For USUA BFIs only. Every 6 months, USUA instructors are required to submit the following information to the USUA (in accordance with condition #11 and #12 of Training Exemption #4274).

Please submit this form once for each training vehicle you use.

Reporting Period:

Instructor Information:

Instructor Name:
BFI Number:
E-mail Address:
Address:
City:
State:	Zip Code:
Phone:

How many hours of dual ultralight flight instruction did you give during the reporting period?

How many total hours of dual ultralight flight instruction have you given since you became an ultralight instructor?

Training Vehicle Owned Or Used Under The Exemption:

Manufacturer:
Model:
USUA Registration Number:

Type:

Specifications:

Parachute Installed?

Accidents/Incidents:

Have you been involved in any incidents and/or accidents during this reporting period?

If yes, fill out the information below

Incident means an occurence, other than an accident, associated with the operation of an ultralight vehicle, which affects or could affect the safety of operations. Accident means an occurence associated with the flight operation of an ultralight vehicle in which any person suffers death or injury or the ultralight vehicle is substantially damaged.

Details:

If you previously submitted this form to USUA on an Accident Report, you do not need to complete the rest of this form.

If you wish, you can fill out the Online Accident Report now. (This form will open in a new browser window)

Date of incident: (mm/dd/yyyy)

Type Of malfunction:

Number of injuries:

Description of injuries, if any:

Number of fatalities:

Description of event:

Any Other Comments for USUA?

Thank you!

Note: If you want to save a copy of this report, please print this screen before pressing the Submit button.

Date of incident:	(mm/dd/yyyy)
Type Of malfunction:
Number of injuries:
Description of injuries, if any:
Number of fatalities: