 2011
2011. RISK ASSESSMENT CODES
1. Risk assessment codes (RACs) are an estimation of overall risk severity potential of an identified hazard. There are five codes that are used to prioritize the maximum amount of Aircraft/Property damage and/or injury should that hazard continue to exist or reoccur.
2. Codes I and II are considered severe hazards. Codes III, IV, and V are considered routine hazards.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Risk Assessment Codes
I Class A Level damage and/or injury more than 50% of the time.IIClass A Level damage and/or injury less than 50% of the time.
IIISome degree of injury/damage more than 50% of the time.IVSome degree of injury/damage less than 50% of the time.
V Potential for damage and/or injury is remote.
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PRE-MISHAP PLAN
CHAPTER 3
AIRCRAFT MISHAP BOARD
PARAGRAPH PAGE
RESPONSIBILITIES. . . . . . . . . . . . . . . . . . . .3000 3-3COMMANDING OFFICER . . . . . . . . . . . . . . . .3001 3-3
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.SENIOR MEMBER. . . . . . . . . . . . . . . . . . . . .3002 3-3OPERATIONS MEMBER . . . . . . . . . . . . . . . . .3003 3-4MAINTENANCE MEMBER . . . . . . . . . . . . . . . .3004 3-4AVIATION SAFETY OFFICER . . . . . . . . . . . . . .3005 3-4FLIGHT SURGEON. . . . . . . . . . . . . . . . . . . . .3006 3-4
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PRE-MISHAP PLAN
CHAPTER 3
AIRCRAFT MISHAP BOARD
3000. RESPONSIBILITIES
1. General. The Aircraft Mishap Board (AMB), is responsible for gathering all information concerning aircraft mishaps and submitting accurate reports that will assist in the prevention of similar mishaps. An AMB exists
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.when the first member of the AMB arrives at either the squadron area or the mishap site. This member, if not the Senior Member, will be responsible for coordinating all activities involving the mishap investigation until the Senior Member arrives.
2. Duties. AMB members will maintain thorough knowledge of this instruction, the references, the squadron Safety and Standardization program and any other item contained in their specific AMB turnover folder.3. Reports. The AMB will make all reports in accordance with references (a) thorough (k), unless the Commanding Officer has been informed in writing that he has been relieved of the responsibility for conducting the investigation.
3001. COMMANDING OFFICER. In the event of an aircraft mishap, the Commanding Officer is responsible for the continued operation of the squadron. He will ensure that all personnel involved in the investigation or reporting process are released from all other duties and responsibilities. The Commanding Officer must be continually kept abreast of the status and completion of required reports. In the event that there are casualties, he will make notification to the next of kin. A comprehensive checklist of reports required is furnished in Tab 11A of Appendix A.
3002. SENIOR MEMBER
1. The Senior Member of the AMB shall be senior to the pilot in command or flight leader. For a Class A mishap he will be designated by the controlling custodian from outside the squadron. The Senior Member is responsible for the prompt and orderly execution of the investigative and reporting procedures relative to an aircraft mishap. Prior to a mishap, the duties of the Senior Member of the AMB shall include but are not limited to:
a. Ensuring the training and readiness of the AMB.
b. Ensuring the readiness of materials and equipment in the squadron mishap investigation kit.
c. Supervising drills of the squadron Pre-Mishap Plan.
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3003 PRE-MISHAP PLAN
2. After notification of a defined naval aircraft mishap or hazard, the Senior Member shall comply with the requirements of Tab 11B of Appendix A.
3003. OPERATIONS MEMBER. After notification of a defined naval aircraft mishap or hazard, the
Operations Member shall comply with the requirements of Tab 11C of Appendix A.
3004. MAINTENANCE MEMBER. After notification of a defined naval aircraft mishap or hazard, the
Maintenance Member shall comply with the requirements of Tab 11D of Appendix A.
3005. AVIATION SAFETY OFFICER
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.1. As a member of the Aircraft Mishap Board, the ASO is responsible for the following:
a. Act as principle advisor to the Commanding Officer and Senior Member of the AMB on all Aviation Safety matters.
b. Conduct quarterly AMB training.
c. Keep and maintain the Mishap Investigation Kit.
d. Assist Senior Member in the preparation of reports.
e. Maintain a Pre-Mishap Plan Folder for the ODO/SDO and all training deployments.2. After notification of a defined naval aircraft mishap or hazard, the Aviation Safety Member shall comply with the requirements of TAB 11E of Appendix A.
3006. FLIGHT SURGEON
1. As a member of the Aircraft Mishap Board, the Flight Surgeon is responsible for the following:
a. Be familiar with this and other appropriate instructions.
b. Maintain current directives on local facilities available for assistance in the autopsy or laboratory analysis of the remains.
2. After notification of a defined naval aircraft mishap or hazard, the Flight Surgeon shall comply with the requirements of Tab 11F of Appendix A.
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PRE-MISHAP PLAN
CHAPTER 4
MISHAP REPORTING
PARAGRAPH PAGE
MISHAP CHECKLIST. . . . . . . . . . . . . . . . . . .4000 4-3DISCLOSURE OF INFORMATION. . . . . . . . . . . 4001 4-3NOTIFICATION AND VERIFICATION . . . . . . . . 4002 4-3OVERDUE AIRCRAFT. . . . . . . . . . . . . . . . . . 4003 4-5
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.CHRONOLOGICAL RECORD . . . . . . . . . . . . .4004 4-5NOTIFICATION OF STATION ODO . . . . . . . . . .4005 4-5SQUADRON MISHAP RECALL. . . . . . . . . . . .4006 4-5MISHAP CLASSIFICATION . . . . . . . . . . . . . .4007 4-6FLASH REPORT/OPREP-3 . . . . . . . . . . . . . . .4008 4-6MISHAP TELEPHONE REPORT . . . . . . . . . . . .4009 4-7WEATHER BRIEFING. . . . . . . . . . . . . . . . . .4010 4-7KEY PERSONNEL CHECKLISTS . . . . . . . . . . . .4011 4-7SECURITY FORCE BRIEF . . . . . . . . . . . . . . .4012 4-8BRIEF OF ON-HAND PERSONNEL . . . . . . . . . .4013 4-8MISHAP REPORT. . . . . . . . . . . . . . . . . . . . 4014 4-8FAA INVOLVEMENT . . . . . . . . . . . . . . . . .4015 4-9NEWS MEDIA RELATIONS . . . . . . . . . . . . .4016 4-9DETACHMENTS/DEPLOYMENTS . . . . . . . . .4017 4-10
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PRE-MISHAP PLAN
CHAPTER 4
MISHAP REPORTING
4000. MISHAP CHECKLIST
1. The Operations Duty Officer (ODO) or the Squadron Duty Officer (SDO) will normally be the first person to learn of a mishap involving a squadron aircraft. He is the key individual in initiating the appropriate chain of events. It is absolutely paramount that all SDOs and ODOs be familiar and comfortable with the Mishap Checklist (Appendix A). You must respond correctly and without hesitation. Each SDO and ODO will review this instruction at the beginning of every watch. The ODO/SDO will initiate all appropriate action until released by the Senior Member of the AMB. He will assist the AMB as required.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.2. The checklist has been devised so that it may be implemented with ease, provided that appropriate personnel are cognizant of its contents prior to its implementation. Upon assuming the SDO watch, the SDO shall brief the SDC concerning the duties expected of him should a mishap occur.
4001. DISCLOSURE OF INFORMATION
1. Mishap information is limited access information. You must not allow any information to be divulged to anyone except through official channels. Do not give out the names of the personnel involved in a mishap over the phone except to the Commanding Officer, Executive Officer, or as specifically directed in this instruction.2. Be particularly wary of persons claiming to be high ranking officers. Some unscrupulous members of the news media have been known to use this ploy to gain information. Be courteous but firm in not divulging information. Refer them to the Joint Public Affairs Officer at MCAS Miramar x6000, after hours call (619) 920-0836 and ask to recall the duty JPAO.
3. If the next of kin should call and request any information prior to the official notification, respond with, "I'm sorry, but we are not able to release any information at this time. The Commanding Officer will authorize a statement soon." Immediately report the call to the Commanding Officer along with the next of kin's phone number.
4002. NOTIFICATION AND VERIFICATION. Notification of a mishap can be made by telephone or
message from numerous sources, including civilian, military, and various law enforcement agencies. If the mishap is within the local area, they will coordinate with local bases for response. If the site is distant, the nearest military airfield should be contacted.
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2. Search and rescue. The safety of the pilots, crew members, passengers and other personnel is the first priority and requires immediate attention. Ensure that a SAR aircraft and/or ambulance is dispatched immediately unless absolutely certain that they are not required.
3. Dispensary. The dispensary will be placed on alert for coordination of casualty assistance. If on base or within the local area of responsibility, they will dispatch an ambulance.
4. Explosive Ordnance Disposal (EOD). In aircraft mishaps where there is no danger of Cartridge Activated
Device (CAD) explosion, squadron maintenance personnel will remove CAD's. In other cases where the possibility of CAD activation exists, EOD personnel will assist and/or remove CADs from the aircraft. In all cases CADs will be turned over to authorized squadron personnel for possible Engineering Investigation. In all cases when other types of ordnance are aboard call EOD. If known, inform the unit called of the exact type of ordnance on board.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.5. Provost Marshal. When contacted by tower, PMO will respond to the scene of all aircraft mishaps. They will assist supervisors and set up perimeter security at the site. They will remain on scene until relieved by squadron personnel. If the mishap site is away from the local area, the nearest military installation is tasked with providing the same service. They will provide security until relieved by the squadron. They should provide rope, signs, stakes, etc.
6. Flight Clearance. The tower and other local agencies that may have been dealing with the aircraft will need to be notified so that records that may prove useful to the AMB are preserved.
7. Photo Lab. The base photography unit will dispatch a photographer immediately on request of the squadron. If the mishap occurs outside the local area, coordinate with the nearest military unit for photographic assistance.8. Joint Public Affairs Officer (JPAO). The JPAO will be the clearing house for all information released on all Class A mishaps or others that may generate public interest. JPAO shall be notified of the mishap as soon as possible so that they can assimilate information and respond to questions properly and intelligently. Once notified, the JPAO will keep in constant contact with the squadron. Under no circumstance will JPAO be given privileged information or any information that would not be appropriate on a Mishap Report as discussed in paragraph 4014.3.
9. Local Law Enforcement. PMO will liaison with local law enforcement agencies to coordinate initial emergency response and security for off-base mishaps.
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4003. OVERDUE AIRCRAFT
1. If you are notified that a squadron aircraft is overdue, (30 minutes beyond scheduled arrival time) or an aircraft is determined to be missing, contact Station Operations immediately. Speak only with Operations Officer or the Senior Marine present. Request that a radio search by Air Traffic Control facilities be initiated. If radio contact cannot be established, declare the aircraft missing and request from Station Operations that the crash alarm be activated notifying all stations of missing aircraft.
2. Missing Aircraft. If an aircraft is determined to be missing, proceed under the assumption that an aircraft mishap has occurred and continue with the steps in appendix A. When calling Station Operations, be prepared to pass on information concerning the aircraft's route of flight, intended destination, ETAs, etc.4004. CHRONOLOGICAL RECORD
1. Start a chronological log to ensure all facts, times, names, information, etc., are recorded for future references, and to keep accountability on what has been accomplished. It would be highly advisable to use the duty clerk or anyone else available to perform this and other time consuming administrative functions.
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.2. To ensure a steady flow of incoming information, secure one phone line for incoming phone calls only (Safety/NATOPS phone is a good line to secure). Allow no one to use this line for outgoing calls and give this number only to individuals from whom you require information.
4005. NOTIFICATION OF STATION ODO. Call the Station ODO at extension 4277, and provide the
information as per appendix A tab 5. Since lives could be at stake, i.e.. SAR or use of the fire department, it is important that this action be accomplished as quickly as possible. If coordination with local law enforcement agencies is required, call 9911.
4006. SQUADRON MISHAP RECALL
1. Initially, the Commanding Officer, Executive Officer, Operations Officer, Aviation Safety Officer, and Aviation Maintenance Officer should be notified immediately. Do not recall others at this time unless directed. Current phone numbers are listed in Tab 6 of Appendix A of the ODO/SDO Mishap folder and on the ODO desk.
2. If there is the determination that a mishap has in fact occurred, notify each member of the Aircraft Mishap Board. If a member cannot be reached, contact his alternate.
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3. Other personnel will be required in order to accomplish specific required tasks:
a. Administrative Officer (S-1). In all cases involving fatalities or serious injury, the S-1 Officer shall be notified. In the event squadron personnel need to be sent to an aircraft mishap site away from the local area, the squadron S-1 will coordinate the issuance of orders and disbursing requirement. The S-1 officer shall comply with the requirements of Tab 11G of Appendix A.
b. Logistics Officer (S-4). Initially, PMO will provide security of the mishap site. The S-4 officer shall be notified to coordinate the posting of squadron personnel, including a Security Officer, as soon as possible. The S-4 Officer shall also be prepared to provide any logistic or transportation support required by the AMB or the security force. Initially, six enlisted Marines and at least one officer or SNCO will normally be required. Transportation to the crash site should be by the most expeditious, practical method. The S-4 Officer shall comply with the requirements of Tab 11I of Appendix A.
c. Sergeant Major. The Sergeant Major will be the key point of contact in assembling work parties and security watches. The Sergeant Major will also assist the Commanding Officer in the notification of NOK if required (Tab 11L of Appendix A).
d. Chaplain. Chaplains are available on a 24 hour basis to tend to the spiritual and emotional needs of victims and their families. In all mishaps involving serious injury or death, contact the chaplain. If known,
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.inform the chaplain of the religious preferences. The S-1 Officer can obtain this information from the OQR/SRB.
4007. MISHAP CLASSIFICATION. The category and severity of the mishap can be determined utilizing
Tabs 7A and 7B of Appendix A. The SDO/ODO should not waste an excessive amount of time here initially. He should only be concerned with the Mishap Category, Tab 7A, at first, in order to get the Flash Report out within 5 minutes.
4008. FLASH REPORT/OPREP-3
1. Send a Mishap Flash Report (Tab 8 of Appendix A) to the MAG-16 Aviation Safety Officer (x4534) within 5 minutes. If there is no answer, submit the report to the MAG-16 Operations Officer. During non-working hours, call the MAG-16 Duty Officer at x1779. These individuals will forward the Mishap Flash Report to the 3d MAW Safety Officer, who will draft and send the OPREP-3 message based on the information available from the Flash Report.
2. Do not hold up the report due to lack of information. Timeliness is paramount in the submission of the Flash Report. Submit the current information and follow it up as more information becomes available.4-6
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3. An OPREP-3 report is required if the mishap is likely to generate national and/or high level interest. This report is normally sent by 3d MAW Safety. The basic criteria and guidelines apply sending the OPREP-3 report:
a. If a squadron aircraft mishap results in civilian fatalities, or widespread civilian property damage. (Flash Precedence)
b. If a squadron aircraft mishap occurs on foreign territory. (Flash Precedence)
c. If a squadron aircraft is destroyed or substantially damaged (Class A or B), but does not fulfill requirements of "a", or "b" above, an OPREP-3 Navy Blue Report is required. (OP Immediate Precedence)4. When deployed, a mishap flash report will be sent to MAG-16, info the MEU. If the host station has already submitted an OPREP-3 report, another one is not required. Ensure that this fact is passed to 3d MAW when contact is made.
5. The OPREP-3 format can be found on disk located in the ODO folder, along with a written example and info addresses.
4009. MISHAP TELEPHONE REPORT. For all class A mishaps, a telephone report must be called into the
Naval Safety Center by the squadron within 60 minutes of initial notification. The phone numbers and format are found in Tab 9 of Appendix A. Do not holdup the report due to lack of information. This is a general use report and shall not contain any privileged information. It shall not state the source of any information, nor
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.contain any information from statements made to an Aircraft Mishap Board, nor any information discovered as a result of statements made to an Aircraft Mishap Board, any analysis, conclusions or recommendations of an Aircraft Mishap Board, nor any known, probable or possible cause factors of a mishap.
4010. WEATHER BRIEFING. Obtain a thorough weather briefing from the station closest to the mishap site. If the mishap is located at a remote site, or a significant distance from a reporting station, obtain the reports from two or more stations in the vicinity to get a general overview of the weather at the mishap site. MCAS Miramar Weather is tasked with and should be able to get most of this for you. Use the format in Tab 10 of Appendix A. Ensure that this information is passed to the AMB.
4011. KEY PERSONNEL CHECKLISTS. While awaiting the arrival of the AMB and other key personnel, the
ODO/SDO should go through the checklists contained in Tab 11 of Appendix A. As time allows, he should attempt to complete any items listed with an asterisk (*), in order to assist in the timely completion of required tasks.
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4012. SECURITY FORCE BRIEF. The Security Officer will normally be an officer or SNCO selected
initially by the S-4/SDO. He shall ensure that all sentries are thoroughly familiar with the contents of Tab 12A of Appendix A and Appendix B upon assumption of each watch. For the initial posting of the first watch, the S-4 officer or SDO will brief all personnel. Afterwards, the Security Officer will be briefed by the S-4 Officer and then brief his watch.
4013. BRIEF OF ON-HAND PERSONNEL. All squadron personnel present should be briefed concerning a
mishap in accordance with Tab 13 of Appendix A. Particular emphasis should be placed on the reasons for restricting the release of information outside of the squadron. To ensure adequately trained personnel are readily available, all members of the squadron will also be briefed on mishap site security measures (Tab 12A of Appendix A). During working hours, muster all on-hand personnel, brief them and prepare them for selection as work party or security personnel. This may require a recall of barracks personnel, if night crew has secured.
4014. MISHAP REPORT
1. An Initial Mishap Report (MR) will be sent via message for all Class A and B mishaps within four hours of mishap notification. The purpose of the message is to inform interested commands that a significant aircraft mishap has occurred. The ASO or a safety school trained individual will begin preparing the initial MR message which shall be released by the AMB. If there are no school trained personnel available, notify Group that assistance with the message is needed.
2. The First Amended Mishap Report for class A or B mishaps and the Initial Mishap Report for class C mishaps shall be submitted within 24 hours of the mishap. Deadlines for additional Mishap Reports are as appropriate, and may be established by higher authority.
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.3. Non-privileged Status. Mishap Reports are general use reports and shall not contain any privileged information. They shall not state the source of any information, nor contain any information discovered as a result of statements made to an aircraft mishap board, any analysis, conclusions or recommendations of an aircraft mishap board, nor any known, probable, or possible cause factors of a mishap. These items are privileged by law. When in doubt, check with the Senior Member or the ASO.
4. Precedence. Mishap Reports required within 24 hours shall be sent via priority message. All other Mishap Reports shall be sent via routine message.
5. Classification. Message Mishap Reports will normally be unclassified. If any portion of the report warrants classification, that information shall be omitted and the word "Classified" entered in its place. If a meaningful report can not be submitted, a classified report may be submitted.
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6. The following also apply:
a. Mishap Reports are exempt from minimize.
b. Mishap Reports are For Official Use Only (FOUO).
7. Mishap Report Format
a. A separate message folder contains the Mishap Report Format. A blank shell can also be found on the diskette contained in the ODO's message folder.
b. If any information is not available when the message is released, enter "TBA" (To Be Added) in the space for that information.
c. If information is estimated, enter the term "ESTIMATED" prior to that information.
d. If any information is obviously not appropriate for the mishap being reported enter "NA" (Not Applicable) in the space.
e. Amended Reports are required only to report new or corrected information.
4015. FAA INVOLVEMENT
1. If a function of the FAA is, or may be involved in an aircraft mishap, a telephone call and message to the nearest FAA facility is required. The telephone report will include all
available information and shall be made within four hours of the time the incident occurred.
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.2. The determination of FAA involvement, possible or probable, rests with the military unit conducting the investigation. Specific instructions for criteria to determine involvement are included in reference (b). Basically, involvement will include any contributing factor to the mishap which is controlled, supervised, accomplished, or the responsibility of the FAA or its personnel. This would include erroneous chart information, collisions with civilian aircraft, and improper air traffic clearances. A follow-up priority message will be sent as soon as possible, but no later than 24 hours after the incident. The message folder contains the telephone and message formats required. A blank shell of the message format can also be found on the diskette contained in the folder.
4016. NEWS MEDIA RELATIONS
1. General. Whenever death or serious injury to military or civilian personnel is the result of an aircraft mishap involving military aircraft, it becomes a matter of dissemination. Although release of such information is a command prerogative, Joint Public Affairs Officers are charged
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with the responsibility and possess facilities for the proper release of such information. When the squadron is deployed, and/or operating from another airfield or ship, information pertaining to the mishap should be made to the Public Affairs section of that base or the nearest military activity to the scene of the mishap for proper dissemination.
2. Inquiries by media personnel. If sentries, board members or anyone in the investigating party is questioned by a reporter, refer that individual to the JPAO. Under no circumstances will the names of persons involved be given. Tell the reporters that you are there only to investigate the accident and the details will be given to them as soon as they are known. DO NOT VOICE SPECULATION AS TO THE CAUSE OR CULPABILITY.
3. Taking of photographs by media personnel
a. No attempt should be made to stop photographers from taking pictures, unless classified equipment is involved. In that case, warn the photographer that pictures of classified equipment are not allowed. Should he persist after warning, inform him that the FBI must be notified of his actions. If possible, get the name and address of the person and give this information to the Public Affairs Officer and the Senior Member of the Aircraft Mishap Board. The nearest field office of the FBI should be immediately notified.
b. In the past, news photographers have been cooperative in refraining from taking pictures of an objectionable nature. However, if this is violated, attempt to cover the remains with a tarp or other suitable material and report the photographer's name and the firm represented to the JPAO and to the Senior Member of the AMB.
4. UNDER NO CIRCUMSTANCES SHALL MILITARY PERSONNEL USE ANY DEGREE OF FORCE
TO PREVENT OR OTHERWISE INTERFERE WITH CIVILIAN PHOTOGRAPHERS OBTAINING
PICTURES OUTSIDE OF NAVAL JURISDICTION.
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.5. News Media Mutual Cooperation Statement. To better control the access of the news media representatives
at the mishap site, a copy of Appendix B should be given to each as they arrive.
Copies shall be maintained in the Mishap Investigation Kit and given to the Security Officer in the event that no AMB members are present.
4017. DETACHMENTS/DEPLOYMENTS. Normally squadron detachments or deployments will be made to
areas where phone contact can be maintained with the local area. If the command element has not shifted, the Detachment OIC will complete Appendix C. He shall pass all required information to the command element via phone or facsimile machine and the reporting will be conducted from home base.
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CHAPTER 5
MISHAP INVESTIGATION
PARAGRAPH PAGE
INITIAL 24 HOURS. . . . . . . . . . . . . . . . . . .5000 5-3CONDUCT OF THE INVESTIGATION. . . . . . . .50015-3
WITNESS STATEMENTS . . . . . . . . . . . . . . .5002 5-4PHOTOGRAPHING WRECKAGE. . . . . . . . . . .5003 5-5WRECKAGE DIAGRAMMING . . . . . . . . . . . .5004 5-6TECHNICAL ASSISTANCE . . . . . . . . . . . . . .5005 5-7DEEP WATER RECOVERY. . . . . . . . . . . . . . .5006 5-8WRECKAGE PRESERVATION . . . . . . . . . . . .5007 5-8MISHAP INVESTIGATION REPORT . . . . . . . . .5008 5-8RELEASE OF WRECKAGE. . . . . . . . . . . .. . 5009 5-9
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CHAPTER 5
MISHAP INVESTIGATION
5000. INITIAL 24 HOURS. The initial 24 hours following an aircraft mishap are the most difficult. The checklists provided will aid everyone in making best use of their time. During this period, the board should not rush into anything. It should take time to consider the consequences of actions, particularly those pertaining to material evidence. It should keep an open mind and collect as much factual information as possible, leaving the analysis and conclusions to later. During this period, the wreckage will not be removed or disturbed unless the wreckage interferes directly with vital civil functions or essential military operations. In the case of bona fide interference, the Commanding Officer of the base or unit concerned is authorized to direct the removal of the wreckage from the scene to the salvage yard or to an area where there is no interference.
