Airport Technology R & D Branch
Aircraft Rescue & Firefighting Vehicle Rollover Study - On-Line Reporting

ARFF VEHICLE ROLLOVER QUESTIONNAIRE
   
General Info:
Airport: Name:    Airport Identifier: 
Date of Incident: Month    Day    Year   
Local Time of Incident: Dawn Day Dusk Night   Hour:Min (24 Hr Clock)
Weather Conditions:       Visibility:   
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:   
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) 
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 $):  
         or

Totaled   Replacement Cost (US $):  

Injuries: Operator: Yes No   Crew Member(s): Yes No
Fatalities: Operator: Yes No   Crew Member(s): Yes No
Seat Belts Worn By: Operator: Yes No   Crew Member(s): Yes No
Turnouts Worn By: Operator: Yes No
Contact Info:
Your Name:
Your Title:
Your Dept/Organization:
Your Phone:
Your E-Mail:
Date Reported:
5/16/2012
Can the Technical Center research personnel contact you for additional information, if needed?
YesNo


Please print a copy of this Questionnaire for your records prior to submittal. After submittal, the screen will show the assigned Confirmation Number. Record this number on your printout for future reference.
Thank You.

  


Ignore Entries & Return To
ARFF Vehicle Rollover Study Home Page

 
Prepared for the FAA by
Embry-Riddle Aeronautical University
Prescott, AZ
Revised: HM, August 2, 2011