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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Daytime PhoneEvening PhoneEmail address* Total number of jumpsNumber of jumps during the last 12 months MAIN - ManifacturerRESERVE - ManifacturerMAIN - Date of ManufactureRESERVE - Date of ManufactureMAIN - Canopy ModelRESERVE - Canopy ModelMAIN - Size of CanopyRESERVE - Size of CanopyMAIN - Approx Wing Load of CanopyRESERVE - Approx Wing Load of CanopyMAIN - Date of last RepackRESERVE - Date of last RepackMAIN - Rigger for Last RepackRESERVE - Rigger for Last RepackMAIN - Cutter installed on flap numberRESERVE - Cutter installed on flap numberMAIN - Bag and Harness TypeRESERVE - Bag and Harness TypeMAIN - Container ManufacturerRESERVE - Container ManufacturerMAIN - Date of ManufactureRESERVE - Date of ManufactureMAIN - Container ModelRESERVE - Container Model Manufacturer and Model of AircraftDoor Type*Side DoorCargo DoorRear Drop DoorPressurized cabin*YesNoEstimated 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?YesNo Name of Drop Zone*CityZip codeCountryStatePhone NumberDrop Zone Manager Drop Zone Phone NumberEmail Address Jump Pilot's Name Serial Number*Manufacture Date ( DOM )Installation DateInstalled by (name)Configuration (Pro, Student or Tandem)*ProStudentTandemProgrammed in Meters or Feet?*MetersFeetAltitude correction*YesNoSign (+,-) of the altitude correction*+-Altitude correction value*Altitude correction unit (Meters or Feet)*MetersFeet Date of incident (DD,MM,YYYY)*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time of incident : HH MM Ground Temperature °CGround Temperature °FBarometric Pressure hPaBarometric Pressure inHgAltitude of Drop Zone compared to main sea level (MSL) in metersAltitude of Drop Zone compared to main sea level (MSL) in feetJump altitude compared to ground level (AGL) in metersJump altitude compared to ground level (AGL) in feetWhen did the activation take place?*Upon ascensionDuring the free fallWhen opening the main parachuteWhen opening the reserveOthers (Please describe)Others (Please describe)Number of hours that the Vigil® was switch on before activationActivation DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parachutist Body Position*StableBelly upBelly downSittingSpiralingHead downOthers (Please describe)Other (Please describe) Brief description of the incident* Other remarks EmailThis field is for validation purposes and should be left unchanged.