5001. CONDUCT OF THE INVESTIGATION
1. After the initial 24 hours, the Senior Member will direct the efforts of the board in accordance with applicable references. The board's goal is to examine ALL possible mishap causal factors. It will determine not only WHAT happened but WHY it happened, WHERE the problem originated, WHAT can be done to
eliminate it and WHO can do it.
2. The investigation will be divided into several phases:
a. The Basic Examination. The initial investigative work where factual evidence is collected from the field and from witnesses, records, autopsy, etc. This investigation also covers the examination of management and supervisory processes involved. Keep an open mind, do not start to develop theories during this phase.
b. Analysis of the Evidence. A list is made of possible scenarios that are supported by the facts. These theories should be tested, and if further evidence is necessary to either prove or disprove a theory, then this evidence must be obtained.
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
c. In-depth Investigation. As the investigation narrows the suspect scenarios, there will probably be the need for information that can only be obtained by detailed disassembly of components and/or laboratory analysis.
d. Final Analysis. Once all evidence that can possibly be obtained has been gathered, the board must ascertain the cause factors. In almost every mishap there are going to be anomalies that cannot be explained. You should go with the preponderance of evidence. You are not in a court of law where everything must be proven beyond a shadow of a doubt. If you have evidence that a hazard may have caused the loss of an aircraft or injury, then it must be corrected.
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e. Conclusions. Make sure you dig deep enough for the cause factors. A finding that the aircraft was destroyed because the pilot flared incorrectly during a practice autorotation is not adequate. Pilots are expected to complete a routine task of this type. If the question of why cannot be answered, then the investigation is not complete.
f. Recommendations. Make sure that the recommendations correct the situations that caused the mishap and not just address the symptoms. The recommendations should spell out in detail what, in the board's best judgment, would prevent the mishap from being repeated. Treat each factor separately and assign management action to just one command per recommendation.
5002. WITNESS STATEMENTS
1. The timely identification of witnesses is an important step in the conduct of a successful investigation. In many cases, the evaluated statements made by the witnesses may point directly to the immediate area in which the investigation should be concentrated and assist in saving valuable time and energy in conducting the investigation. In many cases witnesses at the accident site will have information as to the behavior of the aircraft just prior to the mishap. However, do not rely entirely upon witnesses located in the immediate vicinity. Witnesses not at the mishap site may have valuable information to contribute and should be sought. Often witnesses who do not come forward voluntarily can be found through local police, news media, rescue agencies, or by going door to door along the aircraft's flight path.
2. Try to obtain a statement from witnesses as soon as possible and preferably before a witness can compare their views with those of others. Even though such a statement may be brief, witnesses can always be contacted again if additional information or clarification is desired. When interviewing witnesses the investigator must be as courteous as possible. He or she must make every effort to make the witness feel comfortable and willing to talk openly. Before starting the interview, explain that a witness's statement will be used only for safety purposes to prevent a future reoccurrence of the mishap. Do not explain Safety Privilege at this time unless the witness is hesitant. Reference to legal proceedings may scare the witness off. If hesitant, utilize the Advice to Witnesses form (OPNAV 3752.1), which is part of Appendix D. In obtaining statements, observe the following as well as the above:
a. If possible, take the witness back to the spot from which he observed the mishap.
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Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
b. Allow the witness to relate his story without being interrupted. Utilize a tape recorder unless it makes the witness uncomfortable. If it does, take notes unobtrusively.
c. Record the statement verbatim, if possible.
d. If available, use a model to assist witnesses in describing the flight characteristics and path of the aircraft.5-4
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e. After the witness has finished, go over the Witness Statement form (Appendix D) and ensure that all the required information has been covered.
3. After the interview, point out that the witness's name will be given to the JAG Investigator but that the JAG Investigator will not be privy to the contents or topics of the statement to the AMB. Ensure that the witness has read and understands the Advice to Witnesses.
4. The statements of the flight crew should be taken as soon as possible, with due regard for their physical condition. The Flight Surgeon can determine if crew condition will permit interviews and should normally obtain the initial statements from them. Tape recordings of statements made by crew members are required.5003. PHOTOGRAPHING WRECKAGE
1. Photographs are very important to the recording of the accident. Do not be reluctant to have as many photographs as necessary made. These will preserve the evidence.
2. The duty photographer will be under the supervision of the Aviation Safety Officer to ensure that meaningful and quality photographs are taken.
3. Photos of victims/fatalities will be avoided unless they serve a definite purpose for valid reasons.4. The following is a guide for photographs:
a. A general view of the scene from four directions and back along the wreckage pattern to the point of initial contact.
b. Aerial view of the accident scene.
c. View along direction of flight path, including initial impact point.
d. Damage to objects struck.
e. Engine components.
f. Major parts of wreckage.
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g. Wheel and landing gear components.
h. Detailed view of cockpit, instrument panel, engine controls, switch and radio settings, etc.
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i. All parts involved in, or suspected of, structural failure or having contributed directly to the accident. The photographs should be in sufficient detail to show the grain of metal at the failure point or other detailed information, such as direction of shear, fracture, etc.
5. All photographs should be given exhibit numbers and should carry descriptive captions which give place and date of the accident and point out the details or evidence which they contribute. It is extremely helpful to use a blackboard slate and chalk on which to write captions and inserts into foregrounds of the pictures being taken. The location of the photographer and the direction in which the photographs were taken should be carefully recorded.
6. To produce quality photographs that show greater detail use color film. Fluids and other types of discoloration may not show up on black and white film. Crop and enlarge photos to show greater detail. Poor quality photographs, such as Polaroids or those taken from great distances, can be computer enhanced. The NTSB, FBI and NASA have this capability and are usually receptive to requests for assistance.7. All photographs need to be controlled. They should be seen only by those with a need to see. All photographs must contain the legend "SPECIAL HANDLING REQUIRED IN ACCORDANCE WITH
OPNAVINST 3750.6Q".
5004. WRECKAGE DIAGRAMMING
1. Sketches frequently present information more clearly than any other method. A general sketch of the accident area is highly desirable of most accident sites. It portrays to the analyst a general setting of the accident and the relative location, bearing and distance of the following items from the center of the wreckage:
a. Point of initial contact.
b. Location of deceased or injured personnel.
c. Engines and component parts.
d. All major portions of the aircraft with identification notes.
e. Landmarks or prominent terrain features.
f. Distance and direction to the nearest airport, town or major landmarks.
g. Location of witness(es) whose statement(s) are included.
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h. Elevation (MSL) and north point at scene of mishap.
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i. Path of aircraft by dotted line.
j. Distance between important points or objects.
k. Location and direction in which photos were made (show by arrows).
2. Sketches may also be used to show details of taxing accidents, collisions, proximity of obstructions to runways and taxiways, width or conditions of runways, size, and layout of emergency landing sites and special conditions involved in accidents.
3. Surveyor. In mishaps where aircraft wreckage is scattered over a wide area, it is often beneficial to utilize a surveyor for precise wreckage diagramming. Surveyor assistance can be arranged on short notice through the Engineering Division of Facilities Management. MWSG-37 is an alternate source of surveyor support.5005. TECHNICAL ASSISTANCE
1. Technical assistance rendered to the AMB is advisory in nature and in no case will technical specialists be considered as members of the board, nor will the board be required to accept any conclusions or decisions arrived at by the technical specialists.
2. Sources of technical assistance in the investigation include the following:
a. BUMED
b. Aeromedical Laboratories
c. Environmental and Preventive Medicine Units
d. Aeromedical Safety Officer (AMSO)
e. Armed Forces Institute of Pathology
f. National Institute of Health
g. Aviation Physiology and Water Survival Units
h. Naval Aviation Depots
i. Naval Laboratories and Development Centers
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j. Aircraft and Component Manufacturers
k. Naval Safety Center
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3. When technical assistance is desired in an investigation of aviation material, the AMB should submit a message requesting an Engineering Investigation (EI). Technical assistance can be requested via paragraph 7 of Mishap Reports.
5006. DEEP WATER RECOVERY. If the wreckage is in water of depth precluding location and recovery, it will be necessary to decide whether or not it would be justifiable to attempt recovery of the wreckage. If it is determined that a salvage attempt would be justified, request assistance from CINCPACFLT in paragraph 7 of the Mishap Report. For assistance in determining the feasibility of a salvage attempt, contact Naval Safety Center Aircraft Mishap Investigation Division at (DSN) 564-3321 or (COMM) 804-444-3321.
5007. WRECKAGE PRESERVATION
1. Following an aircraft mishap, the wreckage will not be moved or disturbed for a period of 24 hours except to protect life, limb or property, to facilitate essential military or civil activities, or to protect the wreckage from loss or further damage. In the case of bona fide interference, the Commanding Officer of the airfield or unit concerned is authorized to direct the removal of wreckage to an area where there is no interference. When the wreckage is moved prior to termination of the investigation by the AMB, it is the responsibility of the officer ordering such removal to first take photographs and prepare an accurate plot of the wreckage and wreckage distribution. A record of any damage to the wreckage inflicted during rescue or salvage shall also be maintained. The 24 hour period specified herein is necessary to allow for other activities to receive notification of the mishap and make decisions relative to their interests in conducting an independent investigation.2. When the wreckage is in or under water, the wreckage should be removed as soon as possible and anti-corrosion measures taken. This will normally be conducted by the squadron Emergency Reclamation Team after the Senior Member's approval. A record of any damage inflicted during recovery operations must be maintained. An accurate diagram of underwater wreckage may be difficult to obtain, but an effort should be made. All reasonable efforts will be made to retrieve all items associated in any manner with the aircraft and/or crewmembers.
5008. MISHAP INVESTIGATION REPORT
1. General. Reporting a defined naval aircraft mishap is accomplished through the submission of a Mishap Investigation Report (MIR). These reports are extremely important in preventing the reoccurrence of aircraft mishaps. AMBs must spare no effort in communicating their knowledge of the mishap in the MIR. The success of the Aviation Safety program depends on the submission of complete and open information, opinions and recommendations.
2. Deadline. Mishap Investigation Reports will be submitted for all defined naval aircraft mishaps. The deadline for submission is 30 calendar days following the mishap. If the deadline cannot be met, an extension can be requested from MarForPac (Ref A).
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.5-8
PRE-MISHAP PLAN5009
3. Submission. The Mishap Investigation Report message shall be submitted in accordance with chapter 7 of reference (a). No extra copies of the hard copy report shall be made. The squadron copy shall be locked up and maintained on file for two years following the final endorsement.
5009. RELEASE OF WRECKAGE
1. The Senior Member of the AMB is authorized to release the wreckage for removal or salvage upon completion of all investigations of the mishap. In those cases where investigations are being conducted by other activities, the Senior Member shall not release the wreckage for salvage until all investigating teams have announced the completion of their investigations.
2. When a Naval Safety Center investigator is assigned to an aircraft mishap investigation, he will control the wreckage and all real evidence. No disposition of any wreckage or real evidence shall be authorized by the Senior Member until released by the Naval Safety Center investigator.
3. Once all investigations have been completed, the Senior Member will release the wreckage and real evidence to the reporting custodian. The reporting custodian will notify the controlling custodian that the wreckage is ready for final disposition.
5-9
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
PRE-MISHAP PLAN
CHAPTER 6
HAZARD REPORTING
PARAGRAPH PAGE
PURPOSE . . . . . . . . . . . . . . . . . . . . . . .6000 6-3TYPES OF HAZARDS . . . . . . . . . . . . . . . .6001 6-3NEAR MID-AIR COLLISION . . . . . . . . . . . .6002 6-4IN-FLIGHT PHYSIOLOGICAL EPISODE . . . . . 6003 6-4
NOTIFICATION OF AMB . . . . . . . . . . . . . .6004 6-4NON-PRIVILEGED STATUS. . . . . . . . . . . . .6005 6-5REPORTING. . . . . . . . . . . . . . . . . . . . . .6006 6-5
6-1
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
INTENTIONALLY LEFT BLANK
6-2
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
PRE-MISHAP PLAN
CHAPTER 6
HAZARD REPORTING
6000. PURPOSE. There are three purposes for Hazard Reports, all of which are intended to eliminate hazards:1. To report a hazard and the remedial action taken, so that others may take similar action to eliminate the hazard.
2. To report a hazard and recommend corrective action to be taken by another organization to eliminate the hazard.
3. To report a hazard, so that some other organization may determine appropriate corrective action to eliminate the hazard.
6001. TYPES OF HAZARDS. The following list is provided as examples of situations, conditions, or occurrences which may demonstrate a need for investigation and the reporting of hazard. This list is not all inclusive:
1. Bird and Bat strikes (generic format).
2. Mid-air or near mid-air collisions (special format). See definition in paragraph 6002.3. In-flight physiological episodes (special format). See definition in paragraph 6003.4. Landing necessitated by conditions making further flight inadvisable.
5. Unintentional departures from controlled flight.
6. Jettisoning of external slung cargo loads.
7. Inaccurate weather forecasts.
8. Deficient operations of airfields and shipboard aviation support facilities.
9. Inadequate or improper control of air traffic.
10. Inadequate personnel selection, training or education.
11. Deficient air traffic regulations, procedures or policies, including those published by the FAA.
6-3
6002PRE-MISHAP PLAN
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.12. Faulty air navigational aids.
13. Difficulty in the use of aviation life support or survival equipment not otherwise reportable.
14. Unintentional jettisoning or loss of aircraft parts or externally mounted equipment or stores.15. Lightning strike.
6002. NEAR MID-AIR COLLISION. A Near Mid-Air Collision can be said to have occurred when, in the
opinion of the pilot in command, the safety of an airborne aircraft was jeopardized by the hazardous proximity of another airborne aircraft, not a member of the same flight. The following criteria are applicable in determining a hazardous proximity:
1. A situation where collision avoidance was due to chance, rather than an act on the part of the pilot, or;2. An occurrence which may have resulted in a collision if no action had been taken by either pilot, or;3. A situation involving an estimated miss distance of less than 500 feet.
6003. IN-FLIGHT PHYSIOLOGICAL EPISODE. An In-Flight Physiological Episode can be considered to
have occurred whenever any of the following in-flight conditions exists without a defined Naval Aircraft Mishap:
1. Proven or suspected hypoxia.
2. Carbon monoxide poisoning or other toxic exposure.
3. Hyperventilation.
4. Spatial disorientation or distraction resulting in an unusual attitude.
5. Loss of consciousness for any reason.
6. Other physiological, behavioral, pathological or physical problems which become manifest during flight.6004. NOTIFICATION OF AMB. In order to determine the severity of a hazard the Senior Member of the AMB and the Aviation Safety Officer must be notified. If the hazard is determined to be severe, then a recall of the entire AMB will be required for the purpose of investigating the hazard and issuing a report within 24 hours. Routine hazards will be handled on the next working day.
6-4
PRE-MISHAP PLAN6005
6005. NON-PRIVILEGED STATUS. Hazard reports are not privileged. Care should be taken to avoid giving any impression that Hazard Reports are privileged; they exist solely for the purpose of safety. The only restriction on their use is For Official Use Only. Personnel identifiers such as a name or SSN shall not be included in Hazard Reports.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.6006. REPORTING
1. Type Format. The following formats as found in Chapter 3 of reference (a) apply to Hazard Reports:
HAZARD REPORT (general format)
BIRD STRIKE (generic format)
NEAR MID-AIR COLLISION (special format)
IN-FLIGHT PHYSIOLOGICAL EPISODE (special format)
2. Deadlines. All reports of hazards with a severe risk assessment code should be submitted within 24 hours of detection. All other reports of hazards should be submitted within 30 days of detection.3. A shell for each of the Hazard Report Formats is contained on the Diskette located in the ODO's folder. The following also apply to Hazard Reports:
a. Are "For Official Use Only".
b. Are normally unclassified. If any portion warrants classification, that information shall be omitted and the word "CLASSIFIED" submitted. If a meaningful report cannot be submitted in this fashion, a classified report may be submitted.
c. Are priority messages for severe risk assessment codes.
d. Are routine messages for routine risk assessment codes.
e. Are exempt from Minimize.
f. Are serialized sequentially by type within the fiscal year.
6-5
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
INTENTIONALLY LEFT BLANK
6-6
PRE-MISHAP PLAN
APPENDIX A
INITIAL MISHAP CHECKLIST
1. ODO/SDO: Do not attempt to do this all by yourself. Pull out the Tabs and assign them to available personnel.
DONE TIME ACTION TIME LIMIT TAB
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
( ) ________ Mishap Notification Immediate 1( ) ________ Mishap Verification Immediate 2( ) ________ Overdue Aircraft Immediate 3
(if required)
( ) ________ Start Chronological Log Immediate 4 ( ) ________ Station Notification Immediate 5( ) ________ Start Mishap Recall Immediate 6( ) ________ Mishap Classification Immediate 7( ) ________ Call in MAG-16 Flash Rpt 5 minutes 8( ) ________ Get Weather Observation 30 minutes 9( ) ________ Call in Safety Center Mishap 60 minutes 10
Phone Report (Class A only)
( ) ________ Key Personnel begin chklst ASAP 11( ) ________ Post Security Force ASAP 12( ) ________ Brief on-board personnel ASAP 13
( ) Notify HAZMAT O ASAP
(if required)
( ) ________ Initial MR Message 4 hours
(Class A&B)
( ) Confirm OPREP-3 report 4 hours
submitted (if deployed)
( ) ________ FAA Phone Report 4 hours
(if required)
( ) ________ 1st Amended MR Message 24 hours
(A&B)
2. Go back through all Tabs and ensure proper completion. A-1
PRE-MISHAP PLAN
APPENDIX A
TAB 1
MISHAP NOTIFICATION
1. DATE/TIME OF CALL _______________________________________________________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
2. CALLER'S NAME ___________________________________________________________ 3. CALLER'S PHONE __________________________________________________________4. CALLER'S ADDRESS ________________________________________________________5. WAS CALLER AN EYEWITNESS? YES/NO
6. TIME AND LOCATION OF MISHAP (Road, Map, Landmarks, etc.)
______________________________________________________________________________7. HOW MANY AIRCRAFT WERE INVOLVED? ___________________________________8. TYPE AND DESCRIPTION OF AIRCRAFT, SIZE AND MARKINGS _____________
______________________________________________________________________________9. WAS FIRE INVOLVED? YES/NO
10. IS FIRE TRUCK ON SCENE? YES/NO; HAS ONE BEEN CALLED? YES/NO11. EXTENT OF INJURY TO PERSONNEL
______________________________________________________________________________12. HOW MANY PEOPLE? ______________________________________________________ 13. HAS MEDICAL AID BEEN SUMMONED? YES/NO
14. HAVE PERSONNEL BEEN REMOVED TO A HOSPITAL? YES/NO
15. IF IN A HOSPITAL: WHERE?_________________________________________________ CURRENT CONDITION OF CASUALTIES:
DIAGNOSIS __________________________________________________________________ PROGNOSIS__________________________________________________________________16. EXTENT OF INJURY TO CIVILIAN PERSONNEL?______________________________17. EXTENT OF DAMAGE TO AIRCRAFT?_______________________________________A-1-1
PRE-MISHAP PLAN
APPENDIX A
TAB 1
MISHAP NOTIFICATION
18. EXTENT OF DAMAGE TO GOVERNMENT PROPERTY?_________________________19. EXTENT OF DAMAGE TO PRIVATE PROPERTY? ______________________________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
20. ARE CIVILIAN AUTHORITIES ON THE SCENE? YES/NO WHO?
______________________________________________________________________________21. CAN YOU STAND BY TO DIRECT SECURITY PERSONNEL? YES/NO
22. LOCATION TO MEET AT? __________________________________________________ 23. WITNESSES:
NAME PHONE NUMBER LOCATION
__________ _________________ _____________
24. DESCRIPTION OF MISHAP
_____ _______________________________________________________________ _ _
25. WEATHER AT TIME OF MISHAP_____________________________________________26. CAN A HELICOPTER LAND NEAR OR IN THE VICINITY OF CRASH?
YES/NO
27. ANY WIRES/POLES OR OTHER OBSTACLES IN LANDING AREA?
YES/NO
28. DESCRIBE OBSTACLES____________________________________________________ _____________________________________________________ _____
29. WHOM ELSE HAS BEEN NOTIFIED?
______________________________________________________________________________30. ASK THE PERSON CALLING TO PRESERVE AND NOT DISTURB WRECKAGE UNTIL MARINE CORPS REPRESENTATIVES ARRIVE.
________________________SIGNATURE OF PERSON RECEIVING CALL / TIME
A-1-2
PRE-MISHAP PLAN
APPENDIX A
TAB 2
MISHAP VERIFICATION
1. WAS THE CALL A HOAX???
2. CALL BACK TO SEE IF THEY ANSWER.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.3. DID THEY? YES/NO
4. BE COURTEOUS, BUT TO THE POINT. STATE THAT ONE OF THE QUESTIONS WAS UNCLEAR AND YOU WOULD LIKE MORE INFORMATION IN THAT AREA (SO THEY WILL NOT BE SUSPICIOUS AS TO WHY YOU CALLED BACK).
5. IF YOU SUSPECT A HOAX, CONTINUE, BUT INFORM THE ASO/SENIOR MEMBER OF THE AIRCRAFT MISHAP BOARD OF YOUR SUSPICIONS.
6. SECURE ONE PHONE FOR INCOMING CALLS, THE SAFETY/NATOPS PHONE IS A GOOD PHONE FOR THIS. ENSURE NO OUTGOING CALLS ARE MADE ON THIS LINE.
A-2-1
PRE-MISHAP PLAN
APPENDIX A
TAB 3
OVERDUE AIRCRAFT PROCEDURES
Upon notification of an overdue aircraft (30 minutes past ETA) the ODO/SDO shall:1. If notification is received from squadron personnel, list all pertinent information concerning the flight.
Acft type: ____________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.Buno: _________________
Modex: ________________
Call Sign: __________________________________
Pilot: ______________________________________
Estimated time of return: ___________________
Operating area: _____________________________
Remarks: _____________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Contact Station Operations immediately, EXT. 4277, and declare the aircraft overdue. Speak only with the Operations Officer (or, in his absence, the Senior Marine present). Request that a radio search with approach control be initiated. If radio contact cannot be established declare the aircraft as missing and request that Station activate the crash alarm notifying all stations of missing aircraft.
3. If an aircraft is determined to be missing, proceed under the assumption that an aircraft mishap has occurred and continue with the Aircraft Mishap Checklist located in this appendix.
A-3-1
PRE-MISHAP PLAN
APPENDIX A
TAB 4
CHRONOLOGICAL LOG
1. The ODO/SDO must maintain a chronological log of phone calls, events and actions taken by him and those assisting him.
Date/Time By whom Event
____________/_______ ____________ ___________________________________________
____________/_______ ____________ ___________________________________________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.____________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ _______________________________________________________/_______ ____________ ___________________________________________
A-4-1
PRE-MISHAP PLAN
APPENDIX A
TAB 5
STATION NOTIFICATION
1. Call the MCAS Miramar Station ODO (x4277) and provide the following information:
a. Mishap Location
b. Aircraft Type
c. Bureau Number
d. Modex
e. Souls on Board
f. Nature of Mishap (if known)
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
g. Extent of Injuries (if known)
h. Point of Contact and phone number
2. Ensure that the following agencies are placed on alert or in action (as required). Call those which will not be. The Station ODO should notify the first three agencies listed below. Verify this information with him or her. As the Squadron ODO, you will be responsible for contacting the other agencies if the situation dictates.
a. Miramar Crash Crew x6912 DISPATCHER x6494 OIC x6497
b. Miramar Fire Dispatcher x4059
c. Flight Clearance x4981
d. Miramar Branch Clinic x4656/4655
e. Explosive Ordnance Disposal x6036/6040
f. PMO Dispatcher x1213/Desk Sergeant x4068
g. Miramar Photo Lab x1891 (DWH) / Call PMO ask for duty pager # (AWH)
h. Joint Public Affairs x6000/6648 or 24hrs/day (619) 920-0836
3. Notify appropriate local law enforcement agency by dialing 9911.
A-5-1
PRE-MISHAP PLAN
APPENDIX A
TAB 6
SQUADRON MISHAP RECALL
1. During working hours, send a runner to get or call the personnel listed below. Personnel with asterisk (*) should get called first to ensure that the entire mishap plan is activated.
