Revised 6120 Form

FORM APPROVED FOR USE THROUGH

BY OMB NO. 3147-0001

NATIONAL TRANSPORTATION SAFETY BOARD (NTSB) Form 6120.1
PILOT/OPERATOR AIRCRAFT ACCIDENT/INCIDENT REPORT
A blank version of this form, instructions for when to complete it, and
information
for
how
to
return
it
are
available
at https://www.ntsb.gov/Pages/aviationreport.aspx. Forms may be
returned via e-mail to notify@ntsb.gov or via post mail to NTSB, Office of
Aviation Safety, 490 L'Enfant Plaza, S.W., Washington, D.C. 20594.
Completed forms should be returned within 10 days after an accident for
which notification is required by 49 CFR § 830.5, or after 7 days if an
overdue aircraft is still missing. An aircraft accident, as defined in 49 CFR
§ 830.2, is determined as an occurrence that involves a fatality or serious
injury, or substantial damage to the aircraft.

operation of an aircraft that takes place between the time any person
boards the aircraft with the intention of flight and all such persons have
disembarked, and in which any person suffers death or serious injury, or in
which the aircraft receives substantial damage. The definition of “aircraft
accident” includes “unmanned aircraft accident,” as defined at 49 CFR
§ 830.2.
2. "Substantial Damage" means damage or failure that adversely
affects the structural strength, performance or flight characteristics of the
aircraft, and which would normally require major repair or replacement of
the affected component. NOTE: Engine failure or damage limited to an
engine if only one engine fails or is damaged, bent fairings or cowling,
dented skin, small puncture holes in the skin or fabric, ground damage to
rotor or propeller blades, and damage to landing gear, wheels, tires, flaps,
engine accessories, brakes, or wing tips are not considered "substantial
damage" for purposes of this report.
3. "Operator" means any person who causes or authorizes the
operation of an aircraft, such as the owner, lessee, or bailee of an aircraft.
4. "Fatal Injury" means any injury that results in death within 30 days
of the accident.
5. "Serious Injury" means any injury that (1) requires hospitalization
or more than 48 hours, commencing within 7 days from the date the
injury was received; (2) results in a fracture of any bone (except simple
fracture of fingers, toes, or nose); (3) causes severe hemorrhages, nerve,
muscle, or tendon damage;(4) involves injury to any internal organ; or (5)
involves second- or third-degree burns, or any burns affecting more than 5
percent of the body surface.

For occurrences that do not involve a fatality, the determination that
the occurrence is an accident can be appealed by writing to the Director,
Office of Aviation Safety, NTSB, 490 L'Enfant Plaza, S.W., Washington,
D.C. 20594.
The NTSB uses this form for aircraft accident prevention activities and
for statistical purposes. NTSB regulations require that ALL questions be
answered completely and accurately. Completion of this form will take
approximately 60 minutes. The NTSB does not guarantee the
privacy of any information provided in this form. Accordingly, the
information provided herein may be subject to public release. You
need not complete this form unless it displays a valid OMB control number.
See 5 C.F.R. § 1320.5(b).
DEFINITIONS
1. "Aircraft Accident" means an occurrence associated with the

