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Airport Technology R & D Branch Aircraft Rescue & Firefighting Vehicle Rollover Study - Off-Line Reporting |
| General Info: |
| Airport: Name: ____________________________________________ Airport Identifier: _____ |
| Date of Incident: ____________ |
Local Time of Incident:  Dawn Day Dusk Night
Hour:Min (24 Hr Clock): _______ |
| Weather Conditions: Clear Rain Drizzle Fog Snow
Visibility: Low High |
| Surface Condition: On Off
Road Wet Dry Ice Snow/Slush
Taxiway Runway Public
Roadway Access Road |
| Vehicle Info: |
| Vehicle Type: Make: ___________________ Model: ________ Year: ______ |
| Elevated Boom?: Yes No
Position: Bedded Transitioning High
Attack Low Attack |
| Vehicle GVW: __________ lbs |
| Weight Distribution (if known): Front:__________ lbs Rear: __________ lbs |
| Vehicle Payload:
Water Tank Status: Full 1/2 1/4 Empty
Foam Tank Status: Full 1/2 1/4 Empty
Equipment load configuration same as when delivered from factory? Yes No |
| Vehicle Suspension: Straight
Axle Independent
Roll Dampening Modified? Yes No |
| Was a Monitoring and
Data Acquisition System (MADAS) installed on the vehicle? Yes No |
| Personnel: |
| Operator Experience: ____ Total Years of Service ____ Years as ARFF Vehicle Operator |
| Had the operator attended
an ARFF Vehicle Operators Safety Course prior to the incident?
Yes No |
| Incident: |
| Vehicle Speed: ____ mph (Approx Speed at Time of Incident) |
| Type of Vehicle Operation: Training Emergency Timed
Response Drill Other (Explain)
If Other (above), explain here _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ |
| Brief Summary of Incident:
_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ |
| Was an "Accident Reconstruction
Investigation" conducted by an independent party and a copy of the report
submitted? Yes No |
| Damage/Injuries: |
| Vehicle Damage/Cost Information:
Repairable
Time Out of Service: _____ Hours Days Est Cost of Repairs
(US $): __________
Est Other Costs (lease/replacement vehicle, etc.) (US $): __________
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| Injuries: Operator: Yes No
Crew Member(s): Yes No
If yes (above), number of each: _______________________________________________________________________________ _______________________________________________________________________________ |
| Fatalities: Operator: Yes No
Crew Member(s): Yes No
If yes (above), number of each: _______________________________________________________________________________ _______________________________________________________________________________ |
| Seat Belts Worn Operator: Yes No
Crew Member(s): Yes No
Turnouts Worn Operator: Yes No |
| Contact Info: | ||
| Your Name:
____________________________ |
Your Title:
____________________________ |
Your Dept/Organization:
____________________________ |
| Your Phone:
____________________________ |
Your E-Mail:
____________________________ |
Date Reported:
____________________________ |
| Can the Technical
Center research personnel contact you for additional information, if needed? Yes No |
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Federal Aviation Administration
Thank You. |
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ARFF Vehicle Rollover Study Home Page
Prepared
for the FAA by
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