BILLET HOME PHONE TIME PERSON RECEIVING CALL
CO
BEEPER/CELLPHONE
XO
BEEPER/CELL PHONE
OPSO(AMB)
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
ASO (AMB)
DOSS
AMO
(GO TO TAB 7 AND FINISH RECALL LATER)
FLT SURGEON (AMB)
S-1 O (Death or Serious Injury)
CHAPLAIN (Death or Serious Injury)
S-4 O (For logistic support)
ALT SENIOR MEMBER (AMB)
ALT OPS MEMBER
(If OPSO unavailable)
ALT MAINT MEMBER
(If AMO unavailable)
SGT MAJ
2. This list will be updated on a monthly basis by the ASO.
***SEE PRE-MISHAP PLAN BINDER ON SDO/ODO DESK FOR CURRENT BILLET HOLDERS AND RECALL PHONE #S ***
A-6-1
PRE-MISHAP PLAN
APPENDIX A
TAB 7
INJURY CLASSIFICATIONS
1. Injury classifications are defined below. For reporting purposes the defined injuries are fatal injury, permanent total disability, permanent partial disability, lost workday, lost at sea and missing/unknown.
a. Fatal Injury. An injury which results in death from a mishap or the complications arising therefrom, regardless of the length of time intervening between the mishap and a subsequent death.
b. Permanent Total Disability. Any nonfatal injury which, in the opinion of competent medical authority, permanently and totally incapacitates a person to the extent that they cannot follow any gainful occupation. In addition, the loss of, or the loss of use, of both hands, or both feet, or both eyes, or a combination of any of these body parts as a result of a single mishap will be considered as a permanent total disability.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
c. Permanent Partial Disability. An injury which does not result in death or permanent total disability but, in the opinion of competent medical authority, results in permanent impairment or loss of any part of the body, the loss of the great toe, the thumb, or an unrepairable inguinal hernia, with the following exceptions:
(1) Teeth;
(2) The four smaller toes;
(3) Distal phalanx of any finger;
(4) Distal two phalanges of the little finger;
(5) Repairable hernia;
(6) Hair, skin, nails, or any subcutaneous tissue.
d. Lost Workday Injury. An injury which does not result in death, permanent total disability or permanent partial disability, but which results in one or more lost workdays (not including the day of injury). Lost Workday level injuries are further divided into major and minor categories:
A-7-1
PRE-MISHAP PLAN
INJURY CLASSIFICATION (CONT)
(1) Major Injury. A nonfatal injury which does not result in permanent total disability or permanent partial disability but which results in five or more lost workdays and requires admission to a hospital or quarters, or a combination of both, for five or more days. It also includes any of the following regardless of hospital status:
(a) Unconsciousness for more than five minutes due to head injury;
(b) Fracture of any bone, except simple fracture of the nose or phalanges;
(c) Traumatic dislocation of major joints or internal derangement of the knee;
(d) Moderate to severe lacerations resulting in severe hemorrhage or requiring extensive surgical repair;
(e) Injury to any internal organ;
(f) Any third degree burns, or any first or second degree burns (including sunburn) over five percent of the body surface.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
(2) Minor Injury. An injury less than major which results in one or more lost workdays.
(a) First Aid Injury. An injury requiring minimal treatment or no treatment and not resulting in a lost workday.
(b) No injury.
(c) Lost at sea.
(d) Missing/unknown.
NOTE: Lost at sea and missing/unknown injuries equate to fatality for mishap severity level classification.A-7-2
PRE-MISHAP PLAN
APPENDIX A
TAB 7A
MISHAP CATEGORIES
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-7A-1
PRE-MISHAP PLAN
APPENDIX A
TAB 7B
MISHAP SEVERITY CLASSIFICATION
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-7B-1
PRE-MISHAP PLAN
APPENDIX A
TAB 8
MAG-16 FLASH REPORTGroup Receiver: Time: Date:
Unit Sender: Sqd:________ Ext: Sign:
Aircraft Incident
Airborne Emergency Flight Related
Near Mid Air Flight Mishap
Bird Strike FOD
Dropped Object(TFOA) Ground Emerg
ACFT Ground Mishap Fuel Spill
Other
Time and Date of Incident: General Location: __________________ Lat/Long: __ ___________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Personnel Data (AIRCREW):
Last Name Initials Rank SSN DOB Unit
1. _______________________________ __________
2. 3.
____________________________________________________________________________ 4. ____________________________________________________________________________Narrative:
___________________________________________________________________________________________________________________________________________________________Requires: Follow-up Sqdn Msg
Personnel Injury: None Minor Moderate Major Death Unknown
Extent:
A-8-1
PRE-MISHAP PLAN
MAG-16 FLASH REPORT (CONT)
ACFT Model: BUNO:
Extent of Damage:
Equipment Damage: DOD: Non-DOD:
Group Notification: DOSS GDO (Squadrons will call DOSS, ext 4534 , during working hours, and the GDO, ext 1779, during Non-working hours.)
Comments/Recommendations:
______________________________________________
Follow-up:
______________________________________________Things Falling Off ACFT (TFOA)
Description:
Height: inches
Length: inches
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
Thickness: inches
Weight: pounds
What area of ACFT did object fall off of? ____________________________________________
A-8-2
PRE-MISHAP PLAN
APPENDIX A
TAB 9
WEATHER OBSERVATIONS
1. Call MCAS Miramar Weather (x4028 or x1533/1576/1436) and have them give you the weather for the
mishap location at the time of the mishap.
a. Station:________________________________________________
b. Date/Time of Observation:_______________________________
c. Cloud Cover:____________________________________________
d. Visibility:_____________________________________________
e. Pressure Altitude: ____________
f. Density Altitude: ____________
g. Surface Temperature: ____________
h. Dew Point: ____________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
i. Relative Humidity: ____________
j. Temperature Aloft: ____________
k. Freezing Level: ____________
l. Surface Winds: ____________
m. Winds Aloft: ____________
n. Weather Warnings: ____________
2. Have them confirm this weather brief with the nearest weather station to the mishap location and call you
back.
3. Weather reconfirmed - YES/NO
A-9-1
PRE-MISHAP PLAN
APPENDIX A
TAB 10
SAFETY CENTER MISHAP PHONE REPORT
1. This report is only required for Class A mishaps.
2. The phone numbers for the Safety Center are: DSN 564-3520 or (COMM) 804-444-2929. These numbers
are to be used only for mishap telephone reports.
3. Provide the following information:
a. Reporting Custodian - HMM-163
b. Aircraft type and Bureau Number______________________________________________
c. Mishap Location___________________________________________________________
d. Brief Narrative_______________________________________________________________________________________________________________
e. Point of Contact ___________________, ASO DSN 267-8178/8194/8187
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-10-1
PRE-MISHAP PLAN
APPENDIX A
TAB 11
KEY PERSONNEL CHECKLISTS
1. The following pages contain procedures to be followed by key personnel during the first 24 hours following a mishap.
2. As key personnel arrive, they should get a copy of their appropriate checklist. AMB members should also get a folder from the mishap investigation kit.
3. These checklists are duplicates of the checklists contained in each AMB members folder. It is preferable to distribute the AMB members' folder rather than these checklists. These are intended primarily for ease of reference, or as a backup.
4. Some checklists contain items that must be done within the first four hours. The ODO/SDO and his assistant(s) should attempt to execute these steps, until properly relieved. They should notify the appropriate person of the status of any action taken from a Key Personnel Checklist.
5. Record who received each checklist:
a. Commanding Officer _______________________________________________________
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
b. Senior Member ____________________________________________________________
c. Operations Member _________________________________________________________
d. Maintenance Member _______________________________________________________
e. Aviation Safety Member _____________________________________________________
f. Flight Surgeon _____________________________________________________________
g. Senior S-1 Person __________________________________________________________
h. Senior S-3 Person __________________________________________________________
i. Senior S-4 Person __________________________________________________________
j. Senior Safety/NATOPS Person ________________________________________________
k. Senior Maintenance Person ___________________________________________________
l. Sergeant Major _____________________________________________________________
A-11-1
PRE-MISHAP PLAN
APPENDIX A
TAB 11A
COMMANDING OFFICER'S CHECKLIST
1. Initially the Commanding Officer will make a call to the MAG-16 Commanding Officer. He will then organize a team to assist him in the notification of next of kin, consisting of:
a. Commanding Officer
b. Chaplain
c. Medical Officer
d. Close friend/Squadron mate of deceased/injured personnel
e. Any personnel requested in the deceased's OQR/SRB
2. The following checklist provides the Commanding Officer with a checklist to ensure appropriate and timely action in the event of an aircraft mishap. Those personnel assigned the responsibility of completing required reports shall ensure the Commanding Officer is informed as to the status and completion of such reports. In the event of an aviation mishap involving death, serious injury, extensive damage to government property or the
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
possibility of a claim by or against the government, a JAG Manual Investigation will be initiated in addition to
the AMB's Mishap Investigation. The reports are as follows:
INIT REPORT TITLE TIME LIMIT REFERENCE RESPONSIBLE
____ Notify Next of Kin Immed MCO P3040.4_ CO
____ Casualty Report Immed MCO P3040.4_ S-1
____ Overdue Aircraft Rpt Immed SqdnO P3750.1_ ODO
____ Mishap Flash Report 5 min WgO P5100.1_ ASO,ODO ____ Telephone Mishap Rpt 60 Min OPNAV 3750.6_ ODO
____ Engine Transaction ASAP COMNAVAIRPAC AMO
Report 13700.9_
A-11-2
PRE-MISHAP PLAN
COMMANDING OFFICER'S CHECKLIST (CONT)
INIT REPORT TITLE TIME LIMIT REFERENCE RESPONSIBLE
____ HAZMAT Officer ASAP OPNAV 4790.2 HAZMATO/
notified in event ASO
of a spill
____ Appoint JAG Invest 4 hrs JAGINST 5800.7_ CO
____ Initial Mishap Rpt 4 hrs OPNAV 3750.6_ ASO,ODO (Class A & B)
OPREP-3 report 4 hrs OPNAV 3100.6 ASO/Host Station
(when deployed)
____ Telephone Rpt to FAA 4 hrs OPNAV 3750.6_ ASO,ODO____ Acft Status Change By 2400 COMNAVAIRPAC AMO
Report day of mshp 5442.2_ ____ Initial Mishap Rpt 24 hrs OPNAV 3750.6_ ASO,ODO (Class C)
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
____ 1st Amended Mishap 24 hrs OPNAV 3750.6_ ASO Rpt (Class A & B)
____ Request for EI 24 hrs OPNAV 4790.2_ AMO
Request for salvage 24 hrs OPNAV 4790.2 ASO,AMO
____ Message to FAA 24 hrs OPNAV 3750.6_ ASO,ODO ,SDO____ Letter of Condolence 72 hrs MCO P3040.4_ CO
____ Rescue Report 7 days NWP 37-1 AMB____ MIR 30 days OPNAV 3750.6_ AMB____ JAG Investigation TBD JAGINST 5800.7_ A
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. OFFICER
CO Endorsement on 15 days OPNAV 3750.6 CO
MIR after MIR
release
A-11-3
PRE-MISHAP PLAN
APPENDIX A
TAB 11B
SENIOR MEMBER CHECKLIST
1. Proceed to the ready room and take charge of the investigation.2. Coordinate logistics and security with the logistics officer.3. Ensure that the Mishap Plan is proceeding as required.
4. Impound all records listed in Tabs 11H, 11J, and 11K.
5. Act as central clearing house for information.
6. Collect all records generated by the ODO/SDO in the execution of the Mishap Plan.7. Arrange for services of photographer for earliest possible photography.8. Arrange for the support of a surveyor.
9. Direct efforts of AMB members and ensure their active participation in the investigation and completion of
all tasks assigned.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.10. When required, make recommendations to the appointing authority concerning the augmentation of the AMB or changes to the membership.
11. Keep the Commanding Officer posted as to the progress of the investigation.
12. Release the initial Mishap Report message within 4 hours for a Class A or B and 24 hours for a Class C.13. Release the FAA Message (if required) within 24 hours.
14. Ensure that names of all witnesses are passed to the JAG Investigator in a timely manner. Ensure that the JAG Investigator is aware of his reciprocal responsibility.
15. Ensure HAZMAT Officer is notified in the event of a spill.
A-11-4
PRE-MISHAP PLAN
APPENDIX A
TAB 11C
OPERATIONS MEMBER CHECKLIST
1. Report to the scene of the aircraft mishap, unless otherwise instructed by the Senior Member.2. Take charge of media relations until relieved by JPAO. Intercept attempts to obtain non-releasable information.
3. Identify and obtain initial interviews of on-scene witnesses.
4. Obtain the following:
a. Pertinent air operations regulations and flight directives.
b. Data regarding mission, flight briefing, flight plans, flight attitude, flight track and phase of flight. (Tab 11H of Appendix A)
c. Report on navigation and airfield facilities involved.
d. Report on any flight rule violation.
e. Record of all radio communication of the flight.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.5. Provide each member of the AMB with suitable charts of the mishap site and flight path.6. Assist in any other areas as the Senior Member directs.
7. Assist the ASO as necessary.
A-11-5
PRE-MISHAP PLAN
APPENDIX A
TAB 11D
AIRCRAFT MAINTENANCE MEMBER CHECKLIST
1. Report to the scene of the aircraft mishap unless otherwise instructed by the Senior Member.2. Bring an Illustrated Parts Catalog and any other appropriate Maintenance Instructions. A QAR may be useful, but remember that he is neither a board member nor is he privy to board deliberations.3. Examine the mishap scene with the Aviation Safety Member for the following:
a. Controls
b. Extremities (possible mid-air)
c. Airframe surfaces for fire, leaks, ruptures, flow patterns, fuel, oil, hydraulic systems lines, plumbing, tanks, gaskets, seals, strainers, sumps, etc..
d. Cockpit
e. Escape hatches
f. Rotors
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
g. Accessories
h. Engines
(1) Compressor Case Section
(2) Turbine Case Section
(3) Accessory Section
i. Dynamic Components
4. Obtain fuel from each tank, oil from each engine and gearbox, and hydraulic fluid samples.5. Supervise the tagging of all parts.
6. Note damage, to distinguish from possible subsequent damage by the recovery crew.
A-11-6
PRE-MISHAP PLAN
AIRCRAFT MAINTENANCE MEMBER CHECKLIST (CONT)
7. Coordinate with the Aviation Safety Member in preparing EI requests and/or other messages required by reference (c) for submission to the Senior Member.
8. Prepare requests for recovery of the wreckage and for space to make a wreckage layout or airframe buildup if necessary.
9. Carry out all other instructions as directed by the Senior Member.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-11-7
PRE-MISHAP PLAN
APPENDIX A
TAB 11E
AVIATION SAFETY MEMBER CHECKLIST
1. Report to the scene of the mishap with the mishap investigation kit unless instructed otherwise by the Senior Member. Bring a video camera if available.
2. Ensure that the wreckage is not moved.
3. Make an initial walk-through.
4. Identify hazards and mark them.
5. Take initial Polaroid and video photographs of the wreckage and area and supervise subsequent photography.
6. Prepare initial wreckage diagrams and sketches.
7. Assume the duties of the other members not present, until relieved.
8. Assist the Operations member in identifying and obtaining initial witness statements and arrange for translator service, if required.
9. Act as recorder for the AMB and perform the following:
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
a. Ensure timely submission of all safety reports.
b. Take accurate notes on all board meetings.
c. Assemble and present the final report for the Senior Member.
10. Prepare the Initial and First Amended Mishap Reports for the Senior Member's release within the allotted
deadlines as per reference (a).
11. Ensure OPREP-3 report has been submitted via host station if deployed.12. Carry out all other instructions as directed by the Senior Member of the AMB.
A-11-8
PRE-MISHAP PLAN
APPENDIX A
TAB 11F
FLIGHT SURGEON CHECKLIST
1. If there are survivors, proceed to their location.
2. If there are no survivors, proceed to the location of the remains.
3. If unknown, report to the scene of the mishap.
4. Supervise the treatment and handling of any injured personnel and attempt to prevent further injury.5. Conduct initial medical examinations, including collection of required biological samples.6. Obtain aircrew/survivor statements.
7. Construct 72 hour histories.
8. Ground all involved aircrew.
9. Impound medical and dental records.
10. Impound all flight equipment.
11. Determine injury codes.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.12. Photograph all fatalities before movement.
13. Effect liaison with civil authorities/coroner concerning remains.
14. Notify Naval Safety Center and AFIP of location of remains.
15. Attend autopsy, ensure appropriate biological samples are obtained.
16. Conduct liaison with civilian medical personnel and facilities if crew/passengers have been treated by them.17. Investigate the adequacy and functioning of survival equipment in the crash and post crash situation.18. Examine escape hatches for adequacy and functioning.
A-11-9
PRE-MISHAP PLAN
FLIGHT SURGEON CHECKLIST (CONT)
19. Request via the Senior Member assistance from an AMSO or AFIP, as required.20. Carry out all other instructions as directed by the Senior Member.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.A-11-10
PRE-MISHAP PLAN
APPENDIX A
TAB 11G
S-1 CHECKLIST
1. Confirm identity of deceased or seriously injured personnel and circumstances surrounding mishap. Obtain
the following information for each deceased or injured person:
a. Name, rank, SSN
b. Time, place and cause of death
2. Obtain OQR/SRB and check RED and BIR/BTR for pertinent NOK information.3. Notify squadron CACO and assist in the notification of:
a. MAG-16 Adjutant (DWH x6593)
b. MAG-16 GDO (AWH x1779)
c. Duty Chaplain (x1662) --Ask GDO to contact after hours
d. Command Duty Officer (DWH/AWH x1141)
4. Release Personal Casualty Report (PCR) message to HQMC within 24 hrs (IAW Marine Corps Casualty Procedures Manual Appendix A).
5. Release message confirming notification of next of kin by personal condolence visit.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.6. Close out OQR/SRB.
7. Run Unit Diary entries.
8. Assist the CO in preparation of condolence letter.
9. Ensure payment of Death Gratuity.
10. Prepare travel orders for AMB members if required.
A-11-11
PRE-MISHAP PLAN
APPENDIX A
TAB 11H
S-3 CHECKLIST
1. If mishap is off base, have airborne aircraft recalled and prepared for transporting passengers to the crash
site.
2. Obtain all of the following: Flight Logbooks and Training Jackets of all crewmembers involved in flight,
original and corrected flight schedule for the day, filed flight plans, load computation forms, ORM worksheets,
copies of recent flight schedules and NAVFLIRs concerning the mishap crew and aircraft.3. Fill in the following information:
a. Name/Rank/Designation/SSN: HAC: ____________________________________
COPILOT: ____________________________________
HAC COPILOT
b. Primary duties:
c. Collateral duties:
d. Total pilot hours:
e. Hours in model: (7)
(total, last 7, (30)
30, 60, 90 days) (60)
(90)
f. Instrument hours: (30)
(last 30, 60, 90 days) (60)
(90)
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
g. Night hours: (30)
(last 30, 60, 90 days) (60)
(90)
h. Flight hours: (24)
(last 24, 48 hours) (48)
i. NVG hours: (total)
(total, last 30, 60, (30)
90 days) (60)
(90)
4. Provide all of the above to the Senior Member of the AMB.
A-11-12
PRE-MISHAP PLAN
APPENDIX A
TAB 11I
S-4 CHECKLIST
1. If mishap is on base or within a short driving distance, arrange for ground transportation of the security force
and AMB. If it is farther coordinate with the S-3.
2. Designate an officer or SNCO as a security officer, get 4-6 Marines for the security force from the Sergeant
Major, Night Crew or the DNCO and complete Tab 12 of this Appendix.
3. Coordinate with 3d MAW to have a cellular phone and video camera at the crash site.4. In conjunction with the Sergeant Major, arrange a watch schedule.
5. Notify the EDF and arrange for food and water for personnel at mishap site.6. Notify Marine Corps Property and arrange for all necessary gear and shelter.7. Arrange for the inventory of personnel effects of any deceased or hospitalized personnel.8. Ensure HAZMAT Officer is notified in the event of a spill.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-11-13
PRE-MISHAP PLAN
APPENDIX A
TAB 11J
SAFETY/NATOPS CHECKLIST
1. Obtain the NATOPS Jackets of all Crewmembers involved in flight.
2. Fill in the following information:
a. Name/Rank/Designation/SSN HAC:__________________________
COPILOT:__________________
HAC COPILOT
b. Date designated a Naval
Aviator:
c. Age:
d. Date commissioned: e. Date of
initial and latest
NATOPS qualification in model:
f. Type instrument card/
expiration date: / /
g. Other aircraft qualified in:
(type/hours)
h. Special qualifications:
(Mission commander, WTI, etc.)
i. Special training:
(WTI, ASO School, etc.)
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
j. Survival training (last date)
(1) Aviation physiology:
(2) Water survival/DWEST:
(3) SERE/JEST:
k. ACT (last training date)
l. Date of last Egress Drill
3. Provide all of the above to the Senior Member of the AMB as soon as possible.A-11-14
PRE-MISHAP PLAN
APPENDIX A
TAB 11K
MAINTENANCE CHECKLIST
1. Provide all of the following to the Senior Member of the AMB as soon as possible: Aircraft and engine
logbooks, Aircraft Discrepancy Book, all copies of outstanding Maintenance Action Forms, and records on all
flight equipment checked out to the mishap aircraft.
2. Prepare the following reports:
a. Aircraft Status Change Report by 2400 on the day of the mishap.
b. Engine Transaction Report as soon as possible.
c. Request for Engineering Investigation when required/desired by AMB.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-11-15
PRE-MISHAP PLAN
APPENDIX A
TAB 11L
SERGEANT MAJOR CHECKLIST
1. Provide personnel for the Security Force.
2. Assist the Commanding Officer as necessary in notification of NOK.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-11-16
PRE-MISHAP PLAN
APPENDIX A
TAB 12
POSTING OF SECURITY FORCE
1. This checklist will be accomplished by the SDO or the S-4 Officer.
2. The initial security force will be comprised of any available personnel. They should be relieved as soon as possible by a better prepared and scheduled security force. This will be coordinated by the S-4 and the Sergeant Major.
3. The Security Officer will be an officer or SNCO for at least the first 72 hours.
4. All personnel should be provided with a copy of the Instructions for Security Force (Tab 12A). The Security Officer will ensure that it is thoroughly understood by all.
5. The Security Officer will bring several copies of the News Media Mutual Cooperation statement (Appendix B) for use as necessary.
6. Ensure all Marines have necessary food/water/clothing prior to departure.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-12-1
PRE-MISHAP PLAN
APPENDIX A
TAB 12A
INSTRUCTIONS FOR SECURITY FORCE
1. Comply with all General Orders of Sentries and all Special Instructions issued by higher authority.2. Safeguard life and property, preserve the wreckage and prevent abuse of civil property.3. Control traffic and maintain a clear lane for emergency vehicles.
4. Allow only authorized firefighting, medical and mishap board personnel access to the accident scene. This access will be granted only after it has been determined that no danger to life exists from fire or explosion of the wreckage. Joint Public Affairs and authorized representatives of the press are allowed access but should first be referred to the Senior Member of the mishap board present.
5. Prohibit smoking in the crash area. There is likely fuel, oil and fluids throughout the area.6. Record the name, address and telephone number of any witness to the accident and present this information to the Senior Member of the Aircraft Mishap Board present.
7. Use no violence in the performance of these duties. If persuasion is unsuccessful, attempt to discover names, addresses, descriptions and/or automobile license numbers of individuals tampering with the wreckage and present these to the Senior Member of the Aircraft Mishap Board present. Obtain the help of local law enforcement officials if present.
