Incident Report

To report an incident or malfunction or report a product defect, you may either:

1) Download the Incident/Malfunction/Product Defect Reporting Form here: TR425B CPS Incident-Malfuntion-Product Defect Report Form (TR425B CPS Incident-Malfuntion-Product Defect Report Form >1 MB) and return it to the CPS Technical Department and CPS-TTF Manager.

-OR-

2) Complete this online form (form is not encrypted and confidential information will not be transmitted securely).

Report Type (required)


Report Details

Incident DateTime of JumpCourseLocation
Name of Person Filing ReportEmail of Person Filing Report

Description (required):

Injuries (description, if any)


Equipment Details

Harness/Container
Make/ModelOther
Serial #
DOM
Reserve Parachute
Make/ModelOther
Serial #
DOM
AAD
Make/ModelOther
Serial #
DOM
Main Parachute
Make/ModelOther
Serial #
DOM
Deployment ConfigurationOxygen SystemCombat Equipment
Ruck WeightAll-Up Exit Weight
kilograms (kg)pounds (lb)

Jump Details

AircraftDoor Exit (e.g. tailgate, side door)
 
Jump AltitudeDeployment Altitude
meters (m)feet (ft)
 
Exit SpeedDeployment Airspeed
kilometers per hour (kmh)miles per hour (mph)

Parachutist Details

Parachutist NameRankMilitary Unit

Comments

Parachutist's Comments

Malfunction Officer’s Comments

Conclusion

Recommended Product Improvement(s)

Actions


Supporting Documents

Acceptable file types = .doc, .pdf, .xls, .docx, .xlsx, .gif, .png, .jpg. To send video or other files, contact technical@cpsworld.com or your Account Executive.

File 1

File 2

File 3

Link to supporting media (http://www.youtube.com/watch?v=npvJ9FTgZbM for example):


Submit

Jumper’s Signature (required)
Enter Jumper's Initials as Proof of Signature: Date:

MO's Signature (required)
Enter MO's Initials as Proof of Signature: Date:

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By checking this box, you acknowledge that this form is not encrypted and not considered to be a secure form of transmitting confidential information.