Grand Forks International Airport

Safety Management Reporting Form

Event Description

Date/Time (required)

Weather (required)
RainWindT'StormFogIceSnowOtherN/A

Visibility (required)
GoodPoorDawnDaylightDuskNightSmokeDust

Type (required)
AccidentIncidentHazardous ConditionHazardous BehaviorOther

Location (required)
RampFuel FarmTaxiwayRunwayHangarFBOParking LotTerminalRestroomSidewalkOther

Items Involved in the Events
AircraftJet BridgeVehicleGateHeavy EquipmentEscalatorSweeperTransporterCargo ContainerCargo LoaderFuel TruckTugLiftWheelchairLav CartBaggage CartTow BarElevatorAir StairsFurnitureStairsPower ToolsOther

Aircraft Number

Jet Bridge Number

Vehicle Number

Gate Number

Heavy Equipment Number

Description (required) (Please provide a detailed description of the event or hazard including specific location)

Recommendations (Please provide any suggestions or recommendation to correct the issue or prevent recurrence)

*Confidentiality Commitment
You may submit the form anonymously if you so choose. If you do provide your name, it will only be
used by the SMS Administrator to enhance the understanding of the event with follow-up actions if
applicable.

Optional Reporter Information

Name

Organization/Position

Address

City

State

Zip

Phone

Alternate Phone

Email