NASA logo NASA Headquarters' Directives
HQPR 8621.1
Effective Date: November 08, 2011
Expiration Date: June 08, 2019
Responsible Office: LM
Mishap Reporting, Investigating, and Recordkeeping Program and Plan
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Table of Contents | Preface | Chapter1 | Chapter2 | Chapter3 | Chapter4 | Chapter5 | Chapter6 | Chapter7 | AppendixA | AppendixB | AppendixC | AppendixD | AppendixE | AppendixF | Appendix G | AppendixH | AppendixI | AppendixJ | AppendixK | AppendixL

Appendix E: Example of 1-Hour Phone Report to OSMA/SARD

(Follow With Immediate E-mail)

Mishap Type:


Date: Month, Day, Year


Time of Mishap:




Type of Injury, Illness or Fatality:


Type of Employee: Civil Servant, Contractor, Visitor, Public, Other


Organization or Company:


Type of Property Damage:


Estimated Direct Cost :


Description of incident


Actions Taken:


Contact Person:


Center Reporting Mishap: HQ


Author's Phone Number:


Author of Report


Date and Time:


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