DA Form 2397-9 Technical Report of U.S. Army Aircraft Accident, Part X - Injury/Occupational Illness Data

DA Form 2397-9 or the "Technical Report Of U.s. Army Aircraft Accident, Part X - Injury/occupational Illness Data" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 2397-9 - was last revised on February 1, 2009. Download an up-to-date fillable DA Form 2397-9 down below in PDF-format or look it up on the Army Publishing Directorate website.

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TECHNICAL REPORT OF U.S. ARMY AIRCRAFT ACCIDENT
REQUIREMENTS CONTROL SYMBOL
PART X - INJURY/OCCUPATIONAL ILLNESS DATA
CSOCS-309
For use of this form, see DA Pamphlet 385-40; the proponent agency is OCSA.
1.
DEGREE OF INJURY
(Check only the most severe injury)
a.
Fatal
d.
Days Away From Work
g.
First Aid Only
b.
Permanent Total Disability
e.
Restricted Work Activity
h.
Missing and Presumed Dead
c.
Permanent Partial Disability
f.
Medical Treatment Above First Aid
a. Days Away From Work
b. Days Hospitalized
c. Days of Restricted Activity
2. NUMBER OF LOST WORKDAYS
Hrs
Min
None
Hrs
Min
None
3. UNCONSCIOUS
4. AMNESIA
5. INJURIES
Injuries
Mechanism
Cause Factors
Seq
Primary
Inj
Secondary
Body Region
Action
Qualifier
Subject
Action
Qualifier
No.
Aspect
Aspect
Type/Result
a.
b.
f.
g.
h.
i.
j.
c.
e.
d.
6. REMARKS (Use additional sheet if required)
Yes
On Duty
7. AUTOPSY
8. CAUSE OF DEATH / DATE OF DEATH
9. DUTY STATUS
PERFORMED
No
Off Duty
10. NAME (Last, First, MI)
11. SSN
12. GRADE
13.GENDER 14. DUTY
15a. SVC
b. HOME ADDRESS
c. DOB
d. DATE HIRED
(YYYYMMDD)
(YYYYMMDD)
e. TIME EMPLOYEE BEGAN WORK
f. WAS EMPLOYEE TREATED
g. ADDRESS & NAME OF HOSPITAL
IN EMERGENCY ROOM?
Yes
No
h. ATTENDING PHYSICIAN
i. LOG NUMBER
16. UIC
a. Date
b. Time
c. Acft Serial No.
17. CASE NO.
18. OTHER ACFT SERIAL NO.
19. INJURY COST
(YYYYMMDD)
PREVIOUS EDITION IS OBSOLETE.
APD LC v1.00
DA FORM 2397-9, FEB 2009
TECHNICAL REPORT OF U.S. ARMY AIRCRAFT ACCIDENT
REQUIREMENTS CONTROL SYMBOL
PART X - INJURY/OCCUPATIONAL ILLNESS DATA
CSOCS-309
For use of this form, see DA Pamphlet 385-40; the proponent agency is OCSA.
1.
DEGREE OF INJURY
(Check only the most severe injury)
a.
Fatal
d.
Days Away From Work
g.
First Aid Only
b.
Permanent Total Disability
e.
Restricted Work Activity
h.
Missing and Presumed Dead
c.
Permanent Partial Disability
f.
Medical Treatment Above First Aid
a. Days Away From Work
b. Days Hospitalized
c. Days of Restricted Activity
2. NUMBER OF LOST WORKDAYS
Hrs
Min
None
Hrs
Min
None
3. UNCONSCIOUS
4. AMNESIA
5. INJURIES
Injuries
Mechanism
Cause Factors
Seq
Primary
Inj
Secondary
Body Region
Action
Qualifier
Subject
Action
Qualifier
No.
Aspect
Aspect
Type/Result
a.
b.
f.
g.
h.
i.
j.
c.
e.
d.
6. REMARKS (Use additional sheet if required)
Yes
On Duty
7. AUTOPSY
8. CAUSE OF DEATH / DATE OF DEATH
9. DUTY STATUS
PERFORMED
No
Off Duty
10. NAME (Last, First, MI)
11. SSN
12. GRADE
13.GENDER 14. DUTY
15a. SVC
b. HOME ADDRESS
c. DOB
d. DATE HIRED
(YYYYMMDD)
(YYYYMMDD)
e. TIME EMPLOYEE BEGAN WORK
f. WAS EMPLOYEE TREATED
g. ADDRESS & NAME OF HOSPITAL
IN EMERGENCY ROOM?
Yes
No
h. ATTENDING PHYSICIAN
i. LOG NUMBER
16. UIC
a. Date
b. Time
c. Acft Serial No.
17. CASE NO.
18. OTHER ACFT SERIAL NO.
19. INJURY COST
(YYYYMMDD)
PREVIOUS EDITION IS OBSOLETE.
APD LC v1.00
DA FORM 2397-9, FEB 2009

Download DA Form 2397-9 Technical Report of U.S. Army Aircraft Accident, Part X - Injury/Occupational Illness Data

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