|NASA Headquarters' Directives|
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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Appendix K: Example of HQ Type C, Type D, and Low- Visibility Incident/Mishap Report
Subject: Investigation of Mishap (Title), IRIS No.
The investigation of the (Title) mishap has been completed, and the results are as follows:
Incident Description: (What happened, when it happened, who reported it, what actions were taken and the timeline).
Finding: (What the investigation revealed) Discussion:
Proximate Cause(s), Root Cause(s), and Contributing Factors:
Lessons Learned (if any):
MIT Chairperson's or MI's Name