Wufoo

Delta AFA Safety Committee Incident Report

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I understand that all information provided is confidential and used only to investigate safety issues. No information from this form will be shared with anyone other than the AFA Safety committee.
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Name First Last
Email
Phone Number ### - ### - ####
Best time to contact you - please add time zone
Date of Incident MM / DD / YYYY
Approximate time HH : MM : SS AM/PM
Flight number
Model of plane
General type of safety issue
Please provide a description of what happened, who was affected, and any safety concerns noticed.
Is there any additional information that you would like the safety committee to be aware of?
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