AF Form 978 "Supervisor's Mishap Report"

AF Form 978 Instructions

The mishaps are classified by the total direct mishap cost and severity of the injury or occupational illness and include:

• Unplanned occurrence, or series of occurrences, that result in damage to the U.S. Department of Defense (DoD) property;
• Occupational illness of the personnel;
• Injury to on or off duty military personnel;
• Injury to on-duty civilian personnel;
• Damage to the public or private property;
• Injury or illness, caused by the DoD activities.

This form is used to establish the severity of injury/illness and to ensure proper reporting accountability within the Air Force, to identify causes of illness/injuries, so supervisors and functional managers can take appropriate action to eliminate or control unsafe and unhealthy conditions, to prepare statistical and historical reports as required by the DoD, and to provide documentation for cumulative summation of treatment causes.

The Supervisor's Mishap Report needs to be completed for any injuries minor to serious whether they occurred on or off duty. The document is then filed with the safety office. The form is used to document a ground mishap to the Unit Commander and Wing Safety. The installation Ground Safety Manager will review the form to determine reportability and ensure appropriate documentation. The form will be completed by the supervisor of the injured personnel and returned to the appropriate safety office within five workdays following the mishap or notification of the mishap.

AF Form 978 presents detailed factual and analytical information about mishaps. The mishap data information includes: full name, grade/rank, age, sex, unit/office symbol, job title, duty phone, date of mishap, time of the mishap, the mishap occurred, duty status, days scheduled to work, work shift hours, hours on duty prior to the mishap, weather conditions, light conditions, number of days since the last deployment, number of days deployed in the last 365 days, location of mishap site, description of mishap, witnesses and their names, disposition of the individual, type of injury, body part(s) injured, tox testing, and treatment.

The section titled "Property Damage" includes the property description, vehicle description, type/date of training, property and vehicle damage description, cost of repair and materials cost, seatbelt used, speeding, alcohol involved. The section titled "Supervisor, Unit Safety Representative, Commander, and Safety Office Review and Signature" includes these officials' names, their grades/ranks, duty phone numbers, and signatures.

Safety office fills in the following boxes: reportable - check yes or no box, the AF Safety Automated System number, mishap class, date mishap reported to safety, non-reportability reference, and the signature.