Life Saving Report

This Vigil® Life Saving Report must be correctly completed to allow us to sent you a new cutter.

Step 1 of 8 - Parachutist

12%

You can also download the Life Saving Report as a PDF file, to return by mail or fax.
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Daytime Phone
Evening Phone
Email address*

Total number of jumps
Number of jumps during the last 12 months

MAIN - Manifacturer
RESERVE - Manifacturer
MAIN - Date of Manufacture
RESERVE - Date of Manufacture
MAIN - Canopy Model
RESERVE - Canopy Model
MAIN - Size of Canopy
RESERVE - Size of Canopy
MAIN - Approx Wing Load of Canopy
RESERVE - Approx Wing Load of Canopy
MAIN - Date of last Repack
RESERVE - Date of last Repack
MAIN - Rigger for Last Repack
RESERVE - Rigger for Last Repack
MAIN - Cutter installed on flap number
RESERVE - Cutter installed on flap number
MAIN - Bag and Harness Type
RESERVE - Bag and Harness Type
MAIN - Container Manufacturer
RESERVE - Container Manufacturer
MAIN - Date of Manufacture
RESERVE - Date of Manufacture
MAIN - Container Model
RESERVE - Container Model

Manufacturer and Model of Aircraft
Door Type*
Pressurized cabin*
Estimated Aircraft's ascending speed for this jump (indicate mph or km/h)
Estimated Exit Jump altitude (indicate Feet or meter)*
Was the plane put on hold during the ascent?

Name of Drop Zone*
City
Zip code
Country
State
Phone Number
Drop Zone Manager
Drop Zone Phone Number
Email Address
Jump Pilot's Name

Serial Number*
Manufacture Date ( DOM )
Installation Date
Installed by (name)
Configuration (Pro, Student or Tandem)*
Programmed in Meters or Feet?*
- Meters
- Feet
Altitude correction*
- Yes
- No
Sign (+,-) of the altitude correction*
- +
- -
Altitude correction value*
Altitude correction unit (Meters or Feet)*
- Meters
- Feet

Date of incident (DD,MM,YYYY)*
Time of incident

: HH

MM
Ground Temperature °C
Ground Temperature °F
Barometric Pressure hPa
Barometric Pressure inHg
Altitude of Drop Zone compared to main sea level (MSL) in meters
Altitude of Drop Zone compared to main sea level (MSL) in feet
Jump altitude compared to ground level (AGL) in meters
Jump altitude compared to ground level (AGL) in feet
When did the activation take place?*
Others (Please describe)
Number of hours that the Vigil® was switch on before activation
Activation Date
Parachutist Body Position*
Other (Please describe)

Brief description of the incident*
Other remarks
Comments
This field is for validation purposes and should be left unchanged.

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