8. DO NOT MOVE OR HANDLE ANY PIECE OF THE WRECKAGE. You may be destroying evidence.
Ensure that no portion of the wreckage is disturbed or removed unless authorized by the Senior Member of the Aircraft Mishap Board. Take all precautions to prevent alteration of any ground marks made by the aircraft.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.9. Refer all general public and news media inquiries concerning the accident to the Joint Public Affairs Officer or senior member of the Aircraft Mishap Board present. Security Force personnel are not authorized to give out any information concerning the accident.
10. In the event of questionable activity by reporters or photographers, do not use force to stop them. Call the senior person available to deal with them. Obtain their name and the name of the firm they represent.A-12-2
PRE-MISHAP PLAN
APPENDIX A
TAB 13
BRIEF FOR ON-HAND PERSONNEL
1. All personnel in the squadron area should be briefed as follows (to save time, gather shop supervisors and have them pass the word to the troops):
a. Fill them in on the general situation. Do not release the aircraft or names of personnel involved.
b. Ensure that all personnel are informed that they are not to comment on the accident to anyone, including dependents. Only the Joint Public Affairs Office at MCAS Miramar may release any information concerning the mishap to civilian interests. UNDER NO CIRCUMSTANCES SHALL INFORMATION INVOLVING
THE MISHAP BE PASSED TO ANYONE OUTSIDE OF THE SQUADRON, EXCEPT IN THE CASE OF
NECESSITY FOR THE PERFORMANCE OF SEARCH AND RESCUE OPERATIONS!
c. Personnel should be specifically briefed not to pass any information concerning the mishap to dependents. The dependents' "grapevine" is often far more efficient than the official recall and next-of-kin notification process. It is conceivable that the next-of-kin could receive notification by way of the grapevine before it is possible to notify them by way of official channels. This must be avoided at all costs!
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
A-13-1
PRE-MISHAP PLAN
APPENDIX B
NEWS MEDIA MUTUAL COOPERATION STATEMENT
In the interest of fostering a good working relation between our organizations, it is requested that you and your associates adhere to certain guidelines. If available, a Marine will be assigned to you as a guide. For your personal safety stay with him, follow his instructions, and get clearance from him before proceeding. He is not allowed to answer questions pertaining to the mishap, so please do not ask. Refer these questions to the Joint Public Affairs Officer, MCAS Miramar, 619-577-6000, after hours 619-920-0836.
Do not pick up or disturb any wreckage, doing so poses a safety hazard to you and may destroy valuable investigative evidence.
You are allowed to take and publish all the photographs desired with two exceptions. Photos of classified material are strictly forbidden. If photos of classified material are taken, the FBI will be informed. Out of respect for those involved and their families, photos of injured or deceased personnel should not be published.
To aid in the investigation, we request that copies or negatives of all photographs taken be sent to:
Commanding Officer
ATTN: Aircraft Mishap Board
HMM-163
MCAS Miramar P.O. BOX 452117
San Diego, CA 92145-2117
Your cooperation is greatly appreciated.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
B-1
PRE-MISHAP PLAN
APPENDIX C
AIRCRAFT DETACHMENT COMMANDER CHECKLIST
1. Contact local SAR facility, if required.
2. Ensure that Det Duty Officer is completing Appendix A by making all reports to home base via phone or FAX. The squadron will submit all reports to higher headquarters. Pass any information concerning OPREP-3 reports that may have been sent by the host station.
3. Contact the nearest military installation's station operations office, if not at a station. They should provide all initial support required.
4. Proceed to the mishap site and take command of the site. Coordinate all recovery operations.5. Transport aircrew to nearest medical facility, regardless of degree of injury. Request an examination which shall include X-rays, blood and urine analysis and examination by a qualified medical officer (preferably a Flight Surgeon).
6. Obtain initial statements from all aircrew and witnesses utilizing Appendix D.
7. Ensure wreckage is not moved until the AMB arrives, unless it poses a threat of further injury or property damage. If it must be moved, ensure photographs are taken prior to and during the move.
8. Take all actions necessary to safeguard personnel and equipment.
9. Obtain a photographer, and photograph the wreckage, site and damaged parts. Utilize paragraph 5003/5004 as a guide.
10. Keep the squadron informed of all actions taken or anticipated.
11. Instruct all crew members to write a 24 hour and 72 hour history statement. The 72 hour statement should include: meals consumed, all periods of rest, physiological and emotional stress. The 24 hour statement should place particular emphasis on preflight briefing, conduct of the flight, emotional or physiological stress. Remind them of the privileged nature of their statements.
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
C-1
PRE-MISHAP PLAN
12. Standby for the AMBs arrival. With luck they will arrive soon and you will not have to complete all of
these steps yourself. On their arrival, provide them with:
a. Crewmember statements
b. Witness statements
c. Photographic evidence
d. Relevant medical forms
e. Status of your checklist
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
C-2
PRE-MISHAP PLAN
APPENDIX D
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
D-1
PRE-MISHAP PLAN
APPENDIX E
ASO'S MASTER MISHAP CHECKLIST
1. The following checklist should be used by the ASO/Senior Member to ensure all aspects mishap reporting
and its investigation are in compliance with references (a) through (k):
DONE TIME ACTION TIME LIMIT RESPONSIBLE
( ) MISHAP NOTIFICATION N/A ODO( ) MISHAP VERIFICATION IMMEDIATE ODO( ) OVERDUE AIRCRAFT
PHONE CALL TO STATION IMMEDIATE ODO( ) START CHRONOLOGICAL LOG IMMEDIATE ODO( ) STATION NOTIFICATION IMMEDIATE ODO( ) START SQDN MISHAP RECALL IMMEDIATE ODO( ) MISHAP CLASSIFICATION IMMEDIATE ODO( ) NOTIFY NEXT OF KIN IMMEDIATE CO( ) CASUALTY REPORT IMMEDIATE S-1 ( ) CALL IN MAG-16 FLASH RPT 5 MINUTES ODO( ) COMPLETE SQDN
MISHAP RECALL 10 MINUTES ODO
( ) GET WEATHER OBSERVATION30 MINUTES ODO( ) SAFETY CTR PHONE REPORT 60 MINUTES ODO,ASO( ) KEY PERSONNEL CHECKLIST
TAKEN FOR ACTION (TAB 11) ASAP ODO,ASO( ) POST SECURITY FORCE ASAP SGT MAJ
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
( ) CALL PHOTOGRAPHER ASAP ASO,ODO
E-1
PRE-MISHAP PLAN
ASO MASTER MISHAP CHECKLIST (CONT)( ) COORDINATE VEHICLE & ASAP S-4
LOGISTICAL SUPPORT TO SITE
( ) HAZMAT O NOTIFIED IN ASO,ODO/
THE EVENT OF A SPILL ASAP HAZMATO( ) VIDEO CAMERA/CELL PHONE
FROM WING TO CRASH SITE ASAP S-4( ) COLLECT NATOPS JACKETS, AND
CREATE A WORK SHEET ASAP NATOPS
( ) COLLECT TRAINING JACKETS,LOG
BOOKS ROUGH FLT SCHED,ECT. ASAP S-3 ( ) ENGINE TRANSACTION REPORT ASAP AMO( ) BRIEF ON-BOARD PERSONNEL 1 HOUR ASO ( ) INITIAL MISHAP REPORT MSG 4 HOURS ASO
(Class A and B only)
( ) OPREP-3 report submitted 4 HOURS Host Station( ) TELEPHONE REPORT TO FAA 4 HOURS ASO ( ) APPOINT JAG INVESTIGATOR 4 HOURS CO( ) ACFT STATUS CHANGE RPT BY 2400 AMO
DAY OF MSHP
( ) INITIAL MISHAP REPORT 24 HOURS ASO
(Class C)
( ) 1ST AMENDED MISHAP RPT
MESSAGE (Class A and B) 24 HOURS ASO( ) REQUEST FOR EI 24 HOURS AMO( ) REQUEST FOR SALVAGE 24 HOURS ASO,AMO
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
E-2
PRE-MISHAP PLAN
ASO MASTER MISHAP CHECKLIST (CONT)
( ) MESSAGE TO FAA 24 HOURS ASO
( ) LETTER OF CONDOLENCE 72 HOURS CO
( ) RESCUE REPORT 7 DAYS AMB
( ) MISHAP INVESTIGATION REPORT 30 DAYS AMB
( ) REVIEW JAG INVESTIGATION
PRIOR TO ITS RELEASE TBD ASO
( ) CO'S ENDORSEMENT ON MIR 7 DAYS CO
AFTER MIR
RELEASED
Supplement to CSFWPINST 3750.1A
Use for guidance only. Timeline info may not be up to date. See referenced instructions for latest guidance.
E-3
SQUADRON PERSONNEL POST-MISHAP RESPONSIBILITIES1. This enclosure contains individual responsibility lists for various squadron personnel who will be involved with mishap investigations and reporting.
2. If the Aviation Safety Officer is not present, assign someone to pass
out the individual Responsibility Sheets to the appropriate individuals.3. Return to the Post-Mishap Emergency Action Checklist and proceed.
COMMANDING OFFICER MISHAP RESPONSIBILITIES
1. In the event of a mishap involving a fatality or serious injury, the following personnel will coordinate efforts and proceed to the primary/secondary next-of-kin’s residence(s) (PNOK/SNOK), if local, as soon as possible to provide notification. (At a minimum, a Chaplain and a Casualty Assistance Calls Officer (CACO) nearest the PNOK’s location must notify the PNOK within twenty-four (24) hours of the mishap).
a. Commanding Officer (CO) (or Executive Officer in the CO’s absence).
b. CACO
c. Chaplain
d. Close friend
e. Medical Officer
f. Other available personnel specified in the individual’s personal data file.
2. Direct one person in the above group to contact the Squadron Duty Officer and have them inform the Admin Officer that all PNOK/SNOK have been notified.
3. Determine if it is impractical for the squadron to investigate the mishap, for whatever reason. If this is the case, request relief from investigative and reporting responsibilities from AIRPAC in the initial or an amended Mishap Report.
4. Appoint an Aircraft Mishap Board (AMB) per reference (b) paragraph 206. Direct the Admin Department to issue appointment letters.5. Initiate a JAG Manual Investigation in all cases where death or serious injury, extensive damage to property occurs or where a possible claim against the government exists. IN NO CASE MAY AN AMB MEMBER BE
TASKED TO CONDUCT A JAG MANUAL INVESTIGATION FOR THE SAME MISHAP THE AMB IS INVESTIGATING.
6. Within 24 hours after a major accident in CONUS, present a briefing to the Senior Commander present. The briefing will include, but is not limited to the following:
a. Accident
Date:
Reporting Custodian:Model:
BUNO:Pilot:
b. General Description of the Mishap:
(1) Damage/injury to other than military property/personnel.
(2) Planning and preparation conducted for the mission.
(3) State of training of all persons involved in the mishap for the mission assigned.
(4) Possible material/maintenance factors, including performance of maintenance personnel.
(5) Pilot/LSO performance.
(6) Supervisory performance. (This is most important in the flag officers briefing).
(7) Diagrams, charts and other items deemed appropriate.7. Maintain liaison with COMNAVAIRPAC, COMCARAIRWING NINE, COMSTRKFIGHTWINGPAC and other higher authority as required.8. The following is a chronological list of all reports that the squadron will be required to complete.
MESSAGE/REPORTDEADLINE (from time notified)
OPREP-3 Voice Report0+05 (Class A or Class B)
OPREP-3 Message Report0+20 (Class A or Class B)
Lost Material ReportASAP (Class A)
NAVSAFECEN phone report1+00 (Class A or Class B)
Press release1+00 (when press interest is expected)
PNOK/SNOK telephone report to BUPERSUpon receiving confirmation that
Casualty SectionPNOK/SNOK have been notified.
PNOK/SNOK Notification Report toUpon receiving confirmation that
BUPERSPNOK/SNOK have been notified.
Casualty Report4+00 (Class A)
FAA notification message4+00 (when civil/commercial aircraft
or facilities are involved)
Initial Mishap Report4+00 (Class A or Class B)
SORTS message4+00 (all mishaps)
Base Environmental Division notification4+00 (for HAZMAT spills)
Engine Transaction ReportNLT 1200 local of the day following
the mishap (Class A or Class B).
Combined Strike/X-Ray Equipment LossNLT 2359 local of the day
Reportfollowing the mishap (Class A)
HMRs, QDRs, TPDRs24+00 (all mishaps)
Senior Commander briefing24+00 (Class A or Class B)
First amended Mishap Report24+00 (Class A or Class B)Initial Mishap Report24+00 (Class C)
CO’s letter to Next-of-Kin48+00 (Class A)HAZREPs1 to 7 days (all mishaps)
Mishap Investigation Report30 Days (all mishaps)
OPERATIONS OFFICER MISHAP RESPONSIBILITIES
1. Immediately secure and submit the following items to the Aviation Safety Officer (ASO) or the Aircraft Mishap Board (AMB) Senior Member.
a. The original flight schedule for the date of the mishap, plus any
changes made during the day. The words “Certified To Be A True Copy” will appear on it along with your signature.
b. Aviator Flight Log Books for each member involved in the mishap.
c. A copy of the DD Form 175 (Military Flight Plan) or DD Form 1801 (International Flight Plan) and the DD Form 175-1 (Weather Briefing) if available.
d. A completed OPNAV 3752/12, Aircrew Data Form (S/N 0107-LF-037-5260).2. Transmit a SORTS message as soon as feasible but no later than four (4) hours after a major aircraft mishap.
3. Notify the FAA within four (4) hours by telephone and message per OPNAVINST 3750.16 (series) (FAA/NTSB Participation in Military Aircraft Mishaps) if operating ashore and an FAA/civil facility and/or a civil/commercial aircraft is involved in the mishap,. See TAB M of Enclosure (3).
4. Coordinate and schedule the necessary logistic flight to support the AMB if the mishap site is not in the local area.
5. Remove AMB members from flying duties until otherwise notified by the AMB Senior Member.
6. Ensure a Lost Material Report is submitted per the CMS-4K (Communications Security Material System (CMS) Manual) if any CMS material is lost or destroyed as a result of the mishap.
7. Coordinate with the Admin Department to establish funding for the mishap investigation through COMSTRKFIGHTWINGPAC Supply (normally) as required.
8. Ensure the Assistant Operations/Training Officer, the Communications Officer, the Training Officers and Landing Signals Officers are available and are provided full cooperation in the completion of their assigned tasks.
9. Complete OPNAV Form 3750/25 (MIR Enclosure Form 9) for each crew member as appropriate. Submit this form and all other required paperwork to the AMB within five (5) days following the mishap.
10. Assist the AMB as directed.
TRAINING/ASSTISTANT OPERATIONS OFFICER MISHAP RESPONSIBILITIES1. Upon being notified of the mishap, secure and submit the following items to the Aviation Safety Officer (ASO) or the Aircraft Mishap Board (AMB) Senior Member.
a. Training jackets for the applicable aircrew involved in the mishap.
b. If not part of the training jacket, all evaluation/debrief sheets for all aircrew involved in the mishap.
c. A copy of the squadron training instruction and/or the aircrew training syllabi.
2. Be prepared to discuss the entire training syllabus with the AMB at length.
3. If required by the squadron Safety Officer, proceed to the mishap site to assist in locating and interviewing witnesses. Ensure you have a tape recorder, pencil and paper and copies of the witness statement form (available from the Squadron Duty Officer). Report to the ASO or the AMB Senior Member upon arrival at the scene.
4. Assist the AMB as directed.
COMMUNICATIONS OFFICER MISHAP RESPONSIBILITIES
1. Monitor the status of OPREP-3 reports. Ensure the Commanding Officer and the Squadron Duty Officer (SDO) are aware of the time limits and requirements for initial and follow-up reports.
2. Assist the SDO, Aviation Safety Officer, AMB Senior Member, Admin Officer and Maintenance Officer in preparing required reports and ensure such reports are released under the appropriate time limits.3. Maintain separate incoming/outgoing files for mishap related messages. Place clean copies of all outgoing and incoming messages relating to the mishap into the respective files. Maintain log sheets listing the subject, originator and date/time group of all such messages.4. Assist the Aircraft Mishap Board as directed.
5. The following is a chronological list of all messages that the squadron will be required to transmit.
MESSAGE/REPORTDEADLINE (from time notified)
OPREP-3 Report0+20 (Class A or Class B)
SITREP Report0+20 (Class C)
Lost Material ReportASAP (Class A)
Press Release1+00 (when press interest is expected)
PNOK/SNOK Notification Report toUpon receiving confirmation that
BUPERSPNOK/SNOK have been notified.
Casualty Report4+00 (Class A)
FAA Notification Message4+00 (when civil/commercial aircraft or facilities are
involved)
Initial Mishap Report4+00 (Class A or Class B)
SORTS Message4+00 (all mishaps)
Engine Transaction ReportNLT 1200 local of the day following
the mishap (Class A or Class B).
Combined Strike/X-Ray Equipment LossNLT 2359 local of the day
Report following the mishap (Class A)
First amended Mishap Report24+00 (Class A or Class B)
Initial Mishap Report24+00 (Class C)
MESSAGE/REPORTDEADLINE (from time notified)
HMRs, QDRs, TPDRs24+00 (all mishaps)
HAZREPs1 to 7 days (all mishaps)
Mishap Investigation Report30 Days (all mishaps)
LANDING SIGNALS OFFICER MISHAP RESPONSIBILITIES
1. Be prepared to discuss the landing and approach competence of the mishap pilot with the Aircraft Mishap Board (AMB) in detail. Be prepared to submit a written report if required.
2. Assist the Aviation Safety Officer (ASO) during the investigation of shipboard mishaps as directed. You may be directed to interview the Catapult and Arresting Gear Officer, CATCC personnel, the Air Officer and Pri-Fly personnel.
3. If personally involved in the mishap as the Landing Signals Officer (LSO), submit a written statement concerning the events leading up to the mishap. Include a separate statement concerning your experience and qualifications as an LSO.
4. Prepare a statement for the AMB describing the operation and limitations of all landing and approach equipment used (e.g., arresting gear, abort gear, Fresnel Lens Optical Landing System, abort gear, over-run gear, etc.).
5. Assist the ASO in obtaining custody of any PLAT tapes of the mishap. The tapes will now be classified CONFIDENTIAL per reference (b) paragraph .6. Assist the AMB as directed.
SCHEDULES OFFICER MISHAP RESPONSIBILITIES
1. Acquire the master flight schedule for the date of the mishap and have fifteen (15) copies made. (Check with the Aviation Safety Officer before making the copies). Stamp one copy as “Certified To Be A True Copy” and sign it with name, rank and service. Present all copies to the Operations Officer.
2. Deliver the log books for all mishap crew members to the Operations Officer for temporary custody.
3. Assist the AMB as directed.
MAINTENANCE OFFICER MISHAP RESPONSIBILITIES
Prior to a mishap:
1. Act as the Maintenance Department representative on the mishap search/investigation team. Through the Quality Assurance Officer, you are responsible for training a team of maintenance experts that will be concerned with the aircraft wreckage and all facts that can be derived from analysis of the various parts.
Following a mishap:
1. Secure all applicable aircraft log books and maintenance records and submit them to the Aviation Safety Officer (ASO) or the Aircraft Mishap Board (AMB) Senior Member.
2. Prepare and submit the following items and any additional assigned reports to the ASO or the AMB Senior Member within five (5) days following the mishap.
a. Maintenance Officer statement.
b. Maintenance Discrepancy Record.
c. Completed OPNAV 3750/26 (MSIR Enclosure Form 10) for each mishap aircraft.
d. Handbook of maintenance instructions.
e. Illustrated parts breakdown as required.
3. If the wreckage is submerged, coordinate with the AMB to determine if recovery and salvage is feasible. If salvage is possible, assist the ASO in preparing the message request for salvage.
4. Coordinate with technical service personnel to assist the AMB as necessary.
5. Prepare all necessary requests for Planning and Estimating (P&E) and Engineering Investigation services.
6. Ensure a Combined Strike X-Ray/Equipment Loss Report message is submitted per reference (e) not later than 2359 local on the day following the mishap (if applicable).
7. Ensure an Engine Transaction Report message is submitted per reference (m) not later than 1200 local on the day following the mishap (if applicable).
8. Ensure any necessary HMRs, QDRs, or TPDRs are submitted per reference (d) within twenty-four (24) hours following notification of the mishap.
9. Coordinate with members of the AMB and the Maintenance Department to determine if material failure or maintenance practices might be involved and initiate reporting procedures outlined in reference (d).10. Assist the AMB as directed.
11. The following is a chronological list of all maintenance related reports and messages that the squadron will be required to complete.
MESSAGE/REPORTDEADLINE (from time notified)
Base Environmental Division notification4+00 (for HAZMAT spills)
Engine Transaction ReportNLT 1200 local of the day following
the mishap (Class A or Class B).
Combined Strike/X-Ray Equipment LossNLT 2359 local of the day
Report following the mishap (Class A)
HMRs, QDRs, TPDRs24+00 (all mishaps)
EMERGENCY RECLAMATION OFFICER MISHAP RESPONSIBILITIES1. If the mishap occurs ashore, the Emergency Reclamation Team will augment the mishap site Security Detail in addition to fulfilling their reclamation and salvage duties.
2. Ensure all Emergency Reclamation Team personnel are wearing leather flight deck boots, long sleeve shirts, long pants and necessary foul weather gear.
3. Obtain leather gloves, surgical gloves and surgical mask for all Emergency Reclamation Team personnel. (Aviation Safety Officer (ASO), Material Control Officer (MCO) or the mishap investigation kit)4. Ensure all Emergency Reclamation Team personnel are briefed on site safety and other hazards. (ASO, Ground Safety Officer (GSO), Aircraft Mishap Board (AMB) Senior Member or Security Detail Leading Chief Petty Officer/Leading Petty Officer (LCPO/LPO))
5. Ensure all Emergency Reclamation Team personnel are briefed on health and biological hazards. (Flight Surgeon or Corpsman)
6. Have all Emergency Reclamation Team personnel assigned to the Security Detail report to the Security Detail LCPO/LPO for further assignment.7. Assign the PR/AME emergency reclamation team representative (who is ordinance qualified) to ensure CADS and flares are de-armed. They should also disconnect and remove all oxygen bottles (including the portable walk around bottle and the emergency bottles in each seat). AVOID DISTURBING
ITEMS; MOVE THEM ONLY AS REQUIRED TO MAKE SAFE. ONCE SAFE, DO NOT REMOVE ITEMS UNTIL THEY ARE MARKED, PHOTOGRAPHED, AND INVENTORIED BY THE AMB.8. Assist the AMB as directed.
MATERIAL CONTROL OFFICER MISHAP RESPONSIBILITIES
1. Coordinate with the Ground Safety Officer (GSO) and the Flight Surgeon or Corpsman to develop a HAZMAT/HAZWASTE handling plan. Use all available HAZMAT resources (MSDS, instructions, etc.).
2. Coordinate with the GSO to prepare and submit all required HAZMAT reports.
3. Coordinate with COMSTRKFIGHTWINGPAC Safety and the Environmental Division of the military base nearest the mishap site for necessary hazardous material spill notification and clean-up.
4. Coordinate with the First Lieutenant to arrange the following:
a. Transportation to/from the mishap site, and around-the-clock duty drivers as required. Consider the terrain of the mishap site when arranging transportation.
b. Food, shelter, clothing, flashlights, other logistics and toilet facilities at the site. Ensure all site personnel are properly outfitted.
c. Necessary communications equipment to include telephones, cellular telephones and walkie-talkies as required.
d. Salvage equipment as necessary. You will likely need to visit the mishap site to determine the equipment required.
5. Assist the Aircraft Mishap Board as directed.
AIRCRAFT DIVISION OFFICER MISHAP RESPONSIBILITIES
1. Proceed to the mishap site and report to the Aircraft Mishap Board (AMB) Senior Member or the Aviation Safety Officer
2. Help determine if any ejection, egress or other Aviation Life Support System (ALSS) components were used and if such use was effective. If ineffective, help determine reasons if possible. Present a written report of all findings to the AMB Senior Member.
