NZHGPA AIRS Report

NZHGPA AIRS Report

Accident & Incident Reporting System (REV 1.1 01/05/25)
Occurrence Reporting
For ongoing improvements in safety, it is important and appreciated that all accidents and incidents, including close calls and near misses, are captured using this NZHGPA AIRS form.

Information is provided for statistical and safety information only, and is not used for enforcement investigation or disciplinary action unless the safety of other people or property has been put in unnecessary danger, or if false information is supplied. The accident information entered into this form will be automatically forwarded onto the CAA and this will fulfil your statutory reporting obligations. CAA applies these principles of Just Culture: https://www.aviation.govt.nz/about-us/what-we-do/operational-policies/just-culture-what-it-means-to-the-caa/

The report will be held on the NZHGPA database. Personal details like name, address, contact details, are provided in confidence. General explanatory information surrounding the incident or accident is published on the AIRS Summary reports on the NZHGPA website and may be shared to help prevent further incidents or accidents in the future.

NZHGPA AIRS - CAA Approved 21 April 2021
How this form works

Form Instructions
- Complete all areas where applicable;
- Allow for 15-20 minutes and be specific in details;
- If you have any changes after you have submitted, please contact safety@nzhgpa.org.nz;
- This form may be saved, continued at a later time, and then submitted when completed. Press SAVE, to save your entries. You will be automatically sent a link to the email you provide, then use the link to continue your reporting, and press SUBMIT REPORT when completed;
- Information provided will be held in confidence and used by the Operations Team for improving safety within the NZHGPA 149 Certification;
- The personnel reporting and the NZHGPA Safety Officer will automatically receive a PDF copy of this report.
This form is a controlled document, managed by the NZHGPA, under the delegation of the Civil Aviation Authority (CAA).
1. If you are a WITNESS to the accident or incident: please complete the NZHGPA AIRS Witness Report ;
2. If you are an INSTRUCTOR: where possible, please select/write 'Unknown' for questions you are unable to accurately answer.
Reporter's Details

Person making the report
Your name (confidential)*
Position - how were you involved?*

Pilot of aircraft involvedPassenger of aircraft involvedInstructor (if this involved your student pilot)Other
Organisation involved*

NZHGPA full/visitor (incident did not occur while part of any school, tandem or other organisaiton)NZHGPA member - studentOther organisation/business name if applicable
Date of this report*

DayMonthYear
Date being reported, not the date of occurrence
Your phone number*
Your email*
example@example.com
Occurrence Details

This is the pilot of the main aircraft involved in the occurrence. If more than one aircraft was involved please provide details in the "other person" section below.
Pilot's name
Pilot pin
Pilot date of birth

DayMonthYear
Date
Pilot Age
Pilot gender*

MaleFemaleOther
Pilot address
Pilot phone number*
Pilot email*
example@example.com
Date of occurrence*

DayMonthYear
Date
Time of occurence*

Hour Minutes
Aircraft type*

ParagliderHang GliderSpeed WingPowered ParagliderPowered Hang Glider
Pilot total flying hours*
Please enter as accurately as possible
Pilot hours in last 90 days*
Pilot hours on glider involved in the occurrence*
Pilot certificate (highest held that is relevant to the occurrence)*

StudentPG1 or NovPG2 or IntPG3 or AdvTandemMotor (PPG or PHG)Other
Type of occurrence - Select all that apply to the incident

No injuryMinor scrapes, cuts or bruisesTreatment required by a physio or other medical providerTime required off work due to the injurySimple fracture on hands, feet or ribsAdmission to hospital for less than 48 hrsSerious Injury: admission to hospital for greater than 48hrsSerious Injury: Head or Internal organ injurySerious Injury: fractured or broken bones that are NOT fractured hands, feet or ribs.Serious Injury: lacerations causing severe haemorrhage, nerve or tendon damage, amputationSerious Injury: significant life-long consequences from injuries sustainedFatal Injury
Type of occurrence calc (do not delete)
Occurrence type helper field (do not delete)
Pilot broken bones*

YesNo
Pilot ACC claim*

YesNo
Pilot location of main injuries*

HeadUpper limbsLower limbsUpper spineLower spineChestAbdomenNo injuries
Describe nature of pilot injuries*
Insert N/A if no injuries
Describe what happened*
Were other people involved or witnesses to be recorded?*

YesNo
Other Person(s) or Witness(s)
If you are a witness to the accident or incident, please complete the witness form here: here
Involvement*

Another PilotPassengerInstructorWitnessBystander

Other person or witness email
example@example.com
Other relevant details*
Other person: broken bones*

YesNo
Other person: ACC claim*

YesNo
Other person: location of main injuries*

HeadUpper limbsLower limbsLower spineChestAbdomenNo injuries
Describe nature of other person's injuries*
Were any other people involved or witnesses to be recorded?*

