DA Form 2397-10 Technical Report of U.S. Army Aircraft Accident, Part Xi - Personnal Protective/Escape/Survival/Rescue Data

DA Form 2397-10 - also known as the "Technical Report Of U.s. Army Aircraft Accident, Part Xi - Personnal Protective/escape/survival/rescue Data" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 2397-10 - was last revised on February 1, 2009. Download an up-to-date fillable PDF version of the DA 2397-10 below or request a copy through the chain of command.

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TECHNICAL REPORT OF U.S. ARMY AIRCRAFT ACCIDENT
REQUIREMENTS CONTROL SYMBOL
PART XI - PERSONAL PROTECTIVE/ESCAPE/SURVIVAL/RESCUE DATA
CSOCS-309
For use of this form, see DA Pamphlet 385-40; the proponent agency is OCSA.
Yes
No
1. DID THIS INDIVIDUAL SUSTAIN AN INJURY OR OCCUPATIONAL ILLNESS BECAUSE OF ACCIDENT?
(NOTE: If "yes" box is checked, ensure a DA Form 2397-9 is completed for this individual)
2.
PERSONNEL PROTECTIVE/RESTRAINT/SURVIVAL EQUIPMENT
Pro-
Al-
Pre-
Re-
Func-
Information Codes
duced
Re-
Avail-
Used
lowed
vented
duced
tioned
Item
Type
quired
able
Injury
Injury
Injury
Injury
as De-
signed
(10)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(1)
a. Helmet
b. Visor
c. Glasses
d. Flight Suit
e. Flight Gloves
f. Flight Jacket
g. Boots
h. Other Clothing
i. Lap Belt
j. Shoulder Harness
k. Gunner Harness
l. Inertia Reel
m. Seat/Litter
n. Survival Equipment
o
.
p.
Information Codes
3.
PERSONNEL EVACUATION/ESCAPE
a. Method of Escape
b. Location in Aircraft
c. Exit Attempted
d. Exit Used
e. Aircraft Attitude During Escape
f. Cockpit/Cabin Conditions
g. Escape Difficulties
Date
Hour of Day
Lapsed Time
4.
LAPSED TIME FOR RESCUE
5. DISTANCE FROM ACCIDENT TO ACTUAL
RESCUE VEHICLE AT TIME OF ACCIDENT
MM
DD
HR
MIN
HR
MIN
a. To Aircraft in Nautical Miles
a. Notification of Rescue Personnel
b. Individual Physically Reached
b. To Ground Vehicle in Statute Miles
c. Individual Actually Aboard Rescue Vehicle
d. Rescue Completed/Abandoned
Information Codes
6.
PERSONNEL SURVIVAL/RESCUE
a. Survival Problems Encountered
b. Means Used to Locate Individual
c. Rescue Equipment Used
d. Factors That Helped Rescue
e. Factors Complicating Rescue
f. Individual Physical Condition
g. Vehicles Actually Performing Evacuation
(Specify)
h. Other Vehicles Assisting in Rescue
(Specify)
7. REMARKS (Use additional sheet if required)
8. NAME (Last, First, MI)
10. GRADE
11. GENDER
12. DUTY
13. SVC
14. UIC
a. Date (YYYYMMDD)
b. Time
15. CASE NO.
c. Acft Serial No.
16. OTHER ACFT SERIAL NO.
DA FORM 2397-10, FEB 2009
PREVIOUS EDITION IS OBSOLETE.
APD LC v1.01
TECHNICAL REPORT OF U.S. ARMY AIRCRAFT ACCIDENT
REQUIREMENTS CONTROL SYMBOL
PART XI - PERSONAL PROTECTIVE/ESCAPE/SURVIVAL/RESCUE DATA
CSOCS-309
For use of this form, see DA Pamphlet 385-40; the proponent agency is OCSA.
Yes
No
1. DID THIS INDIVIDUAL SUSTAIN AN INJURY OR OCCUPATIONAL ILLNESS BECAUSE OF ACCIDENT?
(NOTE: If "yes" box is checked, ensure a DA Form 2397-9 is completed for this individual)
2.
PERSONNEL PROTECTIVE/RESTRAINT/SURVIVAL EQUIPMENT
Pro-
Al-
Pre-
Re-
Func-
Information Codes
duced
Re-
Avail-
Used
lowed
vented
duced
tioned
Item
Type
quired
able
Injury
Injury
Injury
Injury
as De-
signed
(10)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(1)
a. Helmet
b. Visor
c. Glasses
d. Flight Suit
e. Flight Gloves
f. Flight Jacket
g. Boots
h. Other Clothing
i. Lap Belt
j. Shoulder Harness
k. Gunner Harness
l. Inertia Reel
m. Seat/Litter
n. Survival Equipment
o
.
p.
Information Codes
3.
PERSONNEL EVACUATION/ESCAPE
a. Method of Escape
b. Location in Aircraft
c. Exit Attempted
d. Exit Used
e. Aircraft Attitude During Escape
f. Cockpit/Cabin Conditions
g. Escape Difficulties
Date
Hour of Day
Lapsed Time
4.
LAPSED TIME FOR RESCUE
5. DISTANCE FROM ACCIDENT TO ACTUAL
RESCUE VEHICLE AT TIME OF ACCIDENT
MM
DD
HR
MIN
HR
MIN
a. To Aircraft in Nautical Miles
a. Notification of Rescue Personnel
b. Individual Physically Reached
b. To Ground Vehicle in Statute Miles
c. Individual Actually Aboard Rescue Vehicle
d. Rescue Completed/Abandoned
Information Codes
6.
PERSONNEL SURVIVAL/RESCUE
a. Survival Problems Encountered
b. Means Used to Locate Individual
c. Rescue Equipment Used
d. Factors That Helped Rescue
e. Factors Complicating Rescue
f. Individual Physical Condition
g. Vehicles Actually Performing Evacuation
(Specify)
h. Other Vehicles Assisting in Rescue
(Specify)
7. REMARKS (Use additional sheet if required)
8. NAME (Last, First, MI)
10. GRADE
11. GENDER
12. DUTY
13. SVC
14. UIC
a. Date (YYYYMMDD)
b. Time
15. CASE NO.
c. Acft Serial No.
16. OTHER ACFT SERIAL NO.
DA FORM 2397-10, FEB 2009
PREVIOUS EDITION IS OBSOLETE.
APD LC v1.01

Download DA Form 2397-10 Technical Report of U.S. Army Aircraft Accident, Part Xi - Personnal Protective/Escape/Survival/Rescue Data

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