INSTRUCTIONS TO PILOTS/OPERATORS FOR COMPLETING THIS FORM
ALL questions must be answered completely and accurately.
If more space is needed, continue on a blank sheet of paper.
Nearest City/Place: Use the name of the nearest community in the state where the accident/incident occurred.
Date/Time: Indicate the date, local time of the event, and time zone.
Phase of Operation: Indicate the phase of operation during which the accident/incident occurred.
Aircraft Information: Enter aircraft make and model information as indicated on the aircraft registration certificate, including series. If the involved aircraft is certified
as "amateur-built," include the name of the producer of the kit or plans.
Maximum Gross Weight: Enter the certificated maximum gross weight for the aircraft involved in the occurrence. This should be the same as the maximum gross
weight indicated on the aircraft weight and balance documents.
Engine: Enter engine make and model information as indicated on the engine data plate.
Type of Fire Extinguishing System: If a fire extinguishing system was used to fight an aircraft fire, specify the type(s) of extinguishing system(s) used. Examples
include handheld extinguisher, engine fire bottle, cargo/baggage compartment fire suppression system, or airport emergency ground equipment.
Owner/Operator Information: Enter the owner information as shown on the registration certificate. Commercial operators, enter the operator information, including
"doing business as" when applicable, as shown on the operator certificate.
Revenue Sightseeing Flight: Indicate whether the accident aircraft was conducting revenue sightseeing operations under 14 CFR Part 91 at the time of the
accident.
Air Medical Flight: Indicate whether the accident flight was being conducted for the purpose of carrying medical personnel, patient(s), or organs.
Public Aircraft: Federal, state or local government flight operations such as official travel, law-enforcement, low-level observation, aerial application, firefighting,
search and rescue, biological or geological resource management, or aeronautical research. Indicate whether the flight was conducted by the armed forces,
Federal, state, or local government.
Purpose of Flight: 14 CFR Parts 91, 103, 133, 136, and 137: Indicate the type of operation that was being conducted at the time of the occurrence using the
following definitions:
AERIAL APPLICATION—Operations using an aircraft to perform aerial application or dispersion of any substance. Examples include agricultural, health,
forestry, cloud seeding, firefighting, insect control, etc.
AERIAL OBSERVATION--These flights include aerial mapping/photography, patrol, search and rescue, hunting, highway traffic advisory, ranching,
surveillance, oil and mineral exploration, criminal pursuit, fish spotting, etc.
AIR DROP—Aerial operations, other than aerial application, that are intended to release items in flight.

1

FORM APPROVED FOR USE THROUGH

BY OMB NO. 3147-0001

AIR RACE/SHOW—Includes any flight operations conducted as part of an organized air race or public demonstration.
BUSINESS--includes all personal flying without a paid professional crew for reasons associated with furthering a business, including transportation to
and from business meetings or work. This does not include corporate/executive operations, air taxi, or commuter operations.
EXECUTIVE/CORPORATE—Company flying with a paid professional crew.
FERRY--Non-revenue flight under a special flight or "ferry" permit. Refer to 14 CFR § 21.197 for details of special flight permit issuance.
FLIGHT TEST—Flight for the purpose of investigating the flight characteristics of an aircraft/aircraft component or evaluating an applicant for a pilot
certificate or rating.
INSTRUCTIONAL--Flying while under the supervision of a flight instructor or receiving air carrier training. Personal proficiency flight operations and
personal flight reviews, as required by Federal air regulations, are excluded.
OTHER WORK USE--Miscellaneous flight operations conducted for compensation or hire such as construction work (not 14 CFR Part 135 operation),
parachuting, aerial advertising, towing gliders, etc.
PERSONAL--Flying for personal reasons (excludes business transportation) including pleasure or personal transportation. This also includes practice
or proficiency flights performed under flight instructor supervision and not part of an approved flight training program.
POSITIONING--Non-revenue flight conducted for the primary purpose of relocating the aircraft. Examples include moving the aircraft to a maintenance
facility or to load passengers or cargo, etc.
UNKNOWN--Use only if the primary purpose of flight is not known.
Other Aircraft--Collision: For all accidents involving a collision with another aircraft, including parked aircraft, check "Collision with other aircraft" under Basic
Information and complete this section indicating details about the OTHER aircraft involved in the collision.
Airport Information: Complete this section if the accident/incident occurred on approach, landing, takeoff, departure, or within 3 statute miles of an airport. Please
refer to the FAA Chart Supplement or other official source for airport information.
Airport Identifier: Provide the official 3 or 4 character airport identifier number.
Runway: Indicate the number of the runway used—including L, R, or C, if applicable.
Runway/Landing Surface: Indicate the type of intended runway/landing surface (do not indicate surface conditions). If the surface type was mixed, check all that
apply.
Condition of Runway/Landing Surface: Indicate the condition of the intended runway/landing surface. If multiple conditions existed at the time of the accident,
check all that apply.
Weather Information at the Accident/Incident Site: Indicate the weather conditions reported at the accident/incident site at the time of occurrence. If no weather
reporting was available for the accident/incident site, indicate the reported conditions at the nearest reporting site. Specify the weather reporting site identifier, the
observation time, and distance from the accident/ incident.
Sky/Lowest Cloud Condition: Indicate the height above ground level of the lowest cloud condition present at the time of the accident/incident and whether coverage
was reported as few, scattered, broken or overcast. Also indicate the height above ground level and coverage of the lowest cloud ceiling present at the time of the
accident/incident (reported as broken or overcast).
NOTAMs (D and FDC), AIRMETs, SIGMETs, PIREPs: Describe all NOTAMs (distant (D) or Flight Data Center (FDC), if known), AIRMETs, SIGMETs, and
PIREPs in effect near the accident/incident.
Flight Crewmember Information: Indicate the category that best describes the capacity served by this flight crewmember at the time of the accident. The designators
"Flight Crewmember 1" and "Flight Crewmember 2" do not refer to a specific pilot position or responsibility. If more than one pilot is aboard, they may be entered
in any order and their capacity entered as appropriate.
Degree of Injury: See Definitions on the top half of Page 1 of the instructions. Minor injury is not defined. If an injury does not meet the criteria for another injury
category, select Minor.
Date of Last Flight Review or Equivalent: Enter the date of the most recent flight review, or equivalent, completed by this pilot. Refer to 14 CFR 61.56 for accepted
equivalents.
Type Ratings: List all type ratings on the pilot certificate. If the pilot holds no type ratings indicate "none." If the pilot holds a pilot certificate other than student and
was flying an aircraft requiring an endorsement, enter the type and date of any logbook endorsement(s) for that aircraft. See 14 CFR § 61 for examples of required
endorsements.
Student Endorsements: If the pilot holds a student pilot certificate, enter all solo endorsements and dates on the student pilot certificate.
Flight Time: Complete the flight time matrix. Solo flight time should be included as "Pilot-in-Command (PIC)" and all dual flight instruction given should be included
as "Time as Instructor."
Additional Flight Crewmembers: Complete this section if there were more than two required flight crewmembers on the aircraft. This also includes a check airman
performing official duties but does not include cabin crew. State the capacity served by each included crewmember at the time of the accident.
Passenger(s)/Other Personnel: Enter identification and injury severity information for all passengers, cabin crew, and other personnel involved in the accident.
See Page 1 of the instructions for the official definition of injury levels.
Several questions throughout the form allow for multiple responses; when appropriate, choose all responses that apply.

