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:

 

Location:

 

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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