3. Work closely with the NATOPS Officers to determine if an extra-envelope ejection occurred. Help determine reasons for any extra-envelope ejection that did occur. Present a written report of all findings to the AMB Senior Member.
4. Help determine what, and to what extent, any personal survival equipment was used. Be prepared to discuss this subject with the AMB and submit a written report if required.
5. Help determine any changes which might improve survival equipment/training and submit a written report to the AMB Senior Member.6. Assist the AMB as directed.
LINE DIVISION OFFICER MISHAP RESPONSIBILITIES
1. Coordinate mishap site security requirements with the Aviation Safety Officer (ASO) or the Aircraft Mishap Board (AMB) Senior Member.2. Coordinate with the First Lieutenant to establish site security.
Contact Station Security at _________________ for rope, signs, stakes and other security related material. They may be able to provide transportation as well. The following responsibilities are associated with site security:
a. Tape off the mishap site boundary.
b. Establish a controlled entry point to the mishap site.
c. Furnish written copies of the general orders for sentries. (See TAB A).
d. Provide arm bands or other suitable identifying insignia for issue to the Security Detail.
3. Assign a minimum of four (4) Line Division personnel to the mishap site Security Detail.
4. Assign the Line Division Leading Chief Petty Officer (LCPO) or Leading Petty Officer (LPO) as the Security Detail LCPO/LPO.
5. Ensure all Security Detail personnel are properly prepared for their duties as follows:
a. All personnel are wearing leather flight deck boots, long sleeve shirts, long pants and necessary foul weather gear.
b. All personnel are issued leather gloves, surgical gloves and surgical masks from the mishap investigation kit or the Aviation Safety Officer (ASO).
c. All personnel have been briefed on site security using Enclosure (7), TAB A. (ASO, Ground Safety Officer (GSO), AMB Senior Member or the Security Detail LCPO/LPO)
d. All personnel have been briefed on site safety and hazards. (ASO or GSO)
e. All personnel have been briefed on health and BIOHAZARDs. (Flight Surgeon or Corpsman)
6. Assist the AMB as directed.
QUALITY ASSURANCE OFFICER MISHAP RESPONSIBILITIES
Prior to a mishap:
1. Train a team of maintenance experts that will be concerned with the aircraft wreckage and all facts that can be derived from analysis of the various parts. This will be the mishap search/investigation team.Following a mishap:
1. Ensure a photographer has been dispatched to the mishap site.2. Organize the wreckage investigation at the mishap site. Ensure all pieces are tagged for identification and photographs are taken of significant items. Help the ASO and other AMB members diagram the wreckage location by identifying parts.
3. Provide the AMB Senior Member with recommendations for wreckage removal when the initial mishap site investigation is completed. Coordinate with the Maintenance Officer to obtain a suitable shelter for aircraft layout reconstruction.
4. Supervise the layout of aircraft parts under the command and guidance of the Maintenance Officer and the Naval Safety Center representative if present.
5. Periodically meet with the AMB Maintenance Member to analyze and discuss the maintenance aspects of the mishap, and when analysis is completed, present a written report to the AMB Senior Member. (This report should be presented no later than six (6) days following the mishap. Provide the AMB Senior Member with an estimate of any expected delays).
6. Assist the AMB as directed.
ADMIN OFFICER MISHAP RESPONSIBILITIES
1. Initiate casualty reporting procedures prescribed by applicable directives if required. (All primary next-of-kin (PNOK) must be notified by a Chaplain and a Casualty Assistance Calls Officer (CACO) nearest the PNOK’s location within twenty-four (24) hours of the mishap).2. Immediately provide the Commanding Officer (CO) with each mishap crew member’s Record of Emergency Data.
3. Initiate the following for the CO:
a. Telephone report to the BUPERS Casualty Section and a follow-up message report documenting PNOK/SNOK notification within four (4) hours if possible when the primary and/or secondary next-of-kin (PNOK/SNOK) live in the local area. See paragraphs 7 below.
b. Casualty Report per reference (g).
c. JAG investigation.
d. CO’s letter to the next-of-kin per MILPERSMAN 4210140.
e. Injury Report.
f. Recommended press release for the COMNAVAIRPAC Public Affairs Officer.
4. Make the squadron PAO available to the AMB to help control release of information concerning the mishap to the media.
5. Provide appropriate TAD travel orders for required personnel when the mishap occurs outside the local area.
6. Submit the personnel records for all mishap crew members to the Aviation Safety Officer or the Aircraft Mishap Board (AMB) Senior Member.7. Provide the following information to BUPERS by telephone if a personal visit to the PNOK/SNOK has been made by the CO, or if out of area notification has been made.
a. Name of casualty and organization.
b. Confirm that official notification of PNOK/SNOK has been accomplished.
c. Name of the person who performed the PNOK/SNOK notification.
d. Name of the Casualty Assistance Calls Officer.
BUPERS Casualty Section
Working hours:DSN:224-2926Comm:(202) 694-2926
After hours:DSN:224-2768Comm:(202) 694-2768
Record the name of the person who received the call at BUPERS. Follow
up the telephone report with an “official” PNOK/SNOK notification
message to BUPERS.
9. Provide administrative assistance to the AMB to ensure reporting requirements are accurate and timely. Assign a duty YN/PN to the AMB. If more are needed, request support from COMSTRKFIGHTWINGPAC.
10. Ensure the Mishap Safety Investigation Report (MSIR) accurately and properly prepared per the procedures and directions outlined in reference (b). The ASO will provide technical assistance as required.11. Assist the CO in the administrative preparation of his endorsement to the MSIR. The ASO will provide technical assistance as required.12. Assist the AMB as directed.
13. The following is a chronological list of all administrative reports that the squadron will be required to complete.
MESSAGE/REPORTDEADLINE (from time notified)
Press release1+00 (when press interest is expected)
PNOK/SNOK telephone report to BUPERSUpon receiving confirmation that
Casualty SectionPNOK/SNOK have been notified.
PNOK/SNOK Notification Report toUpon receiving confirmation that
BUPERSPNOK/SNOK have been notified
(within 4 hours if possible).
CO’s letter to Next-of-Kin48+00 (Class A)
LEGAL OFFICER MISHAP RESPONSIBILITIES
1. The Legal Officer will provide technical and clerical assistance to the Investigation Officer onboard in any JAG Manual Investigation ordered as a result of a squadron aircraft mishap. It is imperative that the
Aircraft Mishap Board (AMB) investigation and the JAG Manual Investigation be conducted separately. Conclusive and recommended actions reached by the AMB may not be released to the JAG Manual Investigator. The JAG Manual Investigation report should be released before the Mishap Safety Investigation report.
2. Immediately report any conflicts between the AMB and the JAG investigative bodies to the Commanding Officer or the Aviation Safety Officer.
3. Assist the AMB as directed.
PUBLIC AFFAIRS OFFICER MISHAP RESPONSIBILITIES
1. Regulations regarding the release of information to the news media about aircraft mishaps and incidents are governed by effective editions the following directives:
a. SECNAVINST 5720.44
b. MILPERSMAN 4210140
c. CINCPACFLT OPORD 201 Annex F4
d.COMSTRKFIGHTWINGPACINST 3750.2D
2. If there will likely be press interest, the squadron PAO shall submit
the proposed press release by IMMEDIATE message to COMNAVAIRPAC within 60
minutes of mishap notification/determination.
3. DO NOT RELEASE ANY INFORMATION DIRECTLY TO THE NEWS MEDIA.4. Refer all questions to the COMNAVAIRPAC PAO at (619) 545-1134.
5. No one but the CO/XO will make statements to the press.
6. Do not delay the initial press release to gather the “full story.” Amplifying information can and should be sent as necessary when more information is know. NAMES OF PERSONNEL MAY ONLY BE RELEASED BY THE COMMANDING OFFICER THROUGH THE COMSTRKFIGHTWINGPAC AND COMNAVAIRPAC PAOs. NAMES MAY ONLY BE RELEASED AFTER NEXT-OF-KIN HAVE BEEN NOTIFIED.
7. Proceed to the mishap site to assist/escort media personnel as required and to control the release of information regarding the mishap through the COMNAVAIRPAC PAO or the Area Coordinator (SOPA).8. In the event photographers insist on taking close-up photos of the scene and classified material is exposed, any military authority at the scene shall:
a. Inform the photographer of the presence of classified material and ask their cooperation in its protection. Inform them that it is a federal crime to violate prohibitions against photographing classified material (18 USC 795 and 797).
b. Refrain from using force if the media representative refuses to cooperate in protecting classified material. Request the assistance of local civil law enforcement officials in protecting or recovering classified material. Request the assistance of superiors of the offending media representative informing them that the publishing the photos of classified material or refusing to return such photos and material to the military is a federal crime.
9. Brief all squadron members on the requirements for non-disclosure of information in the event a mishap. Any remark by Navy personnel, however off-handed, may be categorized as coming from an “Official Navy Source.”
Direct all personnel to reserve their comments and to refer any queries
for information to you.
10. Assist the Aircraft Mishap Board as directed.
FIRST LIEUTENANT MISHAP RESPONSIBILITIES
1. Coordinate with the Line Division Officer to establish site security.
Contact Station Security at _________________ for rope, signs, stakes and other security related material. They may be able to provide transportation as well. The following responsibilities are associated with site security:
a. Tape off the mishap site boundary.
b. Establish a controlled entry point to the mishap site.
c. Furnish written copies of the general orders for sentries.
d. Provide arm bands or other suitable identifying insignia for issue to the Security Detail.
2. Assign as many First Lieutenant Division personnel as possible to the mishap site Security Detail.
3. Ensure all Security Detail personnel are prepared for their duties as follows:
a. All personnel are wearing leather flight deck boots, long sleeve shirts, long pants and necessary foul weather gear.
b. All personnel are issued leather gloves, surgical gloves and surgical masks from the mishap investigation kit or the Aviation Safety Officer (ASO)
c. All personnel are briefed on site security and site safety. (ASO, Aircraft Mishap Board (AMB) Senior Member, GSO)
d. All personnel are briefed on health and biological hazards. (Flight Surgeon or Corpsman)
4. Coordinate with the Material Control Officer to arrange the following:
a. Transportation to/from the mishap site, and around-the-clock duty drivers as required. Consider the terrain of the mishap site when arranging transportation.
b. Food, shelter, clothing flashlights, other logistics and toilet facilities at the site. Ensure all site personnel are properly outfitted.
c. Necessary communications equipment to include telephones, cellular telephones and walkie-talkies as required. (See Enclosure (7), TAB D).
d. Salvage equipment as necessary. You will likely need to visit the mishap site to determine the equipment required.
5. Assist the AMB as directed.
SAFETY OFFICER MISHAP RESPONSIBILITIES1. Provide the Aircraft Mishap Board a copy of the following:
a. Squadron Standard Operating Procedures.
b. Pilot briefing guides used by the mishap crew.
c. FA-18C NATOPS Flight Manual.
d. FA-18C NATOPS Pocket Checklists.
2. Assist the AMB as directed.
NATOPS OFFICERS MISHAP RESPONSIBILITIES
1. Secure the NATOPS Flight Personnel Training/Qualification Jackets of all Pilots involved in the mishap. Immediately submit these to the Aviation Safety Officer (ASO) or the Aircraft Mishap Board (AMB) for temporary custody.
2. Provide the AMB a copy applicable NATOPS Flight Manuals and Pocket Checklists.
3. Assist the Operations Officer in completing OPNAV Form 3750/25 (MIR Enclosure Form 9) for each pilot as appropriate. Submit this form and all other required paperwork to the AMB within five (5) days following the mishap.
4. Determine what maneuvers were involved at the time of the mishap or which might have resulted in the mishap, and prepare copies of the maneuver charts or limitations charts from the NATOPS Manuals as directed by the ASO or AMB Senior Member.
5. Determine the emergency procedures employed and investigate their correct application. Be prepared to discuss this subject with the AMB and submit a written statement if required.
6. Determine as soon as possible any NATOPS procedures which may have been violated and report them in writing to the AMB Senior Member.7. Prepare and timely submit any NATOPS change recommendations deemed necessary by the AMB.
8. Assist non-aeromedically qualified medical personnel (when lack of a qualified Flight Surgeon requires assistance by a doctor of another discipline) as required in those portions of the medical investigation requiring aeronautical knowledge.
9. Assist the AMB as directed.
GROUND SAFETY OFFICER MISHAP RESPONSIBILITIES
1. Contact the Photo Lab at ________________ (ashore) or __________ (afloat). Request that a photographer be assigned to the mishap. Request a photographer who is qualified and trained in aerial photography. The photographer will need at least twenty (20) rolls of color film and twenty (20) rolls of black and white film.
2. Coordinate transportation for the photographer to the mishap site.3. Proceed to the mishap site. Assist the Aviation Safety Officer (ASO) with ensuring the site is secure and all site personnel are properly prepared to include the following:
a. The mishap site boundary has been taped-off. (First Lieutenant or Line Division Officer)
b. A controlled entry point to the mishap site has been established. (First Lieutenant or Line Division Officer)
c. All site personnel wearing leather flight deck boots, long sleeve shirts, long pants and necessary foul weather gear. (Material Control Officer (MCO) or First Lieutenant)
d. All site personnel have been issued leather gloves, surgical gloves and surgical masks. (ASO, MCO or the mishap investigation kit)
e. All site personnel have been briefed on site security as outlined in Enclosure (7), TAB A. (ASO, GSO, AMB Senior Member, or Security Detail LPO/LCPO)
f. All site personnel have been briefed on health and biological hazards. (Flight Surgeon or Corpsman)
g. All site personnel have been briefed on site safety and other hazards. The following should be discussed:
(a) The potential missile or explosive hazards posed by pressurized oxygen bottles, hydraulic system accumulators and tires. (ASO or GSO)
(b) All hazardous material listed in Enclosure (11). (ASO or GSO)
(c) All natural hazards with regard to site location (e.g., terrain hazards, dangerous plants, animals and reptiles, etc.). (ASO or GSO)4. The AMB is in charge of all mishap photography. Ensure the photographer is escorted by an AMB member at all times. DO NOT LET THE
PHOTOGRAPHER INDISCRIMINATELY PHOTOGRAPH THE WRECKAGE.
5. Coordinate with the MCO and the Flight Surgeon or Corpsman to develop a HAZMAT/HAZWASTE handling plan. Use all available HAZMAT resources (MSDS, instructions, etc.).
6. Coordinate with the MCO to prepare and submit all required HAZMAT reports.
7. Coordinate with COMSTRKFIGHTWINGPAC Safety and the Environmental Division of the military base nearest the mishap site for necessary hazardous material spill notification and clean-up.
8. Assist the AMB as directed.
MISHAP ACTION PLAN
(MAP)
APRIL 2002
INTRODUCTION
The Mishap Action Plan (MAP) Checklist is a booklet provided as a user's guide at the unit level. The booklet is divided into three sections to address the three basic areas involved with a ground mishap and reporting procedures.
Section I provides the Duty Personnel guidance and immediate actions procedures to be followed. Section II provides guidance and procedures to members of a Safety Investigation Board conducting a Safety Investigation.
Section III provides examples of required message reports.
The MAP Checklist booklet is also being provided electronically for the individual units to customize its contents as necessary.
TABLE OF CONTENTS
PageSECTION I
Instructions for Duty Officer/DNCOI-1Reference ListI-2
Flow Chart of EventsI-3
Mishap ChecklistI-4
Mishap Information SheetsI-5
Command Notification SheetI-7
Mishap Reporting MatrixI-8
Naval Safety Center POCI-9
SECTION II
Guidance for Safety Investigation BoardsII-1Senior Board Member Appointment Letter ExampleII-2
Mishap Investigation GuideII-3
Safety Report (SAFEREP) GuideII-5SAFEREP Endorsement GuideII-7
Hazard Report GuideII-8
SECTION III
PCR ExampleIII-1
OPREP-3 SIR ExampleIII-2
Safety Report (SAFEREP) Part A Format ExampleIII-3
Off-Duty PMV SAFEREP Format ExampleIII-8Off-Duty Recreational SAFEREP Format ExampleIII-12
SAFEREP Endorsement Format ExampleIII-15Hazard Report Format ExampleIII-17
SECTION IDUTY OFFICER
DUTY NCO
GUIDANCE
INSTRUCTIONS FOR DUTY OFFICER/DNCO
1. General. The Duty Officer/DNCO will probably receive the initial report of a ground mishap. It is absolutely paramount that all Duty Officer/DNCOs be familiar and confident with the MAP checklist. 2. Immediate Actions. The MAP checklist is a step-by-step guide designed to help the Duty Officer/DNCO gather pertinent information and meet the reporting requirements after being notified of a ground mishap. All Duty Officer/DNCOs should review the MAP checklist at the beginning of every tour of duty. Upon notification of a mishap involving unit personnel or equipment, turn IMMEDIATELY to the Mishap Checklist and execute the appropriate steps.
3. Upon initial notification of a mishap and after obtaining all essential information, the Duty Officer/DNCO should take down the caller's name, telephone number, and location.
I-1
REFERENCES
1. SAFETY CAMPAIGN PLAN
2. MARADMIN 139/02 SAFETY INVESTIGATIONS 9135130Z MAR 02
3. MARADMIN 047/02 SERIOUS INCIDENT REPORTS
4. MCO 5100.29 MARINE CORPS SAFETY PROGRAM
5. MCO P5100.8F MARINE CORPS OCCUPATIONAL SAFETY AND HEALTH PROGRAM MANUAL6. MCO P5102.1A MARINE CORPS GROUND MISHAP INVESTIGATION
AND REPORTING MANUAL
7. MCO P 3040.4D CH 1 MARINE CORPS CASUALTY PROCEDURES
MANUAL (SHORT TITLE: MARCORCASPROCMAN)
8. MCO 5740.2F OPREP-3SIR: SERIOUS INCIDENT REPORTS
9. NAVAL TELECOMMUNICATION PROCEDURE (NTP) PUBLICATIONS
NTP-3 (UNCLAS)
NOTE:
REFERENCES 1 - 3 ARE LOCATED ON HQMC SAFETY DIVISION WEBSITE ().
MARINE CORPS ORDERS AND DIRECTIVES CAN BE LOCATED AT THE FOLLOWING MARINE LINK WEBSITE (+category).
NAVAL TELECOMMUNICATION PROCEDDURE PUBLICATIONS ARE LOCATED ON THE NCTAMS LANT WEBSITE ().
I-2
WHOWHATWHENMISHAP NOTIFICATION OVERVIEW WHERE STEP 1
OODPCRMISHAP ?CONTACTOPREP-3NOLISTDATASTEP 5STEP 2STEP 3/4
YEYOU'RE DONES
UNITNOTIFYSAFETY SAFETY NOPREVENTIONSAFETYSAFETYREPORTINVESTIGATION ACTIONINVESTIGATIOOFFICERREQUIRED?BOARD NSTEP 5REQUIRED?STEP 5
YEYESS
SUBMITINITIATEASSIGN SAFETY SAFETYSENIORNOW YOU'RE REPORTINVESTIGATIONMEMBERREALLY DONE!MESSAGESTEP 7STEP 6/7
WITHIN 30 DAYS SUBMIT RUCREQUESTAND UNIT LOG NAVSAFECENBOOK NUMBERINVESTIGATORSTEP 9 STEP 8
I-3
MISHAP CHECKLIST
STEPACTION TIME
1.NOTIFICATION OF MISHAP _______ 2. INITIATE COMMAND NOTIFICATION _______ 3.PCR MESSAGE DATA _______
4.OPREP-3 SIR _______
5.DETERMINE MISHAP CLASS _______
AND CATEGORY
6.ACTIVATE SAFETY INVESTIGATION _______
BOARD (if required)
7.ACTIVATE UNIT INVESTIGATION _______
8.NOTIFY NAVAL SAFETY CENTER _______
FOR ALL CLASS A MISHAPS
9.NOTIFY MARFOR WITH THE RUC, LOCAL _______
LOGBOOK MISHAP NUMBER, CATEGORY,
AND CLASSIFICATION TO ESTABLISH THE
SAFEREP FILE NUMBER
I-4
MISHAP INFORMATION SHEETSPART I PMV mishap
MISHAP UNIT:
MISSION/EVOLUTION: (Describe in plain language the activity being performed at the time
of the mishap.)
PERSONNEL (MILITARY/CIVILIAN) INVOLVED: (For each person, list: name, social
security number, duty status, rank/rate, NEC/designator/MOS, service parent organization,
civilian DOD/Non-DOD, type injury.)Personnel injured:
Personnel killed:
Other Personnel involved:
ENVIRONMENT:
Date:
Local time:
Day or night:
Mishap location:
Weather conditions at time of mishap:Road conditions, if applicable:
POLICE REPORT:
Speed:
Alcohol involved:
Seat belts worn?
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PART II non-PMV mishap
MISHAP UNIT:
MISSION/EVOLUTION: (Describe in plain language the activity being performed at the time
of the mishap.)
PERSONNEL (MILITARY/CIVILIAN) INVOLVED: (For each person, list: name, social security number, duty status, rank/rate, NEC/designator/MOS, service parent organization,
civilian DOD/Non-DOD, type injury.)
Personnel injured:
Personnel killed:
Other Personnel involved:
EQUIPMENT INVOLVED: (Model, make, nomenclature)
ENVIRONMENT:
Date:
Local time:
Day or night:
Mishap location:
Weather conditions at time of mishap:
Road conditions, if applicable:
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COMMAND NOTIFICATION SHEET1. The OOD must notify the first three people listed below. The DNCO should make the
remaining calls.
2. If the person to be notified is not at the number listed and cannot be immediately
contacted, leave a message to contact the Duty Officer and continue with the recall.
BILLETWORKHOME
COMMANDING OFFICER
EXECUTIVE OFFICER
ADMIN OFFICER
SAFETY OFFICER
S-4 OFFICER
MEDICAL OFFICER
IMPORTANT PHONE LISTINGSAGENCYNUMBER
Battalion/Squadron Duty OfficerBattalion/Squadron Safety OfficeFSSG/DIV/MAW Duty Officer
FSSG/DIV/MAW Safety Office
Base Duty Officer
Base Safety Office
MEF Duty Officer
MEF Safety Office
MarFor Command Center
MarFor Safety Office
HQMC Command Center
HQMC Safety Office
NAVAL SAFETY CENTER (NORFOLK, VA)Others as appropriate
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MISHAP REPORTING MATRIX
APPENDIX D
MishapMishap DamageMishap ClassReportsReport DeadlineInvestigation
TypeRequiredBy
a.Fatality
b.Permanent Total Disability (PTD)ASAFEREPSAFEREP: 30 daysSIBParts A and B(COMNAVSAFCEN Investigator will assist)c. $1,000,000 or morea.Permanent Partial Disability (PPD)1. On or Off
Duty On Baseb.$200,000 - $999,999BSAFEREPSAFEREP: 30 DaysSIBORc.Hospitalization of 3 or more personnelParts A and B(COMNAVSAFECEN Investigatormay assist)d.Coma of more than 24 hours2. On Duty
ORa.Lost Workday resulting from injury or Unit Safety Officer / SNCO/ NCO/Supervisor illnessCRecord in unit logbook Logbook: 90 Daysformally trained in mishap investigation3. Arisingb. $20,000 - $199,999from a
USMC
Operation
On or Off a.Injury ( No lost workday) Base DRecord in unit logbook Logbook: 90 DaysUnit Safety Officer / SNCO/ NCO/Supervisor b. Property damage $2000 – $19,999formally trained in mishap investigation
Involves explosives or combat chemical Per DamageSAFEREPagents. (Hazard reports req. for negligent Parts A and BSAFEREP: 30 DaysSIBdischarge with no injury.)
SAFEREPFatality or InjuryA, BPart ASAFEREP: 30 DaysOff Base (Para 1-6, 9, 11-13)Mishap Investigation Trained Unit Safety Officer / SNCO/ NCO/SupervisorOff DutyInjuryC, DRecord in unit logbookLogbook: 90 Days
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THE NAVAL SAFETY CENTER WILL PROVIDE A MISHAP INVESTIGATOR FOR ALL CLASS A MISHAPS.
Contact Naval Safety Center, Code 40:
Comm. (757) 444-3520, extension 7145/7147
DSN 564-3520, extension 7145/7147
THE MISHAP UNIT MUST PROVIDE THE MARFOR WITH THEIR RUC, THE LOCAL LOG BOOK MISHAP NUMBER, CATEGORY, AND CLASSIFICATION TO ESTABLISH THE SAFEREP FILE NUMBER.
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SECTION II
GROUND SAFETY MISHAP
INVESTIGATION AND
REPORTING
GUIDANCE FOR SAFETY INVESTIGATION BOARDS
Senior member assignment, if required. The first general officer in the chain of command makes this assignment. (example attached)
Subject matter experts depending on the circumstances of the mishap.
(maintenance, motor transport, engineers, weapons, etc.)
Medical officer for the 72 hour history, medical evaluation, and psychological profile.Naval Safety Center investigator for all on duty Class A and most Class B mishaps.Any others that would provide relevant insight into the causal factors resulting in the mishap.
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SENIOR BOARD MEMBER APPOINTMENT LETTER EXAMPLE
(UNIT LETTER HEAD)
5102
From: Commanding General/Officer (MEF/Wing/Division/FSSG/MEU)
To:
Subj: SAFETY INVESTIGATION BOARD (SIB) APPOINTMENT LETTER
Ref: (a) MCO P5102.1A
1. You are hereby appointed as the Senior Member to the (unit) Safety Investigation Board, per the reference.2. You will adhere to the provisions of the reference that concern the use and protection of information to which you will become privy as a member of the SIB and which defines your responsibilities as a member of this board.3. Upon receipt of this appointment, your duties as a Senior Member of the SIB, when convened, shall take precedence over all other duties until release of the safety investigation report (SAFEREP).
4. The success of preventing similar serious mishaps is dependent upon thorough investigation and reporting of mishaps to identify and eliminate the potential causes of damage or injury. The objective of the board is to improve safety. Your efforts
must include open and candid expressions of your opinions and views.
5. As the Senior Member of the SIB, you have the authority to release Naval Messages directly relating to this appointment. Additionally, you will authorize "Promise of Confidentiality" authority to those members of the SIB who are trained as Mishap Investigators.
6. The Naval Safety Center Mishap Investigator is (provide name, telephone number and email address). You are encouraged to designate the investigator as a voting member of the Safety Investigation Board (SIB).
7. Should any circumstances arise which would preclude the proper performance of your duties as a member of this SIB, notify (name the POC and provide telephone numbers) the authority issuing this appointment.
//Signature//
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MISHAP INVESTIGATION GUIDE
COMNAVSAFECEN ((757) 444-3520 ext 7145) will provide on site investigative assistance for all on duty Class A and selected Class B and C mishaps.
CLASS A MISHAPS: Safety Investigation Board Senior Member shall be appointed by the first general officer in the chain of command. MEU, installation, and SPMAGTF commanders are the appointing authority for their commands. Senior Member will be responsible for identifying board membership.
Recommended board membership is Senior Member, Safety Specialist, Competent Medical Authority, Subject Matter Expert, NAVSAFECEN Investigator, and Special Investigative Assistants as required.
MCO P5102.1A can be accessed on the CMC (SD) web site () under “what’s new.”CMC Command Center notification ((703) 695-736, DSN: 225-7366)
The mishap unit must provide the MARFOR with their RUC, the local logbook mishap number, category, and classification to establish the SAFEREP file number.
Safety Investigation information is privileged and should be designated FOUO (Sensitive)
MARFORS will provide SAFEREP file number and endorsement chain.
Investigation Procedures:
The actual procedures used in a particular investigation depend on the nature and results of the accident. The agency having jurisdiction over the location determines the administrative procedures. In general, responsible officials will appoint an individual to be in charge of the investigation. The investigator uses most of the following steps: 1. Define the scope of the investigation.
2. Select the investigators. Assign specific tasks to each (preferably in writing).
3. Present a preliminary briefing to the investigating team, including:
a. Description of the accident with dollar estimates of damage.
b. Normal operating procedures.
c. Maps (local and general).
d. Location of the accident site.
e. List of witnesses.
f. Events that preceded the accident.
4. Visit the accident site to get updated information.
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5. Inspect the accident site.
a. Secure the area. Do not disturb the scene unless a hazard exists.
b. Prepare the necessary sketches and photographs. Label each carefully and keep accurate records.
6. Interview each victim and witness. Also interview those who were present before the accident and those who arrived at the site shortly after the accident. Keep accurate records of each interview. Use a tape recorder if desired. 7. Determine
a. What was not normal before the accident?
b. Where the abnormality occurred.
c. When it was first noted.
d. How it occurred.
8. Analyze the data obtained in step 7. Repeat any of the prior steps, if necessary.
9. Determine
a. Why the accident occurred.
b. A likely sequence of events and probable causes (direct, indirect, or basic).
c. Alternative sequences.
10. Check each sequence against the data from step 7.
11. Determine the most likely sequence of events and the most probable causes.
12. Conduct a post-investigation briefing.
13. Prepare a summary report, including the recommended actions to prevent a recurrence. An investigation is not complete until all data are analyzed and a final report is completed. In practice, the investigative work, data analysis, and report preparation proceed simultaneously over much of the time spent on the investigation.
14. Distribute the report according to MCO P5102.1A. MARFORLANT subordinates can mail both the original Part B and a copy via FEDEX to MARFORLANT (DSS). The Ground Safety Manager will retain the MARFORLANT copy review and hand deliver the original to COMNAVSAFECEN.
Mailing Adress:
COMMANDER
US MARINE CORPS FORCES ATLANTIC
ATTN: DSS/GSM
1468 INGRAM STREET
NORFOLK VA 23551-2596
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SAFETY REPORT GUIDE
PREPARATION OF THE SAFEREP: MCO 5102.1A may not be clear to those not thoroughly familiar with it. This document is provided to assist safety personnel, Safety Investigation Boards and units preparing Off-Duty SAFEREPS. Investigation and report questions should be directed to the respective MARFOR. Questions concerning Navy messages system should be directed to your USMC/Navy Message Center. MCO P5102.1A provides instruction on drafting the SAFEREP, but the
examples given don't necessarily reflect the instructions in the order. Mishap Marine names should not appear in the message body. The following guide is intended to amplify the MCO P5102.1A guidance:
1. From Line is Unit for PMV and Recreational Off Duty Off Base Mishaps. All other SAFEREPS is UNIT//SIB//2. To Line is CMC WASHINGTON DC//SD//
3. Info Line is always Chain of Command and COMNAVSAFECEN Norfolk VA//40/47//
4. Reference A is always MCO 5102.1A. Subsequent references should include the PCR, SAFEREP file number/endorsing chain assignment, extension requests, Engineering Investigation (EI) requests, and other pertinent messages relating to the mishap and investigation.
5. POC: NAME/RANK/CODE/COML (telephone number)/DSN/EMAIL ADDRESS.
6. Personnel Information Paragraph: This paragraph is unclear when providing information on non-vehicular mishaps refers to the appropriate SAFEREP template.
7. Safety Investigation Board Paragraph: In some examples provided, the telephone
Numbers are given for each member. Only one telephone number should be provided, that of the Senior Member of the Board.
8. Evidence Paragraph: This paragraph is omitted for PMV and Recreational mishaps that are Off Duty/Off Base. For all other mishaps that require a SIB, if a privileged piece of evidence is referenced in the paragraph SUMMARY OF FACTUAL FINDINGS, the factual finding line number is preceded by "(P)". Simply, if evidence from paragraph 10.B. (1). (B). Is referenced in a finding, the finding is privileged. The corresponding line number is preceded by "(P)". After a factual finding
is stated, appropriate evidence is referenced to support it. Example: (lA, 1C, 3B). Paragraph 10 lists only facts that are supported by evidence. Analyses and conclusions are assigned in other paragraphs.
9. Analysis Paragraph: For PMV and Recreational mishaps that are Off Duty/Off Base, provide a brief synopsis of the events leading up to the mishap, as they are known. For all other mishaps that require a SIB each subparagraph will begin with a letter, "A.", "B.", "C.", etc. The SIB must state either "PERSONNEL FACTOR." "SUPERVISORY FACTOR." "FACILITIES FACTOR." "MAINTENANCE FACTOR." or "MATERIAL FACTOR." referring to the category of the causal factor the subparagraph addresses. A negative hypothesis
Is then stated. Example: "OPERATOR FAILED TO PERFORM PREVENTATIVE MAINTENANCE."
The hypothesis is either ACCEPTED or REJECTED. The SIB then clearly articulates factual findings that support or undermine the analysis. If any negative hypothesis is ACCEPTED, the SIB states, "BASED ON THE ABOVE ANALYSIS, THE SIB CONCLUDES" and articulates the rationale behind the decision. If a personnel factor/hypothesis is accepted, the SIB must state "WHO:", "WHAT:", and "WHY:". A detailed causal factor list of "WHO:", "WHAT:", and "WHY:" is found in Appendix I of MCO P5102.1A. If the classification of the analysis is PERSONNEL, then the "WHO:" and "WHAT:" must come from the "PERSONNEL" causal factor list found on pages I-3 and I-4 of Appendix I. The same applies for SUPERVISORY, FACILITIES, and MAINTENANCE classifications. The "WHY:" is not broken down into those classifications and the SIB is free to choose from any "WHY:" on the list, page I-5.The SIB is restricted
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to the choices listed in Appendix I. This list is often inadequate. For assistance in cases where there is no appropriate choice,
contact appropriate MARFOR Safety Office (MARFORLANT DSS/GSM (757) 445-4315, 444-5302, DSN 565-4315 OR 564-5302.)
If a material factor/hypothesis is accepted, the SIB must state "COMPONENT:", "MODE:", and "AGENT:". Material causal factors do not have a list to choose from and the SIB must develop the most appropriate choice.9. Conclusion Paragraph: Causal factors of PMV and Recreational Off Duty/Off Base mishaps are formulated from the unit safety representative's investigation. All other mishaps requiring an SIB formulate the causal factors from the ACCEPTED analyses. The category of causal factor as well as the negative hypothesis from Analysis paragraph are the same information required in this paragraph. Assign a Risk Assessment Code, as outlined in Appendix H of MCO 5102.1A. Note, not all of the codes will be 1s. Risk Assessment Codes are Arabic numerals (1, 2, 3) not Roman numerals (I, II, III).
10. Recommendations Paragraph: Each recommendation is derived from a causal factor, as found in the Conclusion
paragraph. Recommendations are clear, concise ideas on how to mitigate the causal factors in the future. They may be for the unit owning the mishap, a higher unit, an MOS school, MARCORSYSCOM, MARCORMATCOM, Training & Education Command, or other command which has preview over relevant ITS's, MCWP's, TM's, etc. Any unit/command that is assigned recommendations will be added to the endorsing chain.
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SAFEREP ENDORSEMENT GUIDE
PREPARATION OF THE SAFEREP ENDORSEMENT: MCO 5102.1A may not be clear to those not thoroughly familiar with it. This document is provided to assist safety personnel and units preparing SAFEREP endorsements. Report format questions should be directed to the respective MARFOR. Questions concerning Navy messages system should be directed to your USMC/Navy Message Center. MCO P5102.1A provides instruction on drafting the SAFEREP endorsements, like SAFEREPS contain privileged information and require special handling. Mishap Marine names should not appear in the message body. The following guide is intended to amplify the MCO P5102.1A guidance:
1. From Line is Command/Unit providing endorsement
2. To Line is CMC WASHINGTON DC//SD//
3. Info Line is always Chain of Command and COMNAVSAFECEN Norfolk VA//40/47//
4. Reference A is always MCO 5102.1A. Subsequent references should include the PCR, SAFEREP file number/endorsing chain assignment, extension requests, Engineering Investigation (EI) requests, and other pertinent messages relating to the mishap and investigation.
5. NARR/REF A MARINE CORPS GROUND MISHAP INVESTIGATION AND REPORTING MANUAL: List other
references.
6. POC/(Name)/(Rank)/(code)/COML (Telephone number)/E-MAIL ADDRESS//.
7. RMKS/1. THIS REPORT CONCERNS A CLASS (A,B,C,D) ON DUTY MISHAP. ENDORSEMENT REQUESTED PER REF A. SUMMARY (Summarize in three lines or less. Do not use names of individuals involved in the mishap.).8. CONCLUSIONS.
A. CAUSAL FACTORS OF THE MISHAP. List each conclusion as previously stated in the SAFEREP in separate sub-paragraphs. After each re-stated conclusion, enter CONCUR or DO NOT CONCUR. If endorser does not concur, provide justification. Additional causal factors with justification may be added in these sub-paragraphs. B. CAUSAL FACTORS OF THE INJURY AND DAMAGE. (List each as in Paragraph 2.A. above).
9. Recommendations Paragraph: List each recommendation of the previous endorser as stated in separate sub-paragraphs. After each re-stated recommendation, enter CONCUR or DO NOT CONCUR. If the endorser does not concur, provide justification. Additional recommendations may be added in these sub-paragraphs. Commands or agencies previously assigned corrective action by the SAFEREP previous endorser may also be modified or included with justification. Endorser shall provide status of recommendations as ACTION COMPLETE or PROJCTED COMPLETION DATE. 10. COMMANDER'S COMMENTS:
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HAZARD REPORT (HR) GUIDE
PREPARATION OF THE SAFEREP: MCO 5102.1A may not be clear to those not thoroughly familiar with it. This document is provided to assist safety personnel, Safety Investigation Boards and units preparing Hazard Reports. Hazard reporting questions should be directed to the respective MARFOR. Submit Hazard Reports via ROUTINE naval message. Questions concerning Navy messages system should be directed to your USMC/Navy Message Center. MCO P5102.1A provides instruction on drafting the Hazard Report. Hazard Reports are intend to be a mechanism to notify chain of command other Marine units using the same equipment and MARSYSCOM of potential problems with ground equipment and weapons systems. The following guide is intended to amplify the MCO P5102.1A guidance:
1. From Line is UNIT//
2. To Line is CMC WASHINGTON DC//SD//
COMARFORLANT//DSS//
COMNAVSAFECEN NORFOLK VA//40//
COMMARCORSYSCOM
3. Info Line is always Chain of Command and other Marine Corps commands using same equipment.
4. Reference A is always MCO 5102.1A. Subsequent references as appropriate.5. NARR/REF A MARINE CORPS GROUND MISHAP INVESTIGATION AND REPORTING MANUAL: List other
references.
6. POC/(Name)/(Rank)/(code)/COML (Telephone number)/E-MAIL ADDRESS//.7. RMKS/1. THIS IS A REPORT CONCERNS A GROUND SAFETY HAZARD. ENDORSEMENT REQUESTED PER
REF A. OR ENDORSEMENT NOT REQUIRED.
SUMMARY (Summarize hazard in three lines or less.)
8. DATA (Provide pertinent to hazard.)
A. EQUIPMENT/MATERIAL.
B. OPERATION/EVOLUTION
9. ENVIRONMENT
10. CIRCUMSTANCES
A. EVIDENCE AND ANALYSIS
B. CONCLUSIONS
C. ESTIMATE/INJURY/DAMAGE/REPAIR COSTS
11. CORRECTIVE ACTIONS.
12. REMARKS.
13. CG/COMMANDER'S COMMENTS:
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SECTION III
MESSAGE
REPORT
FORMATS
PCR FORMAT EXAMPLEFM
TO
INFO
UNCLAS //N03040//
SUBJ/PCR (DD-3040-02)
MSGID/GENADMIN//
POC/
RMKS/1. (rank, Fname MI. Lname ssn/mos/component/sex).
2. NONHOSTILE/(INJURY, VSI, or DECEASED).
3. (Extent of injuries).
4. (Time/date of mishap location of mishap).
5. (Description of mishap/circumstances)
III-1
OPREP-3 SIR FORMAT EXAMPLEFM
TO
INFO
UNCLAS //N05740//
SUBJ/SERIOUS INCIDENT REPORT (SIR)//
MSGID/GENADMIN//
REF/
RMKS/1. (narrative of the circumstances).2. POC: (last name, initials, grade, unit, position/billet, telephone numbers).
3. PERSONNEL INVOLVED
4. INVESTIGATION (if any).
5. LOCAL NEWS MEDIA INTEREST (if any).
6. LOCAL AUTHORITIES NOTFIED (if required).
7. NOK NOTIFICATION (status/progress).
III-2
SAFETY REPORT (SAFEREP) PART A FORMAT EXAMPLEROUTINE
FM UNIT//SAFETY//
TO CMC WASHINGTON DC/SD//
COMMARFORLANT//DSS//
COMNAVSAFECEN NORFOLK VA//40/47//
INFO (ALL ENDORSERS)
UNCLAS FOUO //N05102//
SUBJ/THIS IS A LIMITED DISTRIBUTION GROUND MISHAP SAFETY
INVESTIGATION REPORT (SAFEREP) (PART A), MISHAP CONTROL NUMBER(e.g., (L01162A-011-02) L, RUC, letter of mishap classification designation, unit file number, assigned by
COMMARFORLANT) THAT OCCURRED ON DD MM YY
////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////THIS IS A PRIVILEGED SAFETY INVESTIGATION REPORT. UNAUTHORIZED DISCLOSURE OF THE INFORMATION IN THIS REPORT IS A CRIMINAL OFFENSE UNDER ARTICLE 92 OF THE UCMJ. SEE MCO 5102.1A PARA 4007.1 FOR DETAILS.
////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////REF/A/DOC/MCO P5102.1A
REF/B/(as appropriate)
NARR/REF A IS MARINE CORPS GROUND MISHAP INVESTIGATION AND REPORTING. REF B IS (etc.)POC/(NAME)/(RANK)/(CODE)/COML (TELEPHONE NUMBER)/DSN /EMAIL ADDRESS//
RMKS/1. THIS REPORT CONCERNS A CLASS (A,B,C,D) (ON OR OFF) DUTY
MISHAP. ENDORSEMENT REQUESTED PER REF A. SUMMARY (Summarize in
three lines or less. Do not use names of individuals involved in the mishap.).
2. MISHAP DATA.
A. MISHAP UNIT MCC/RUC.
B. PARENT COMMAND. (First General Officer in the chain of command: MEF, MAGTF, FSSG, DIV, MAW, Base, or equivalent parent activity of the organization or unit having the mishap.)
C. EQUIPMENT (List items (a) through (e) for each as it applies, if it does not, describe the item; e.g., 120 feet of 6 foot chain
link fence).
(1) DOD EQUIPMENT. (List each piece of equipment or property involved in the mishap).
(A) Model and series
(B) NSN
(C) Serial number
(D) RUC and UIC of owning unit
(E) RUC and UIC of using unit if different
(2) PERSONAL EQUIPMENT. (List each piece of personal equipment or property involved in the mishap; e.g., PMVs, boats, bikes, ATVs, power tools):
(A) Item
(B) Year/make
(C) Model
(D) Length for boats/canoes
(E) Engine size (where applicable)_
(3) PERSONAL PROTECTIVE EQUIPMENT (List any protective equipment that was required, whether or not it was used, and whether or not it was effective.).
D. ENVIRONMENT.
(1) DATE
(2) LOCAL TIME
(3) LOCAL TIME ZONE
(4) DAY OR NIGHT
(5) LOCATION: ON or OFF BASE (Select one). Describe location geographically. Use geographic area, body of water, nearest city, town, or a significant landmark; e.g., 111 Old Town Street, San Diego, CA, Deep Creek Lake, MD, or Naples Harbor, Italy. If the location is aboard an installation, list the name of the installation, not the range or training area.
III-3
(A) GRID/TRAFFIC INTERSECTION/RANGE /TRAINING AREA. Use the most applicable method(s) for site location.
(B) STATE/PROVINCE/PREFECTURE/POLITICAL SUBDIVISION/ COUNTRY.
(C) FACILITY. (Buildings, residences, athletic fields, picnic areas, etc.) Where the facility is a structure, identify
number and purpose and specific room if applicable, e.g., Structure: Building NO. 5718 - Pump house/Headquarters building/Fire Station etc., locker room. Indicate if owned or operated by MCCS. If facility is a ship, include name and location within ship, e.g., USS Harper's Ferry, crew's weight room.
(D) MISHAP SITE ELEVATION. Altitude above mean sea level in feet, or depth of water if submerged.
(6) WEATHER (List the following items that apply)
(A) WIND (Direction, speed in kts.)
(B) VISIBILITY
(C) AIR TEMP (Fahrenheit)
(D) WATER TEMP (Fahrenheit)
(E) PRECIPITATION (Type at time of incident)
(F) CUMULATIVE PRECIPITATION (Totals for previous 24 hours)
(G) ROAD/FIELD/PLAYING SURFACE CONDITIONS
(H) SEA STATE
E. SAFETY PROGRAM
(1) RANK OF UNIT SAFETY OFFICER
(2) DATE UNIT SAFETY OFFICER ATTENDED GROUND SAFETY COURSE:
(Provide YYMMDD)
(3) DATE OF LAST COMMAND OR MCCS FACILITY SAFETY INSPECTION
(Provide YYMMDD as well as name of unit that performed Inspection and whether follow up actions are documented).3. CIRCUMSTANCES
A. ORIGIN. Provide geographic location of the activity starting point, e.g.: 7th Mar Motor Pool; T/A Papa-I, line of departure at grid 123456; residence at 100 Puller Ave, Bigtown, USA. Etc.
B. MISSION. State the purpose of the activity in plain language. Administrative convoy operations, conducting single envelopment attack, driving to get groceries, playing hockey, etc.
C. DESTINATION. Provide geographic location of the activity terminating point.
D. MISHAP EVOLUTION. GENERAL ACTIVITY. State the type of exercise, operation, or activity at the time of the mishap. SPECIFIC ACTIVITY. Describe the activity in which the vehicle/personnel/equipment was involved in plain language.
4. MISHAP CLASSIFICATION. Describe the reason on which the classification is based (damage cost, injury, fatality).5. DAMAGE AND COSTS. Itemize the equipment and property damage as follows:
A. DOD PROPERTY DAMAGE. For major end item, if equipment was destroyed, so state. If not describe damage and list repair costs including labor and parts costs. Multiple like serialized items (such as M16s, compasses, etc.) may be captured as
one total cost. Non-serialized items such as 782 equipment will be captured as one cost.
B. NON-DOD PROPERTY DAMAGE. Describe all non-DOD property damage and itemize costs.
6. PERSONNEL INFORMATION, INJURIES, AND MEDICAL COSTS. Provide all information below whether or not injuries are involved.
A. PERSONNEL ON BOARD. Total number of passengers, crew, and operators.
B. CREW/OPERATOR/DRIVER. State numbers of driver(s), assistant driver(s), or crew member(s) on board each mishap vehicle.
(1) DUTY/ACTIVITY AT THE TIME OF THE MISHAP
(2) RANK/RATE
(3) MOS/SERVICE
(4) AGE
(5) PARENT ORGANIZATION
(6) TIME IN BILLET
(7) QUALIFICATIONS/PREVIOUS EXPERIENCE (BOTH ON/OFF DUTY DEPENDING ON ACTIVITY; YRS
DIVING/DRIVING/DIRT BIKING)
(8) ALCOHOL INVOLVEMENT: NO. BAC NOT ADMINISTRATED. YES. BAC (LEVEL).
