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ACCIDENT REPORT/SERIOUS INCIDENT REPORT [SIR]

Use to convey flash traffic to the commander and command post relating to an accident or serious incident within the command. Use FLASH precedence on CMD nets. For all other stipulations and instructions refer to AR 190-40 (SIR) and AR 385-40 (Accident Report)

LINE 1 -- DATE AND TIME_______________________________(DTG of Report)

LINE 2 -- UNIT_________________________________________(Unit Making Report)

LINE 3 -- CATEGORY___________________________________(Category 1 or 2)

LINE 4 -- TYPE_________________________________________(Type of Incident)

LINE 5 -- TIME OF INCIDENT____________________________(DTG of Incident)
WEEK END/HOLIDAY__________________________(Indicate YES or NO and Include Holiday Name)

LINE 6 -- LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 7 -- PERSONNEL__________________________________(Personnel Involved)

a. (SUBJECT)
(1)________________________(Name, Injury, Fatality)
(2)________________________(Pay Grade)
(3)________________________(SSN)
(4)________________________(Race)
(5)________________________(Sex)
(6)________________________(Age)
(7)________________________(Position (CDR, PSG, Gunner))
(8)________________________(Security Clearance)
(9)________________________(Unit, Station, and MACOM Assigned)
(10)_______________________(Duty Status (Leave))

b. (VICTIM)
(1)________________________(Name, Injury, Fatality)
(2)________________________(Pay Grade)
(3)________________________(SSN)
(4)________________________(Race)
(5)________________________(Sex)
(6)________________________(Age)
(7)________________________(Position (CDR, PSG, Gunner))
(8)________________________(Security Clearance)
(9)________________________(Unit, Station, and MACOM Assigned)
(10)_______________________(Duty Status (Leave))

**Repeat lines 7a (1-10) through 7b (1-10) up to four times to transmit multiple data sets. Assign sequential line numbers to succeeding iterations; for example, first iteration a (1) through a (10) or b (1) through b (10); second iteration a (11) through a (20) or b (11) through b (20); third iteration a (21) through a (30) or b (21) through b (30); fourth iteration a (31) through a (40) or b (31) through b (40).

LINE 8 -- SUMMARY___________________________________(Summary of Incident)

LINE 9 -- PUBLICITY___________________________________(Adverse or Anticipated Publicity)

LINE 10 -- COMMANDER_______________________________(Commander Reporting)

LINE 11 -- POC________________________________________(Unit POC/Duty Position)

LINE 12 -- DOWNGRADE_______________________________(Downgrading Instructions)

LINE 13 -- NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report

LINE 14 -- AUTHENTICATION___________________________(Report Authentication)

ACCIDENT SUPPLEMENT (GROUND (GRND)/AIRCRAFT (AC))

LINE 14A -- POC_______________________________________(E-mail, Phone, DSN)

LINE 14B -- MACOM___________________________________(TRADOC, FORSCOM, USAREUR)

LINE 14C -- ACCIDENT CLASS__________________________(GRND/AC-A or B AC-C)

LINE 14D -- WEATHER_________________________________(Visibility, Light Level, Precipitation, Wind)

LINE 14E -- NIGHT VISION DEVICE______________________(Yes, Type, Nomenclature. For Example, NVG-AN/ PVS-5, Abrams Thermal Viewer, No)

LINE 14F -- MILITARY INSTALLATION___________________(Nearest Site)

LINE 14G -- EXPLOSIVE, HAZARDOUS MATERIAL_________(Involved: Yes or No, Secured: Yes or No)

LINE 14H -- ACCIDENT SITE SECURED IAW AR 385-40_____(Yes or No)

LINE 14I -- ACCIDENT SITE DISTURBED__________________(Yes or No)

LINE 14J -- PHOTOS OF DISTURBING SCENE_____________(Yes or No)

LINE 14K -- FLIGHT DATA RECORDER INSTALLED________(Yes or No)

LINE 14L -- LOCAL ACCIDENT INVESTIGATION BOARD APPT_(Yes or No)

LINE 14M -- NEAREST AIRFIELD_________________________(4000 Ft. Min. Runway)

LINE 14N -- NEAREST COMMERCIAL AIRFIELD___________(Name, Town, State)

LINE 14O -- TYPE OF EQUIPMENT_______________________(M1 Abrams, AH64,
30KW, Gen)

LINE 14P -- AC SERIAL NUMBER________________________(Serial, Tail Number)

LINE 14Q -- TYPE MISSION_____________________________(Training, Svc, Single Ship, Multi Ship)

LINE 14R -- NAP OF THE EARTH_________________________(Yes or No)

LINE 14S -- FLIGHT RULES______________________________(VFR/IFR)