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 SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Daytime PhoneEvening PhoneEmail 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*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* City Zip code Country State Phone NumberDrop Zone Manager Drop Zone Phone NumberEmail Address Jump Pilot's Name Serial Number* Manufacture Date ( DOM ) Installation Date Installed by (name) Configuration (Pro, Student or Tandem)*ProStudentTandemProgrammed 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)*DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time of incident : 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?*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 activation Activation DateMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parachutist Body Position*StableBelly upBelly downSittingSpiralingHead downOthers (Please describe)Other (Please describe) Brief description of the incident*Other remarksCommentsThis field is for validation purposes and should be left unchanged.