(9) INJURY (Describe most significant injuries)
III-4
(A) LOST DAYS: HOSPITALIZED: SIQ: CONLV: LIMITED DUTY:
(B) (Repeat for each injured crew/operator/driver) C. TOTAL NUMBER OF PASSENGERS. (Do not include crew)
(1) INJURED PASSENGERS. Provide the total number of injured passengers and list for each injured passenger the following:)
(A) LOCATION AND DUTY AT THE TIME OF THE MISHAP
(B) RANK/RATE
(C) MOS/SERVICE
(D) AGE
(E) PARENT ORGANIZATION
(F) INJURY (Describe most significant injuries)
(G) LOST DAYS: HOSPITALIZED: SIQ: CONLV: LIMITED DUTY:
(2) UNINJURED PASSENGERS. Enter the total number of uninjured passengers for each vehicle.D. INJURED NON-OCCUPANTS. Provide the total number of injured non-occupants and list for each injured non-occupant the following:
(A) LOCATION AND DUTY AT THE TIME OF THE MISHAP
(B) RANK/RATE
(C) MOS/SERVICE
(D) AGE
(E) PARENT ORGANIZATION
(F) INJURY (Describe most significant injuries)
(G) LOST DAYS: HOSPITALIZED: SIQ: CONLV: LIMITED DUTY:
E. MEDICAL OFFICER ANALYSIS. Include 72-hour profile if critical role in mishap.
7. MISHAP INVESTIGATION.
(Include the following if applicable:
- Requests for assistance. State the nature of assistance needed when and where it is needed, and the source of the assistance
if known.
- Requests for relief from investigative and reporting and provide justification in detail.
- Request for extensions. Provide justification in detail).
8. JAG MANUAL INVESTIGATION. Always include the phrase:
THIS (DOES/DOES NOT) MEET THE REQUIREMENTS FOR A JAG MANUAL
INVESTIGATION IAW WITH JAGINST 5800.7. If appropriate, include the following phrase: INVESTIGATION INITIATED (DATE) BY (CONVENING AUTHORITY).
9. SAFETY INVESTIGATION BOARD. List the rank, name and command
of all SIB members beginning with senior member. List the Phone and fax numbers for the senior member or member designated as the point of contact to answer telephone inquiries in the POC message line.
10. EVIDENCE
A. ENCLOSURES HAVE BEEN MAILED PER REF A. Mail completed SAFEREP with the original enclosures to COMNVSAFECEN (CODE 47) and the only copy of enclosures to COMMARFORLANT/PAC/RES or CMC/SD (for those commands not within a COMMARFOR) for all Class A, B, and reportable C and D mishaps.
B. SUMMARY OF EVIDENCE.
(1) THE FOLLOWING ACRONYMS, ABBREVIATIONS AND DEFINITIONS
ARE USED IN THIS SAFEREP:
(A) First acronym, abbreviation or definition.
(B) List remaining acronyms, abbreviations and definitions.
(2) EVIDENCE
(A) NON PRIVILEGED
(1A)
(2A)
(3A) ETC
(B) PRIVILEGED
(1B)
(2B)
(3B) ETC. List the enclosures to the SAFEREP in subparagraph "A" indicating those that are Non-privileged beginning with "(1A)" and those that are privileged with "(1B)" as shown. Enclosure (1A) shall be
III-5
critical to understanding the mishap. List all enclosures in paragraph 10. Recommend a chronological sequence as it enhances clarity. Compile this listing of factual evidence without regard to the source. It must include all the evidence, which
forms the basis for the analysis in paragraph 11 and ultimately, the recommended corrective action in paragraph 12.
(C) SUMMARY OF EVIDENCE.
(1) Denotes non privileged info from Enclosure 13A (13A).
(P)(2) Denotes privileged info from Enclosures 4B and 7B (4B,7B).
(P)(3) Denotes privileged info from Enclosures 7A and 5B (7A,5B). List the detailed sequence of events leading up to
and through the mishap. Many of the items will contain privileged information.
Since privileged information obtained by the SIB from witness statements (oral or written), or speculations about the evidence made by the SIB, may not be released, you must identify all such privileged evidence with the letter "P" in parenthesis at the beginning of each privileged fact listed.
Do not use the symbol (P) when citing information taken from unprivileged witness statements. Discuss data of a personal nature only in general terms in this paragraph. Refer to enclosures and information in enclosures by identifying them as: (2A), (3B), etc. Keep this information detailed, but concise.
A lengthy SAFEREP is neither desired nor warranted. Do not include conclusions or recommendations in this paragraph. 11. ANALYSIS. THE FOLLOWING DISCUSSION AND FINDINGS ARE BASED ON ANALYSIS OF INFORMATION
OBTAINED FROM ALL SOURCES. THEY REPRESENT THE OPINIONS OF THE SIB MEMBERS AND ARE
INTENDED TO PREVENT FUTURE MISHAPS.
A. (Insert Appropriate Term: PERSONNEL, SUPERVISORY,
FACILITIES PERSONNEL, MAINTENANCE, or MATERIAL) FACTOR - (describe factor in terse sentence or phrase) ACCEPTED or REJECTED. Provide the SIB analysis of the causal factor. Causal factors are specific acts of omission or commission. Thus, the hazard statement must contain a Who, What or Component and Mode combination. ACCEPTED or REJECTED. Select appropriate term, based on SIB opinion of whether statement is true). SIB analysis of the causal factor follows. The analysis must specifically state how the causal factor caused the mishap and must clearly detail all the Why(s) or
Agent(s) that gave rise to a particular causal factor. These Why(s) or Agent(s) may also be developed into separate causal factors if need be. If the causal factor is accepted, include the following phrase:
BASED ON THE ABOVE ANALYSIS, THE SIB CONCLUDES (make concise restatements of the accepted causal factor stating who did what and why, or what part failed, how it failed and why. There can be multiple why(s) and agent(s). For each accepted causal factor, add causal factor elements (Who/What/Why or Component/Mode/Agent). See Appendix I. Causal factors shall contain the SIBs analysis of only that evidence discussed in paragraph 10, Figure 6-2. Subsequent factors
may be determined by the SIB from the evidence. Include these in a separate subparagraph of 11. To enhance readability, begin each
element on a new line and indent it. Those causal factors that are accepted in paragraph 11 must also appear in the paragraph 12 narrative, and in the appropriate causal factors of the mishap or causal factors causing damage or injury subparagraph. Exercise care to keep emotions out of this and all other sections of the SAFEREP.
12. CONCLUSIONS. CONCLUSIONS ARE BASED ON ANALYSIS OF INFORMATION OBTAINED FROM ALL
SOURCES AND REPRESENT THE MOST PROBABLE FACTORS AND CIRCUMSTANCES THAT CONTRIBUTED TO
THIS MISHAP.
A. CAUSAL FACTORS OF THE MISHAP.
(1) (Select one or more of the following determination statements according to the degree to which the causal factors are
determined:
THE CAUSAL FACTOR (S) OF THIS MISHAP IS (ARE):
THE MOST PROBABLE CAUSAL FACTOR (S) OF THIS MISHAP IS (ARE): THE CAUSAL FACTOR (S) IF THIS MISHAP IS (ARE) UNDETERMINED WITH THE FOLLOWING POSSIBLE
CAUSAL FACTOR (S):
THE CAUSAL FACTOR (S) OF THIS MISHAP IS (ARE) UNDETERMINED. THE CAUSAL FACTOR OF THIS MISHAP
IS DETERMINED TO BE:
NO FAULT ASSIGNED. THE FOLLOWING MATERIAL FACTOR (S) IS (ARE) ASSIGNED: (Then list each accepted
causal factor in the analysis.)
(A) (Insert appropriate term) FACTOR - (Repeat the description of this factor from paragraph 11 analysis.) RAC
X (Insert the appropriate Risk Assessment Code 1,2,3, or 4.) (This hypothetical example shows the conclusions that should relate to the factors as described in paragraph 11 above.)
III-6
(B) PERSONNEL FACTOR - OPERATOR FAILED TO PERFORM PM BECAUSE HE WAS IN A HURRY.
RAC 3.
(C) (Subsequent conclusions as determined by the SIB.)
B. CAUSAL FACTORS OF DAMAGE OR INJURY. (Include this section if there is "other damage or injury." Begin with appropriate determination statement substituting "OTHER DAMAGE OR INJURY"
for "THIS MISHAP." If no "other damage or injury" then state "NONE."
(1) Include causal factors relating to "other damage or injury" in this paragraph in same format as mishap causal factor.
(2) (Others as required). Separate the SIBs conclusions into two groups: causal factors "CAUSING THE MISHAP," and causal factors causing "OTHER DAMAGE or INJURY" as shown. The plain language conclusions of the SIB are the causal factors and appear in the subparagraphs of each section. Preceding them is the determination statement, selected according to the degree of mishap determination from among the five choices listed. Following each causal factor is the RAC as determined by the SIB. Begin the description of each causal factor with the identification of the classification of the type of factor, such as
PERSONNEL, followed by a short sentence or phrase describing who did what and why in plain language - ending with the RAC. To repeat the analysis paragraph for the factor up to where the factor is accepted, followed by the RAC is both sufficient and appropriate. All factors that are accepted in the analysis section must appear in the conclusions section. Do not
report hazards in the SAFEREP that are not accepted as factors. Send a separate HR in such cases. 13. RECOMMENDATIONS. The format for the Recommendations paragraph is similar to the Conclusions paragraph and separated into the same groups identified in paragraph 12. Do not include recommendations, which do not eliminate hazards identified in paragraph 12 in the SAFEREP. However, all causal factors (hazards) identified in paragraph 12 must have recommendation for remedial action in paragraph 13. THE SIB should test their corrective actions as they develop each to be sure the Why of each Causal Factor is addressed. State the command, with appropriate office code, that will be required to take the recommendation for action. If, through the course of the investigation the recommendation was apparent and the assigned unit has completed the action, so state; or if the recommended action was apparent and is underway but not complete, state an estimated completion date. Recommendations must be direct. Each causal factor must be addressed by recommendation(s). Elimination of causal factors through the completion of the recommended corrective action will prevent recurrence of the same type or similar mishap(s).
III-7
OFF-DUTY PMV SAFEREP FORMAT EXAMPLE
ROUTINE
FM UNIT//SAFETY//
TO CMC WASHINGTON DC//SD//
COMMARFORLANT//DSS//
COMNAVSAFECEN NORFOLK VA//40/47//
INFO (ALL ENDORSERS)
UNCLAS FOUO //N05102//
SUBJ/THIS IS A LIMITED DISTRIBUTION GROUND MISHAP SAFETY
INVESTIGATION REPORT (SAFEREP), SAFEREP LOG NUMBER
LXXXXXXXXX-XX WHICH OCCURED ON DD MM YY.
//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////THIS IS A PRIVILIGED SAFETY INVESTIGATION REPORT. UNAUTHORIZED DISCLOSURE OF THE INFORMATION IN THIS REPORT IS A CRIMINAL OFFENSE UNDER ARTICLE 92 OF THE UCMJ. SEE MCO 5102.1A PARA 4007.1 FOR DETAILS.
//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////REF/A/DOC/MCO P5102.1A
REF/B/MSG/XXXXXXZDEC00 (REFERENCES B-F AS APPLICABLE)
REF/C/MSG/XXXXXXZJAN01
REF/D/MSG/XXXXXXZJAN01
REF/E/MSG/XXXXXXZJAN01
REF/F/DOC/SMALLTOWN USA POLICE DD MM YY
NARR/REF A IS MARINE CORPS GROUND MISHAP INVESTIGATION AND REPORTING MANUAL. REF B IS PCR. REF C IS MARFORLANT ASSIGNMENT OF SAFEREP LOG NUMBER. REF D IS REQ FOR EXTENSION. REF E SAFEREP 7 DAY EXTENSION. REF F IS POLICE REPORT 123456.
POC/(NAME)/(RANK)/(CODE)/COML (TELEPHONE NUMBER)/DSN /EMAIL ADDRESS//RMKS/1. THIS REPORT CONCERNS A CLASS A OFF DUTY/OFF BASE PMV MISHAP. ENDORSEMENT NOT REQUIRED. SUMMARY. A MARINE WAS KILLED AND ANOTHER SERIOUSLY INJURED WHEN THE
AUTOMOBILE THEY WERE RIDING IN COLLIDED WITH A CEMENT PILLAR PORTION OF A BRIDGE SUPPORT CAUSING THE VEHICLE TO CATCH ON FIRE.
2. MISHAP DATA.
A. MISHAP UNIT MCC XXX / RUC XXXXX.
B. PARENT COMMAND. (PARENT COMMAND IS THE FIRST GENERAL OFFICER COMMAND IN THE CHAIN OF COMAND I.E. MEF MAGTF, FSSG, MARDIV, MAW, MCB, ETC.)
C. EQUIPMENT.
(1) DOD EQUIPMENT. N/A.
(2) PERSONAL EQUIPMENT.
(A) PMV.
(B) YEAR: 2000 MAKE: FORD.
(C) MODEL: ESCORT.
(D) LENGTH: UNKNOWN.
(E) ENGINE: 3.6 LITER UNLEADED.
(3) PERSONAL PROTECTIVE EQUIPMENT. PASSENGER RESTRAINTS INSTALLED, POSSIBLY NOT USED BY DRIVER. AIR BAGS INSTALLED: DEPLOYED AS DESIGNED.
D. ENVIRONMENT.
(1) DATE: 31 DEC 00.
(2) LOCAL TIME: 0555.
(3) LOCAL TIME ZONE: EST.
(4) DAY OR NIGHT: NIGHT.
(5) LOCATION: OFF BASE. MISHAP OCCURRED AT MAIN AVE AND WATER ST SMALLTOWN
(A) TOWN/CITY/COUNTY/STATE/PROVINCE/PREFECTURE/COUNTRY: SMALLTOWN, USA.
(B) FACILITY. CEMENT PILLAR, BRIDGE SUPPORT FOR A RAIL ROAD CROSSING.
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(6) WEATHER.
(A) WIND: N/A.
(B) VISIBILITY: CLEAR BUT LIMITED DUE TO DARKNESS, STREET LIGHTS ON.
(C) AIR TEMP: N/A.
(D) WATER TEMP: N/A.
(E) PRECIPITATION: NONE.
(F) ROAD/FIELD/PLAYING SURFACE CONDITION: DOUBLE LANE ROAD IN BOTH DIRECTIONS DIVIDED
BY DOUBLE YELLOW LINE, PAVED BLACKTOP AND DRY.
E. SAFETY PROGRAM.
(1) RANK OF SAFETY MANGER/OFFICER: CAPT.
(2) DATE UNIT SAFETY OFFICER ATTENDED GROUND SAFETY COURSE: 010107 - 010118.
(3) DATE OF LAST COMMAND SAFETY INSPECTION: 001115. SAFETY INSPECTION PERFORMED BY (UNIT). NO FOLLOW UP ACTION REQUIRED.
3. CIRCUMSTANCES.
A. ORIGIN. MARINES LEFT A LOCAL DINING FACILITY AND WERE HEADING NORTH ON CRELING AVE.B. MISSION. MARINES WHERE TRAVELING BACK TO THE HOR OF THE DRIVER.C. DESTINATION: 100 PULLER AVE BIGTOWN, USA XXXXX.
D. MISHAP EVOLUTION. GENERAL ACTIVITY. ENROUTE TO DRIVER'S HOR. SPECIFIC ACTIVITY. PASSENGER IN PMV.
4. MISHAP CLASSIFICATION. CLASS A.
5. DAMAGE AND COSTS.
A. DOD PROPERTY DAMAGE. N/A
B. NON-DOD PROPERTY DAMAGE. 2000 FORD FOCUS - $10,500 (TOTAL BURN OUT).6. PERSONNEL INFORMATION, INJURIES, AND MEDICAL COSTS.
A. PERSONNEL ON BOARD. (PROVIDE NUMBER) TWO.
B. DRIVER.
(1) LOCATION: DRIVER: LEFT FRONT.
(2) RANK: PFC/E2.
(3) MOS: 3531.
(4) AGE: 19
(5) UNIT: MCC XXX RUC XXXXX.
(6) EXPERIENCE OR QUALIFICATION: EARLIEST DATE RECEIVED LICENSE IS UNKNOWN. CURRENT PMV LICENSE ISSUED MARCH 2000.
(7) ALCOHOL USE: NO. BAC NOT ADMINISTRATED. YES BAC .089.
(8) EXTENT OF INJURIES: MULTIPLE TRAUMA.
(9) DAYS HOSPITALIZED AND COSTS: HOSPITALIZED SINCE ACCIDENT 39 AT TIME OF SUBMITTAL $18,174 RECEIVED EXTENSIVE SURGERY ESTIMATED AT $50,000. EXPECTED TO BE IN THE HOSPITAL FOR AT LEAST TWO MORE MONTHS $27,960. GRAND TOTAL $96,134.
(10) DAYS CONVALESCENT LEAVE/SIQ AND COSTS: ESTIMATED 30 DAYS CONV LV UPON RELEASE FROM THE HOSPITAL $11,250.
(11) DAYS LIGHT DUTY AND COSTS: ESTIMATED LIGHT DUTY FOR A
PERIOD OF AT LEAST SIX MONTHS FOLLOWING CONV LV $67,500.
(12) TOTAL LOST DAYS: HOSPITALIZED SINCE THE ACCIDENT, WHICH AT TIME OF THIS SUBMITTAL IS 38 DAYS. TOTAL PROJECTED TIME LOST IS 128 DAYS.
(13) TOTAL INJURY COSTS: ESTIMATED TOTAL IS $174,884.
C. TOTAL NUMBER OF PASSENGERS. ONE.
INJURED PASSENGERS. N/A.
(1) POSITION: PASSENGER: RIGHT FRONT.
(2) RANK: PFC/E2.
(3) MOS: 3531.
(4) AGE: 20
(5) UNIT: MCC XXX RUC XXXXX.
(6) EXPERIENCE OR QUALIFICATION: UNKNOWN.
(7) EXTENT OF INJURIES: FATAL, BLUNT FORCE TRAUMA, BURNED IN FIRE.
(8) DAYS HOSPITALIZED AND COSTS: N/A.
(9) DAYS CONVALESCENT LEAVE/SIQ AND COSTS: N/A.
III-9
(10) DAYS LIGHT DUTY AND COSTS: N/A.
(11) TOTAL DAYS LOST: N/A.
(12) TOTAL INJURY COSTS: $125,000.
D. INJURED NON-OCCUPANTS. N/A
E. TOTAL MISHAP INJURY/FATALITY COSTS. ESTIMATED AT $299,884.
7. MISHAP INVESTIGATION. ASSISTANCE WAS PROVIDED BY (STATE) STATE
POLICE DETECTIVE SMITH (XXX) XXX-XXXX, AND MARINE COUNTY ASSISTANT
PROSECUTOR MR LAWYER (XXX) XXX-XXXX IN OBTAINING LOCAL LAW
ENFORCEMENT REPORTS.
8. JAG MANUAL INVESTIGATION. THIS DOES MEET THE REQUIREMENTS FOR A JAG MANUAL INVESTIGATION IAW JAGINST 5800.7. JAG MAN INVESTIGATION INITIATED 010104, BY X MEF. 9. ANALYSIS. (FOR PMV AND OFF DUTY RECREATIONAL MISHAPS, PROVIDE A BRIEF SYNOPSIS OF THE EVENTS LEADING UP TO THE MISHAP, AS THEY ARE KNOWN. SUBSEQUENT PARAGRAPHS ARE ELIMINATED). DRIVER AND PASSENGER WERE SECURED ON OR ABOUT 1000 ON 001228 FOR THE NEW YEAR 96. SOMETIME THERE AFTER THEY TRAVELED TO SMALLTOWN, USA. AT ABOUT 0430, 001231, MARINES DEPARTED IRVING, NJ TO PURCHASE FOOD AT A LOCAL DINING FACILITY. AROUND 0555, 001231, ENROUTE BACK TO THE DRIVER'S HOR IN IRVING, NJ, THE CAR IMPACTED A RAILROAD BRIDGE CROSSING CEMENT PILLAR SUPPORT. TWO CITIZENS PULLED THE DRIVER OUT OF THE FIRE ENGULFED CAR. THE TWO CITIZENS WERE UNABLE TO REMOVE THE PASSENGER FROM THE VEHICLE DUE TO THE CAR FIRE. THE PASSENGER WAS PRONOUNCED DEAD AT THE SCENE. THE DRIVER SURVIVED WITH INJURIES AS INDICATED ABOVE.
10. CONCLUSION. RAC CODES ARE OMITTED FOR PMV AND RECREATIONAL
MISHAPS THAT ARE OFF DUTY AND OFF BASE.
A. CAUSAL FACTOR (S) OF THIS MISHAP ARE:
(1) PERSONNEL FACTORS.
(A) LACK OF SLEEP: FOLLOWING A SAFETY BRIEF, BOTH
MARINES WERE SECURED FOR THE NEW YEAR 96 LIBERTY PERIOD ON OR ABOUT 1000 001228, AND ARE PRESUMED TO HAVE BEEN ON THE ROAD SINCE THAT TIME. REVEILLE IS SOUNDED AT THE BARRACKS AT 0530. REPORTS INDICATE THAT THE DRIVER MAY HAVE FALLEN ASLEEP BEHIND THE WHEEL.
(B) SPEED: REPORTS INDICATE THAT THE CAR WAS
TRAVELING AT A HIGH RATE OF SPEED. SMALLTOWN POLICE DEPARTMENT
CONTINUES TO EXAMINE THE WRECKAGE TO ESTIMATE HOW FAST THE VEHICLE WAS ACTUALLY TRAVELING. POSTED SPEED LIMIT IS 25 MPH.
(C) ALCOHOL: ASSISTANT PROSECUTOR NOSEX COUNTY STATED THAT THE DRIVER'S BAC WAS .089 AND THAT THEY ARE STILL AWAITING AUTOPSY RESULTS TO DETERMINE THE BAC FOR THE PASSENGER. THE LEGAL LIMIT IN USA IS 0.1. MARINE COUNTY PROSECUTORS OFFICE WILL DETERMINE IF THEY WILL PRESENT THIS CASE TO GRAND JURY.
B. CAUSAL FACTORS OF DAMAGE OR INJURY.
(1) SAFETY DEVICE (S): THE POLICE REPORT INDICATES THAT THE DRIVER DID NOT USE HIS PRIMARY RESTRAINT DEVICE, WHILE THE POLICE REPORT INDICATES THAT THE PASSENGER DID USE HIS PRIMARY RESTRAINT DEVICE, AND THAT THE PASSENGER SIDE AIR BAG WAS DEPLOYED AS DESIGNED. THE MARINE COUNTY PROSECUTORS OFFICE IS CONDUCTING TESTS TO DETERMINE IF THIS IS SO, AS THE AUTOPSY HAS DETERMINED THAT THE PASSENGER DIED AT THE POINT OF IMPACT AS A RESULT OF BLUNT FORCE TRAUMA, WHICH IS AN INDICATION OF NO SEAT BELT USE.
11. RECOMMENDATIONS FOR BN CO:
A. CONTINUE TO STRESS THE USE OF SEATBELTS AND THE IMPORTANCE OF ORM DURING ALL VEHICULAR TRAVEL, BOTH ON AND OFF DUTY. POST HOLIDAY SAFETY STANDDOWN HELD DDMMYY. ACTION COMPLETE.
B. STRESS THE IMPORTANCE OF GETTING ENOUGH SLEEP PRIOR TO GOING ON AN EXTENDED LEAVE OR LIBERTY PERIOD. POST HOLIDAY SAFETY STANDDOWN CONDUCTED DDMMYY. ACTION COMPLETE.
III-10
C. STRESS THE IMPORTANCE OF FOLLOWING ALL TRAFFIC REGULATIONS, IN PARTICULAR THOSE RELATED TO SPEED AND DRINKING AND DRIVING TO
INCLUDE DRIVING WHILE FATIGUED. USE THIS AS AN EXAMPLE FOR THE NEXT BATTALION SAFETY STAND DOWN. POST HOLIDAY SAFETY STANDOWND CONDUCTED DDMMYY. ACTION COMPLETE.//
III-11
OFF-DUTY RECREATIONAL SAFEREP FORMAT EXAMPLE
ROUTINE
FM UNIT//SAFETY//
TO CMC WASHINGTON DC//SD//
COMMARFORLANT//DSS//
COMNAVSAFECEN NORFOLK VA//40/47//
INFO (ALL ENDORSERS)
UNCLAS FOUO //N05102//
SUBJ/THIS IS A LIMITED DISTRIBUTION GROUND MISHAP SAFETY
INVESTIGATION REPORT (SAFEREP) (PART A), SAFEREP LOG NUMBER
LXXXXXXXX-XXX OCCURRED ON DD MM YY.