YesNo
Extra Person(s) or Witness(s)
Involvement*

Another PilotPassengerInstructorWitnessBystander
Extra person or witness name*
Extra person or witness Address
Extra person or witness phone number
Extra person or witness email
example@example.com
Other relevant details
Broken bones - other person*
ACC claim - other person*
Location of main injuries - other person

HeadUpper limbsLower limbsLower spineChestAbdomenNo injuries
Describe nature of other person injuries
Operational Details
Location (SITE name and nearest town or GPS coordinates)*
Region where the occurrence happened*
Nature of flight*

Local recreationCross countryCompetitionInstruction (please provide details of other people involved in last section, if you have not yet filled it out)Tandem (please provide details of other people involved in last section, if you have not yet filled it out)AcroSpeedflyingHike & FlyNOT a flying accident/incident
Foot or tow launched*

Foot launchedTow launchedNOT a flying incident
Flight phase*

Ground handlingTake off runLaunchClimbingGlidingDescent manoeuvreAerobatic manoeuvreApproach to landLandingAfter landing (ie. dragged on ground)NOT a flying accident/incident
Airspace incident*

YesNo
Contributing Factors

NZHGPA use only (data collected to prevent future incidents or accidents.)

	Details
Full Name
Full Address
Contact Number

Human factors*

	YES	NO
Illness
Medication
Stress
Alcohol
Drugs
Fatique
Eating/Dehydration
Decision Making
Distraction
Inadequate training
Situational awareness

Number of years flying*
School and instructor: If currently training or have graduated in the last 12 months, please note where you completed training & the instructor(s)*
Please note as N/A if licenced for >12 month
Any other contributing factors or comments ?*
Equipment
Helmet*

Not wornFull faceOpen faceDamaged prior to accident/incident
Certified helmet*

YesNo
Harness (tick all relevant options)*

BasicStirrupPodPoweredWheeledAcroHG
Certified harness back protection*

Yes - foamYes - air bagYes - other certified back protectionNo - certified back protection
Reserve parachute*

Not carriedCarried but not deployedDeployed but not effectiveDeployed and effectiveDeployed accidentally
How many reserve parachutes were carried?*

Glider details*

	Details
Make
Modle
Size
Minimum weight of certified weight range (kgs)
Maximum weight of certified weight range (kgs)
Pilot all up flying weight including equipment (kgs)

WOF*

	YES	NO
Glider CURRENT WOF
Harness CURRENT WOF

Equipment damage*

NoneMinorSignificant (structural damage affecting structural strength, performance or flight characteristics. Requires major repairs or replacement)Destroyed
Equipment failure*

YesNo
Explain the nature of the damage and any failure that occurred*
nature of damage
Environmental Factors

LAUNCH/LANDING SITES
Launch site name / location*
Site familiarity*

Pilot's first flight at this siteLess than 10 flights at this siteMore than 10 flights at this site
Site and flightpath clear of hazards*

YesNo
Landing and flightpath clear of hazards*

YesNo
Weather checked before flying*

Internet sites (Windy, SkySight, RASP, MetService, etc)Weather stationsOn site assessmentTV forecastOther pilot forecast or assessmentNone
What are the site's wind directions for launching*

SouthSouth EastEastNorth EastNorthNorth WestWestSouth WestNot a flying accident/incident
Prevailing wind direction*

SouthSouth EastEastNorth EastNorthNorth WestWestSouth WestNot a flying accident/incident
Wind speed average (km/h)*

1-10 km/h11-20 km/h21-30 km/h>31 km/hNot a flying incident
Wind Conditions*

CalmVariableSteadyModerate gustsStrong gustsThermalsTurbulentNot a flying incident
Any additional weather or site comments*
Any organisational procedures that may have contributed to the occurrence*
Lessons learnt - What advice would you give to another pilot to reduce the chances of something like this happening to them*
Thank you for completing this report. When you press the submit button you will receive a confirming email to the address you supplied in section 1. If there is anything else you would like to add please do it here.
Please do not upload files as a substitute for completing the fields above. These fields are essential for safety reporting and must be filled out.

any files/photos to upload; Max 5MB
Cancelof
Senior Person Approval

*Signature to acknowledge Report
Senior Person Name / Role (Safety/CEO/other)

First NameLast NameRole
Senior Person Signature

Clear
Senior Person Signature Date

DayMonthYear
Date
safety@nzhgpa.org.nz
Safety@*
example@example.com
Should be Empty:

NZHGPA AIRS Report

Occurrence Reporting

How this form works

Reporter's Details

Occurrence Details

Other Person(s) or Witness(s)

Extra Person(s) or Witness(s)

Operational Details

Contributing Factors

Equipment

Environmental Factors

Senior Person Approval