2

FORM APPROVED FOR USE THROUGH

BY OMB NO. 3147-0001

NATIONAL TRANSPORTATION SAFETY BOARD
PILOT/OPERATOR AIRCRAFT ACCIDENT/INCIDENT REPORT
This form is to be used for reporting civil and public aircraft accidents and incidents
BASIC INFORMATION
Accident/Incident Location

Accident/Incident Date/Time

Nearest City/Place:
ZIP:

State:

Date:

Local Time:
mm/dd/yyyy

Country:
Time Zone:

Latitude:
Longitude:
(Enter in decimal degrees or degrees:minutes:seconds)

Collision with Other Aircraft:

żMidair żOn-ground żNone

AIRCRAFT INFORMATION
Manufacturer:

ƑIFR-Equipped and Certified
ƑCommercial Space Flight
ƑUnmanned Aircraft

Model:

Maximum Gross Weight:

Serial Number:

Weight at Time of Accident/Incident:

Year of Manufacture:

Number of Seats:

Flight Crew Seats: ___________

Cabin Crew Seats:

Passenger Seats: _____________

Registration Number:

Amateur-Built:

żYes
żNo

Category of Aircraft
(Select one)
żAirplane
żBalloon
żBlimp/Dirigible
żGlider
żGyroplane
żHelicopter
żPowered Lift
żRocket
żUltralight
żUnknown
Engine

If yes:

żOriginal Design
żKit/Plans
Make:

Landing Gear
(Check all that apply)

Special
ƑRestricted
ƑLimited
ƑProvisional
ƑSpecial Flight
ƑExperimental
ƑSpecial Light-Sport
ƑExperimental Light-Sport

Engine Type
(Select one)

ƑRetractable
ƑHigh Skid
ƑTricycle
ƑSkid
ƑTailwheel
ƑSki/Wheel
ƑEmergency Float
ƑHull
ƑFloat
ƑSki
ƑAmphibian
ƑOther Launch/Recovery System
ƑNone
ƑUnknown

Ƒ&HUWificate of Waiver or Authorization (COA)
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Engine Manufacturer

Engine Model/Series

lbs.