//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////THIS IS A PRIVELEGED SAFETY INVESTIGATION REPORT. UNAUTHORIZED DISCLOSURE OF THE INFORMATION IN THIS REPORT IS A CRIMINAL OFFENSE UNDER ARTICLE 92 OF THE UCMJ. SEE MCO 5102.1A PARA 4007.1 FOR DETAILS.
/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////REF/A/DOC/MCO P5102.1A
REF/B/MSG/XXXXXXZJUL01
REF/C/MSG/XXXXXXZJUL01
NARR/REF A IS MCO FOR MARINE CORPS GROUND MISHAP INVESTIGATION AND REPORTING. REF B IS ORIGINAL PCR MSG FM (UNIT). REF C IS MARFORLANT ASSIGNMENT OF SAFEREP LOG NUMBER.POC/(NAME)/(RANK)/(CODE)/COML (TELEPHONE NUMBER)/DSN /EMAIL ADDRESS//RMKS/1. THIS REPORT CONCERNS A CLASS B OFF DUTY/OFF BASE MISHAP. ENDORSEMENT NOT REQUIRED. SUMMARY. MARINE LOST SIGHT IN ONE EYE WHEN A BALLOON FILLED WITH ACETYLENE GAS EXPLODED IN HIS FACE.
2. MISHAP DATA.
A. MISHAP UNIT MCC XXX /RUC XXXXX.
B. PARENT COMMAND. (PARENT COMMAND IS THE FIRST GENERAL OFFICER IN THE CHAIN OF COMMAND I.E. MEF MAGTF, FSSG, MARDIV, MAW, MCB, ETC.)
C. EQUIPMENT.
(1) DOD EQUIPMENT. N/A
(2) PERSONAL EQUIPMENT. N/A.
(3) PERSONAL PROTECTIVE EQUIPMENT. NONE.
D. ENVIRONMENT.
(1) DATE: 11 JULY 2001.
(2) LOCAL TIME: 1830.
(3) LOCAL TIME ZONE: PACIFIC.
(4) DAY OR NIGHT: NIGHT.
(5) LOCATION: OFF BASE. MISHAP OCCURRED AT 13 MAIN STREET.
(A) CITY, STATE, COUNTRY: SMALLTOWN, USA.
(B) FACILITY: N/A.
(6) WEATHER.
(A) WIND: N/A.
(B) VISIBILITY: CLEAR.
(C) AIR TEMP: 75 DEGREES.
(D) PRECIPITATION: NONE.
(E) ROAD/FIELD/PLAYING SURFACE CONDITIONS: N/A.
E. SAFETY PROGRAM.
(1) RANK OF UNIT SAFETY OFFICER. CAPT.
(2) DATE UNIT SAFETY OFFICER ATTENDED GROUND SAFETY COURSE: DDMMYY
(3) DATE OF LAST COMMAND SAFETY INSPECTION: DDMMYY.
INSPECTION PERFORMED BY (UNIT). NO FOLLOW UP ACTION REQUIRED.
3. CIRCUMSTANCES
A. MISHAP EVOLUTION.
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(1) GENERAL ACTIVITY. SNM WAS ON LEAVE AT FIANCE'S PARENT'S HOUSE IN SMALLTOWN, USA ON DDMMYY FROM 1300 UNTIL TIME OF MISHAP, HE WAS ASSISTING HIS FATHER AND UNCLE IN CLEANING UP THE FATHER'S PROPERTY.
(2) SPECIFIC ACTIVITY. SNM ALONG WITH HIS FIANCE'S UNCLE, WERE CREATING A HOMEMADE BOMB WITH ACETYLENE GAS FILLED BALLOONS TO BLOW UP AN OLD CAMPER ON THE PROPERTY.4. MISHAP CLASSIFICATION. CLASS B, POSSIBLE PERMANENT LOSS OF VISION IN RIGHT EYE.5. DAMAGE AND COSTS.
A. DOD PROPERTY DAMAGE. NA
B. NON-DOD PROPERTY DAMAGE. NA
6. PERSONNEL INFORMATION, INJURIES, AND MEDICAL COSTS.
A. INJURED PERSONNEL. ONE.
(1) DUTY AT TIME OF MISHAP: OFF DUTY
(2) RANK/MOS. LCPL/E3
(3) MOS/SERVICE. 0341/USMC
(4) AGE. 20
(5) PARENT ORGANIZATION. XXXXXX
(6) TIME IN BILLET. 8 MONTHS
(7) ALCOHOL USE: NO. BAC NOT ADMINISTERED.
(8) EXTENT OF INJURY: SNM HAS POSSIBLE LOSS OF SIGHT IN RIGHT EYE, LACERATION ABOVE AND BELOW RIGHT EYE, AND 2ND DEGREE BURNS TO THE LEFT FOREARM AND RIGHT PALM OF HAND.
(9) LOST DAYS. HOSP: 16 NO DUTY: 60 CONLV: 40 TOTAL COSTS $138,956.7. MISHAP INVESTIGATION. NO OTHER INVESTIGATION CONDUCTED.
8. JAG MANUAL INVESTIGATION. THIS DOES MEET THE REQUIREMENT FOR A JAG MANUAL INVESTIGATION IAW WITH JAGINST 5800.7 INVESTIGATION
INITIATED ON 010720, BY UNIT COMMANDING OFFICER.
9. ANALYSIS. (FOR OFF DUTY PMV AND RECREATIONAL MISHAPS, PROVIDE A BRIEF SYNOPSIS OF THE EVENTS LEADING UP TO THE MISHAP AS THEY ARE KNOWN. SUBSEQUENT PARAGRAPHS ARE ELIMINATED). MARINE WAS ON LEAVE, 11 JULY 2001. HE WAS STAYING AT HIS PARENTS HOUSE AT 13 MAIN STREET SMALLTOWN, USA. FROM 1300-1700 SNM AND FIANCE'S FATHER WERE DOING VARIOUS PROJECTS AROUND THE PROPERTY TO CLEAN IT UP. DURING THIS TIME THE UNDERAGE SNM STATES THAT HE HAD 4-5 BEERS. AT 1700 THEY STOPPED WORKING TO EAT DINNER, THEN WAITED FOR FIANCE'S UNCLE TO ARRIVE AT THE HOUSE. SNM'S FIANCE'S UNCLE ARRIVED AT THE RESIDENCE AROUND 1730 AND BEGAN DISCUSSING HOW TO DESTROY AN OLD CAMPER ON THE PROPERTY BY BLOWING IT UP WITH HOMEMADE BOMBS. SNM'S FIANCE'S UNCLE WAS FORMALLY A SUPERVISOR AND AN INSPECTOR FOR WELDING, AND HAS OVER 31 YEARS OF WELDING EXPERIENCE. SNM PERCEIVED THAT HIS FIANCE'S UNCLE HAD PRIOR EXPERIENCE HANDLING ACETYLENE GAS. SNM, HOWEVER, HAD NO PRIOR EXPERIENCE OR KNOWLEDGE IN HANDLING ACETYLINE GAS. SNM AND HIS FIANCE'S UNCLE WENT OUT TO THE SHED AFTER DINNER AND BEGAN FILLING BALLOONS WITH ACETYLENE GAS TO MAKE
HOMEMADE BOMBS. THEY THEN PLANNED TO PLACE THEM INSIDE A PAIL WITH A HOLE CUT IN IT. THIS WOULD ALLOW THEM TO INSERT A FUSE AND IGNITE THE BALLOONS INSIDE OF THE CAMPER. WHILE SNM WAS PLACING TWO ACETYLENE BALLOONS INSIDE THE PAIL, THE BALLOONS RUBBED TOGETHER CAUSING ELECTROSTATIC BUILD-UP. THIS CAUSED AN ELECTROSTATIC DISCHARGE IGNITING THE BALLOONS AND CAUSING THE EXPLOSION. THE INJURED MARINE RECEIVED SERIOUS FACIAL TRAUMA TO HIS RIGHT SIDE, 2ND DEGREE BURNS TO HIS LEFT FOREARM AND RIGHT PALM, AND A "V" SHAPED LACERATION EXTENDING FROM ABOVE TO BELOW HIS RIGHT EYE. THE EYE WAS SEVERELY DAMAGED FROM THE COMPRESSION OF THE BLAST CAUSING POSSIBLE PERMANENT LOSS OF VISION. SNM WAS TRANSPORTED TO ST. PETERS HOSPITAL IN LYMPIA, WA. BY AMBULANCE AND WAS THEN TRANSFERRED TO MADAGAIN ARMY MEDICAL CENTER IN COMA, WA. WHERE HE UNDERWENT EMERGENCY SURGERY TO TREAT THE INJURIES. SNM DID NOT USE PERSONAL PROTECTIVE EQUIPMENT WHILE WORKING WITH WELDING MATERIALS OR EXPLOSIVES. THE SNM HAD NO EXPERIENCE OR TRAINING
III-13
IN HANDLING WELDING EQUIPMENT AND ACETYLENE GAS. FIANCE'S UNCLE WAS EXPERIENCED IN HANDLING WELDING MATERIALS TO INCLUDE ACETYLENE GAS BUT WAS CONDUCTING AN ACTIVITY THAT IS RECOMMENDED AND IS CONSIDERED INHERENTLY DANGEROUS. A LACK OF GOOD JUDGEMENT BY SNM AND HIS UNCLE WAS THE LEADING CAUSE IN THE MISHAP.
10. CONCLUSIONS. RAC CODES ARE OMITTED FOR PMV AND RECREATIONAL
MISHAPS THAT ARE OFF DUTY AND OFF BASE.
A. CAUSAL FACTORS OF THE MISHAP.
(1) PERSONNEL FACTOR. FAILURE TO IDENTIFY POTENTIAL HAZARD.
HAZARD RECOGNITION WAS COMPLICATED BY ALCOHOL AND AN ADULT PRESENT THAT HAD EXPERIENCE WITH WELDING AND THE USE OF ACETYLENE GAS.
(2) FACILITY FACTORS. INADEQUATE SAFETY PRECAUTIONS AND
EQUIPMENT. PROPER PPE WAS NOT IN PLACE FOR USING ACETYLENE GAS IN THIS MANNER.
(3) PERSONNEL FACTORS. FAILURE TO RECOGNIZE AN INHERENTLY
DANGEROUS ACTIVITY THAT WOULD EVENTUALLY RESULT IN SERIOUS
INJURY.
B. CAUSAL FACTORS OF INJURY. BALLOONS FILLED WITH ACETYLENE GAS EXPLODED WHEN THEY WERE PRESSED TOGETHER CREATING STATIC
ELECTRICITY AND IGNITING THE GAS.
11. RECOMMENDATIONS.
A. FOR UNIT CO
(1) ENSURE ALL MARINES ARE BRIEFED ON THIS MISHAP AND
UNDERSTAND THE INHERENT DANGERS OF MAKING HOMEMADE BOMBS. COMPANY CONDUCTED ALL HANDS TRAINING ON OFF-DUTY RECREATION ORM AND HAZARDS OF ALCOHOL DDMMYY. ACTION COMPLETE.
(2) ENSURE ALL MARINES CONTINUE TO RECEIVE RECREATIONAL SAFETY AND ORM TRAINING SO THAT THEY UNDERSTAND THE IMPORTANCE OF NOT TAMPERING WITH MATERIALS OR CHEMICALS THAT THEY DO NOT HAVE KNOWLEDGE OF OR THE TRAINING REQUIRED TO HANDLE THEM. COMPANY CONDUCTED ALL HANDS TRAINING ON OFF-DUTY RECREATION ORM AND HAZARDS OF ALCOHOL DDMMYY. ACTION COMPLETE.
(3) CONTINUE TO ENFORCE THE POLICY OF NO UNDERAGE DRINKING IN THE COMMAND, AND EDUCATE MARINES ON THE HAZARDS OF MIXING ALCOHOL WITH INHERENTLY DANGEROUS ACTIVITIES. COMPANY CONDUCTED ALL HANDS TRAINING ON OFF-DUTY RECREATION ORM AND HAZARDS OF ALCOHOL DDMMYY. ACTION COMPLETE.//
III-14
SAFEREP ENDORSEMENT FORMAT EXAMPLE
FM ENDORSING UNIT
TO CMC WASHINGTON DC//SD//
COMMARFORLANT//DSS//
COMNAVSAFECEN NORFOLK VA//40/47//
INFO (ALL ENDORSERS))
BT
UNCLAS FOUO//N05102//
SUBJ/THIS IS AN ENDORSEMENT OF A LIMITED DISTRIBUTION GROUNDMISHAP SAFETY INVESTIGATION REPORT (SAFEREP) (PART A), CLASS (A, B, ETC) ON DUTY MISHAP,
CONTROL NO LXXXXXXXX-XX THAT OCCURRED ON DD MM YY.//
//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////THIS IS A PRIVILEGED SAFETY INVESTIGATION REPORT. UNAUTHORIZED DISCLOSURE OF THE INFORMATION IN THIS REPORT IS A CRIMINAL OFFENSE UNDER ARTICLE 92 OF THE UCMJ. SEE MCO
P5102.1A PARA 4007.1 FOR DETAILS.
//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////REF/A/DOC/MCO P5102.1A
REF/B/RMG/XXXXXXZ FEB 02// (REFERENCES B-F AS APPLICABLE)REF/C/RMG/XXXXXZMAR02//
REF/D/RMG/XXXXXZMAR02//
REF/E/XXXXXXZMAR02//
REF/F/LTR/CO XXXXXX/08 MAR 02//
NARR/REF A IS MARINE CORPS GROUND MISHAP INVESTIGATION ANDREPORTING MANUAL. REF B IS ASSIGNMENT OF SAFEREP FILE NUMBER AND ENDORSING CHAIN. REF C IS
SAFEREP. REF D IS XXXXXX ENDORSEMENT. REF E IS XXXXXX ENDORSEMENT. REF F IS XXXXXX
LETTER.//
POC/(NAME, RANK, CODE/TITLE, TELEPHONE, NUMBER, E-MAIL)
RMKS/1. ENDORSEMENT AND SUMMARY
A. THIS REPORT CONCERNS A CLASS C, ON DUTY SMALL ARMS MISHAP.XXXXX ENDORSEMENT REQUESTED PER REF B.
B. SUMMARY: A MARINE WAS INJURED AS A RESULT OF A NEGLIGENTDISCHARGE.
2. CONCLUSIONS.
A. CAUSAL FACTORS OF THE MISHAP.
(1) SUPERVISORY FACTOR. INABILITY TO PROVIDE
UNANNOUNCED INSPECTIONS OF SENTRIES. RAC 2. CONCUR.
(2) PERSONNEL FACTOR.
(A) FAILURE TO OBSERVE SAFE WEAPONS HANDLING
PROCEDURES. RAC 1. CONCUR.
(B) FAILURE TO REPORT PROCEDURAL VIOLATIONS.
RAC 2. CONCUR.
B. CAUSAL FACTORS OF DAMAGE OR INJURY.
(1) BY FAILING TO OBSERVE SAFE WEAPONS HANDLING
PROCEDURES, MARINE WAS INJURED BY A NEGLIGENT DISCHARGE.
RAC 1. CONCUR.
3. RECOMMENDATIONS.
A. FOR COMMANDING OFFICER, XXXXXX(UNIT).
(1) SUBMIT LETTER OF REQUEST TO XXXXX (HOST COMMAND)
COMMANDING OFFICER REQUESTING INSTALLATION OF CLOSED CIRCUIT
CAMERAS IN POSTS TO ALLOW SUPERVISORY PERSONNEL TO MONITOR
POSTS FROM INSIDE THE REACTION FORCE FACILITY. THIS
CAPABILITY IS DESIGNED TO ENHANCE, NOT REPLACE, REQUIRED SITE
CHECKS BY SUPERVISORY PERSONNEL. CONCUR. ACTION COMPLETE
III-15
(2) ENSURE MARINES KNOW AND UNDERSTAND THEIR RESPONSIBILITY TO REPORT UNSAFE ACTS TO SUPERVISORY PERSONNEL. CONCUR. ACTION COMPLETE.
(3) REINFORCE IMPORTANCE OF SAFE WEAPONS HANDLING PROCEDURES. CONCUR. ACTION COMPLETE.
B. FOR COMMANDING OFFICER BATTALION
(1) ENSURE ALL XXXX MARINES RECEIVE PERIODIC INSTRUCTION ON SAFE WEAPONS HANDLING PROCEDURES. CONCUR. THE BN WEAPONS HANDLING ORDER REQUIRES COMMANDERS TO PROVIDE CONTINUOUS TRAINING IN WEAPONS HANDLING PROCEDURES. THE ORDER STATES THAT ALL WEAPONS LOADING AND UNLOADING MUST BE PERFORMED
UNDER THE SUPERVISION OF THE COG, SOG, TEAM LEADER OR SQUAD LEADER, WITH THE LEADER VERBALLY DICTATING EACH STEP PRIOR TO ITS EXECUTION. THE ORDER IS AT ALL COMMANDS. ACTION COMPLETE.
4. ADDITIONAL RECOMMENDATIONS FOR COMMANDING OFFICER XXXX BATTALION.
A. RECOMMEND THE RATIO OF SUPERVISORS/SUBORDINATES BE EVALUATED DURING THE NEXT POST VALIDATION. CURRENT VALIDATION PROCEDURES DO NOT FORMALLY ADDRESS SUPERVISOR POSITIONS. XXXXX HAS MADE EVERY EFFORT TO PROVIDE ADDITIONAL PERSONNEL TO EXPAND THE ZONE OF INFLUENCE. MAINTAINING A LARGE FORCE OF JUNIOR MARINES WITH LESS THAN ONE YEAR ON ACTIVE DUTY PRESENTS CHALLENGES THAT ARE BEST ADDRESSED THROUGH LEADERSHIP AND IMMEDIATE SUPERVISION. CONCUR WITH THE RECOMMENDATION THAT SUPERVISOR/SUBORDINATE RATIO SHOULD BE EVALUATED DURING THE NEXT POST VALIDATION. PER SECNAVINST 5530.4C, POST VALIDATIONS ARE CONDUCTED EVERY THREE YEARS. NEXT XXXX POST VALIDATION IS SCHEDULED FOR OCTOBER 2003. ACTION HAS BEEN ADDED TO POST VALIDATION ITINERARY. ACTION COMPLETE FOR REPORTING PURPOSE.
B. XXXX MARINES ON POSTS WORLDWIDE ARE ARMED ACCORDING TO CURRENT THREAT CONDITIONS AND SPECIFIC MISSION REQUIREMENTS. ROUTINELY SCHEDULED POST VALIDATIONS AND CHANGES TO THREAT CONDITIONS SERVE THE PURPOSE OF ENSURING ADEQUATE ARMING AND FORCE PROTECTION ISSUES ARE ADDRESSED. CONCUR.
C. SEMIANNUAL WEAPONS SAFETY AND HANDLING INSTRUCTION IS MEANT TO BE AUGMENTED BY SUSTAINMENT TRAINING. LIKEWISE, EFFECTIVE TRAINING MANAGEMENT ENSURES ALL MARINES RECEIVE REQUIRED TRAINING, REGARDLESS OF TYPE. CONCUR.
D. RECOMMEND XXXX UNITS INSTITUTE MORE ROLE PLAYING SCENARIOS FOR BOTH WEAPONS HANDLING AND USE OF FORCE TRAINING IAW REF B. CONCUR. ROLE PLAYING SCENARIOS ARE ONE FORM OF SUSTAINMENT TRAINING THAT SUPPORTS INITIAL SKILL TRAINING AND SEMIANNUAL TRAINING. COMMANDERS AT ALL LEVELS ARE RESPONSIBLE FOR THE TRAINING OF THEIR MARINES, AND SHOULD CONSTANTLY ENDEAVOR TO PROVIDE TRAINING WHICH IS EFFECTIVE AND MEANINGFUL. CONCUR. ACTION COMPLETE.
5. COMMANDER'S COMMENTS. THIS IS THE SECOND NEGLIGENT DISCHARGE THAT HAS OCCURRED AT THIS UNIT WITHIN THE LAST TEN MONTHS. THIS INCIDENT IS NOT ABOUT CONDUCTING WEAPONS SAFETY CLASSES--WEAPONS SAFETY CLASSES WERE CONDUCTED PRIOR TO AND AFTER THE NEGLIGENT DISCHARGE LAST MAY. PROPER HANDLING OF LOADED WEAPONS IS A RESULT OF LEADERSHIP, WHICH APPARENTLY BROKE DOWN IN THIS LOW INTENSITY LEADERSHIP ENVIRONMENT. LEADERS MUST BE VIGILANT FOR SIGNS OF INAPPROPRIATE BEHAVIOR AND TAKE DECISIVE, TIMELY ACTIONS.//
III-16
HAZARD REPORT FORMAT EXAMPLE
FM UNIT//SAFETY//
TO CMC WASHINGTON DC//SD//
COMMARFORLANT//DSS//
COMNAVSAFECEN NORFOLK VA//40/47//
COMMARCORSYSCOM
INFO FIRST LARBN//CO//
SECOND LARBN//CO//
THIRD LARBN//CO//
BT
UNCLAS FOUO//N05102//
SUBJ/ THIS IS A GROUND HAZARD REPORT (XXXX)//
REF/A/DOC/MCO P5102.1A
REF/B/DOC/TM 6665/016-50
NARR/ REF A IS MCO P5102.1A ON GROUND MISHAP INVESTIGATION
AND REPORTING. REF B IS TM 6665/016-50 MAINTENANCE PARTS
MANUAL.
POC/NAME/RANK/UNIT/SAFETY OFFICER/COML XXX-XXX-XXXX/E-MAIL//
RMKS/1. THIS REPORT CONCERNS A GROUND SAFETY HAZARD. RAC 1.
ENDORSEMENT NOT REQUIRED.
SUMMARY: POSSIBLE FAILURE OF RUBBER HATCH SEAL OF M93 NBC RECONNAISSANCESYSTEM (FOX) (C2282) VEHICLES.
2. DATA
A. EQUIPMENT/MATERIAL
(1) ALL M93 NBC RECONNAISSANCE SYSTEM (FOX) VEHICLES. TAMCN C2282, ID NR 10195A.
(2) THE PARTS INVOLVED ARE LISTED IN REF B. NSN 5330-12-313-3391.B. OPERATION/EVOLUTION. A MISHAP OCCURRED INVOLVING THE SINKING OF A M93, NBC RECONNAISSANCE SYSTEM (FOX). AFTER THE MISHAP, A PRELIMINARY INSPECTION REVEALED THAT A POSSIBLE CAUSE OF THE MISHAP WAS THE FAILURE OF THE RUBBER SEAL AROUND THE REAR HATCH.3. CIRCUMSTANCES
A. EVIDENCE AND ANALYSIS. RUST DEVELOPED UNDER THE GLUE POSSIBLY ALLOWING THE SEAL TO COME LOOSE.
B. CONCLUSIONS. THIS RESULTS IN THE SEAL BEING UNABLE TO PREVENT WATER FROM ENTERING THE VEHICLE DURING WATER-BORNE OPERATION. THIS COULD RESULT IN THE VEHICLE SINKING.C. ESTIMATE INJURY/DAMAGE/REPAIR COST. N/A
4. CORRECTIVE ACTIONS
A. FOR ALL UNITS POSSESSING THE M93 NBC RECONNAISSANCE SYSTEM: RECOMMEND INSPECTION OF ALL HATCHES AND SEALS PRIOR TO WATERBORNE OPERATIONS TO ENSURE A PROPER BOND.B. FOR COMNAVSAFECEN. RECOMMEND DISSEMINATION OF ABOVE TO OTHER SERVICES OF POTENTIAL HAZARD.
5. REMARKS. NOT APPLICABLE.
6. COMMANDING OFFICER/CG COMMENTS. NONE.//
III-17
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