Accident Reporting

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Army Accident Reporting Practical Exercise
Roy Coker Phone - [phone]
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Accident Reporting Forms

• DA Form 285 - Long Form
• DA Form 285-AB-R - Abbreviated Form

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DA Form 285(Long Form)
On Duty Requirements

• Fatality
• Permanent Total Disability
• Permanent Partial Disability
• None

Off Duty Requirements
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DA Form 285-AB-R(Short Form)
On Duty Requirements

• Military Lost Time (beyond day of
  accident)
  
• Military Fatality
• Lost Time Military

Off Duty Requirements
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U.S. Army Abbreviated Ground Accident Report
(AGAR)

• DA Form 285-AB-R

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AGAR - Block 1, 2 4

• 1 - Time Date of Accident
• yr/mo/day Time 24 hour clock
• 2 - Period of Day
• Day or Night
• 3 - Accident Class
• A, B, C, D, E or FOD
• 4 - Accident Occurred During
• Combat or Non-Combat

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AGAR - Block 5

• 5a - UIC
• 6 digit code
• 5b - Name of Unit
• 5c - Units Branch
• TC, EN, etc.
• 5d - MACOM
• TRADOC, FORSCOM

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AGAR - Block 6

• 6a - Exact Location
• Detailed enough to locate later
• I10. near Tepeetown, WA at mile marker 101
• 6b - Type Location
• Codes come from DA Pam 385-40, Table 4-3
• 6c - State
• 6d - Off Post / On Post

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AGAR - Block 7 8

• 7 - Explosives
• Present
• Involved
• 8 - Mission
• Brief Description
• METL Task

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AGAR - Block 9a - e
9. Vehicle / Equipment / Material Involved

• 9a - Type of Item
• 9b - Model
• 9c - Ownership
• POV, DOD, DA, person, etc.
• 9d - Estimated Cost of Damage
• 9e - Vehicle Collision
• Codes come from DA Pam 385-40, legend of Table 4-6

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AGAR - Block 9f - k
Complete these items only if 9a experienced a
materiel failure that caused or contributed to a
ccident.

• 9f - Failure Mode
• Codes come from DA Pam 385-40, Appendix B-3
• 9g - Part Nomenclature
• 9h - Part
• 9i - Part NSN
• 9j - Part Mfg. Code
• 9k - EIR/QDR Submitted

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Completion of Block 10 Requires that all personn
el remember the PURPOSE of an Accident Investig
ation is to determine the CAUSE of the accident a
nd WILL NOT be used for punishment or adverse act
ion
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AGAR - Block 10a - b
10. Why did Material Fail / Malfunction

• 10a - Leader
• Direct, Unit, Higher Command Supervision
• 10a - Standards / Procedures
• AR, TM, FM, SOP, Other or None Exists
• 10a - Support
• Design, not provided, etc.
• 10b - Root Cause

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AGAR - Block 11 - 16

• 11 - Name
• Of Individual Most Closely Associated
• Address, If Different Than Block 5a 5b
• 12 - SSN
• 13 - Classification
• Codes come from DA Form 285, Block 27
• 14 - MOS
• 15 - Duty Status
• 16 - Age

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AGAR - Block 17 - 19

• 17 - Sex
• 18 - Pay Grade
• 19 - Flight Status

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AGAR - Block 20

• 20a - Degree of Injury
• Codes come from DA Pam 385-40, Fig 4-6
• 20b - Type of Injury
• Codes come from DA Form 285, Block 30
• 20c - Body Part
• Codes come from DA Form 285, Block 29
• 20d - Cause
• Codes come from DA Form 285, Block 28

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AGAR - Block 21 - 24

• 21 - Days Hospitalized
• 22 - Workdays
• Lost Restricted
• Do Not Mix
• 23 - Code
• Comes from DA Form 285, Block 31
• 24 - Description of Activity / Task

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AGAR - Block 25 - 30

• 25 - PPE
• Required, Type, Available Used
• 26 - Alcohol / Drugs
• 27 - Equipment Person Associated With
• Enter Item From Block 9a
• 28 - Licensed To Operate
• 29 - Hours On Duty
• 30 - Hours Sleep
• Cumulative last 24 hours

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AGAR - Block 31 - 35

• 31 - Tactical Training
• 32 - Type Training Facility
• Code comes from DA Pam 385-40, Fig 4-6
• 33 - Last Training
• 34 - Field Training
• If yes, Provide Name
• 35 - Night Vision System
• If yes, Provide Name

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AGAR - Block 36
Did individual make mistake that caused or
contributed to accident?

• 36a - Mistake
• Yes / No
• 36b - Code
• Code comes from DA Pam 385-40, Appendix B-2
• 36c - What was mistake

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Completion of Block 37 Requires that all personne
l remember the PURPOSE of an Accident Investiga
tion is to determine the CAUSE of the accident an
d WILL NOT be used for punishment or adverse acti
on
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AGAR - Block 37
Why was the mistake made? (Root Cause)

• 37a - Leader
• Direct, Unit Command, or Higher Command
  Supervision
  
• 37a - Training
• School, Unit or Experience / OJT
• 37a - Standards / Procedures
• AR, TM, FM, SOP, Other or None Exists
• 37a - Support
• Design, not provided, etc.

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AGAR - Block 38 - 40

• 38 - Environmental Conditions
• Present / Caused / Contributed
• Codes come from DA Pam 385-40, Fig 4-6
• 39 - Brief Synopsis of Accident
• 40 - Corrective Actions Taken

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AGAR - Block 41 - 43

• 41 - Name Telephone Number
• Individual Preparing Report
• 42 - Command Review
• Name of Commander
• Rank
• Signature
• Date
• 43 - Safety Office Review

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Army Accident Reporting Practical Exercise