Number of Engines: ___________

Type of Airworthiness Certificate
(Check all that apply)
Standard
ƑNormal
ƑAcrobatic
ƑBalloon
ƑCommuter
ƑTransport
ƑUtility

lbs.

Engine Serial
Number

Date of Mfg.
(mm/dd/yyyy)

Rated Power
żHorsepower or
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żLiquid Rocket
żSolid Rocket
żHybrid Rocket
żNone
żUnknown

Fuel System Type (Reciprocating)
żCarburetor
żFuel Injected
Total
Time
(hours)

Time Since:
Inspection
(hours)

Overhaul
(hours)

Eng 1
Eng 2
Eng 3
Eng 4

Last Inspection Type

Additional Equipment

ż100-Hour
żAAIP
żAnnual
żContinuous Airworthiness
żCondition Inspection
żUnknown
Date of Last Inspection: (mm/dd/yyyy)
Airframe Total Time:
hours
Hours measured at (Select one)
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Ƒ Autopilot/FMS, Model__________
Ƒ Coupled Flight Director
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Ƒ Device Stall Warning System
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Ƒ Flight Management System

ELT Installed

Type of Maintenance Program (Select one)
żAnnual
żConditional (Amateur-built only)
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żOther Approved Inspection Program
ż(AAIP) Continuous Airworthiness
żOther, specify:

Description of Fire Extinguishing System
ż None
ż Specify

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ƑNight Vision Goggles
Ƒ Onboard Weather
Ƒ Primary Flight Display
Ƒ SAS, Axis (circle one): 2, 3, 4, Model: _______
Ƒ6DWHOOLWH7UDFNLQJ'HYLFH
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Ƒ Wire Strike Detection
Ƒ Wire Strike Protection
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ELT Manufacturer:
Model or Part No.:
TSO No.: ż&0+] ż&D0+]
ż&0+]
Was ELT still mounted in aircraft? żYes żNo
Was ELT still connected to antenna? żYes żNo
Did ELT activate? żYes żNo
If activated: Did ELT aid in locating aircraft? żYes żNo
If not activated: Indicate Reason: ƑImpact Damage
Ƒ Fire Damage Ƒ Battery Ƒ Expired/Damaged Ƒ Unknown

3

Propeller 1
żFixed Pitch
żControllable Pitch
żGround Adjustable
Manufacturer: ________________________
Model:

Propeller 2
żFixed Pitch
żControllable Pitch
żGround Adjustable
Manufacturer: _________________________
Model:

FORM APPROVED FOR USE THROUGH

BY OMB NO. 3147-0001

OWNER/OPERATOR INFORMATION
Registered Aircraft Owner
Fractional Ownership Aircraft:

Name:
City:

żYes

żNo

State:

ZIP:

Country:

Operator of Aircraft

ƑSame address as Registered Owner

ƑThe Operator is also the Registered Owner

Name:

Doing Business As:

City:

Air Carrier/Operator Designator (4-character code):

State:

ZIP:

Country:
Operating Certificates Held
(Check all that apply)

Regulation Flight Conducted Under

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AIRPORT INFORMATION

Air Medical Flight?
żYes
żNo

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Distance from Airport Center:

Airport Identifier:
Proximity to Airport:

żOff Airport/Airstrip

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Runway Information

Direction from Airport:

degrees true

Airport Elevation:

ft. MSL

Length:

ft. Width:

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IFR Approach (Check all that apply)
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Condition of Runway/Landing Surface (Check all that apply)

Runway/Landing Surface (Check all that apply)
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Approach/Departure Segment (Select one)
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(Fill in if accident/incident occurred on approach, landing, takeoff, departure, or within 3 miles of an airport.)

Airport Name:

Runway ID:

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Purpose of Flight for FAR 91, 103, 133, 137 (Select one)
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Revenue Sightseeing Flight?
żYes
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Revenue Operation for FAR 121, 125, 129, 135
(Select one for each group)

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FORM APPROVED FOR USE THROUGH

BY OMB NO. 3147-0001

“FLIGHT CREWMEMBER 1” INFORMATION
“Flight Crewmember 1” Responsibilities at the Time of Accident/Incident
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“Flight Crewmember 1” was pilot flying ƑFile Typeapplication/pdfFile TitleRevised 6120 Package (002).pdfAuthorCurameng KathleenFile Modified2024-03-21File Created2024-03-21