Name of pilot/crew member reporting
Email address
Flight number, call sign, and aircraft registration number
Aircraft Make and Model
Laser light color: Select Beam Color Red Blue Green Yellow Orange White Purple
Date
Time (UTC/Zulu)
Location of aircraft during incident
Approximate altitude AGL
Please feel free to add any additional information or comments about your flight, the laser incident, reporting, and/or subsequent outcome:
54, forty three, eleven, 99 or 97: which of these is the highest? This question is our attempt to prevent spam and will not be submitted with your questionnaire.
Thank you for taking time to complete this short version of the FAA Laser Beam Exposure Questionnaire. You will receive an email at the address you provided above with details on how to complete the full version of the questionnaire.
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