AC 70-2 (mobile qu Laser Incident Reporting Form (Mobile)

An official website of the United States government Here's how you know 
United States Department of Transportation

Home / Aircraft / Aircraft Safety / Report Safety Issues / Laser Incidents

Report a Laser Incident

Overview
Laser Incidents



Paperwork Reduction Act Burden Statement: A federal agency may not conduct or sponsor, and a person is
not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of

Report a Laser Incident

information subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a currently valid OMB Control Number. The OMB Control Number for this information
collection is 2120-0698. Public reporting for this collection of information is estimated to be approximately
15 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, completing and reviewing the collection of information. All
responses to this collection of information are voluntary. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to FAA at:
800 Independence Ave. SW, Washington, D.C. 20591
Attn: Information Collection Clearance Officer, ASP-110
OMB Control Number: 2120-0698
Expiration Date: November 30, 2025

Pilot or crew member reporting
Name

Email address

Phone number

What seat in the cockpit were you occupying

Left
Right
Jumpseat
Flight Engineer
Other/not applicable
How many pilots/crew members had laser light directly enter their eyes?

None
One
Two
Three
Four or more

Flight and aircraft
Flight number, call sign, and aircraft registration number

Aircraft make and model

Aircraft category

Airplane
Rotorcraft
Lighter than air
Other (specify)
Operation type

Commercial aviation
General aviation
Law enforcement
Medical
Military
News reporting
Other (specify)
Local date
mm/dd/yyyy

Local time:
--:-- --

Location of aircraft

Fixed radial distance (FRD) from navaid or airport — or latitude/longitude coordinates

Location of laser source

Example: "The laser source relative to KDFW approach end of runway 35L was approximately 220 degrees radial and
two miles." You can also provide estimated lat/long coordinates.

Altitude above ground level (AGL)

Primary flight direction

North
Northwest
Northeast
East
South
Southwest
Southeast
West
None or hovering
Phase(s) of flight

Taxi
Takeoff
Climb to altitude
Cruise altitude

Descent
Final approach
Landing
Low-altitude (<500 ft. AGL) level flight
Hover
Phase of flight (other)

Effect on flight
Interference

Did the laser incident interfere with your pilot or crew member duties?
Yes
No
Flight path

Did the laser incident cause the pilot/crew member to change the aircraft flight path?
No change in flight path
Minor or non-adverse change
Major or adverse change

Laser incident
Laser light color
blue
green
orange
purple
red
white
yellow
Laser light color (other)

Tracking

Did the laser beam appear to deliberately track the aircraft?
Yes
No
Unsure/other (specify)
Cockpit illumination

Did the laser beam enter through the windscreen and illuminate any part of the cockpit?
Yes
No
Other (specify)
Eye exposure

Did the laser beam shine directly into one or both of your eyes?
Did not shine directly in my eye(s)
Shined a little in my eye(s)
Shined brightly in my eye(s)

Effect on your eye(s)
Vision effects

Did you experience any adverse vision effects† from the exposure?
Did not experience adverse vision effects
Temporary flash blindness and/or afterimages (similar to a camera flash)
Blurry vision
One or more blind spots (spots in visual field lasting longer than 5–10 minutes)
Glare (could not see past the light while it was in your eye(s))
Significant loss of night vision
Vision effect (other):

Examples of common vision effects
Glare
A temporary disruption in vision caused by the presence of a bright light (such as an oncoming
car's headlights) within an individual's field of vision. Glare lasts only as long as the bright light
is actually present within the individuals field of vision.
Flash blindness
A temporary visual interference effect that persists after the source of the illumination has
ceased, similar to a bright camera flash.
Afterimage
An image that remains in the visual field after an exposure to a bright light.
Blind spot
A temporary or permanent loss of vision of part of the visual field. Unlike an afterimage, a blind
spot does not fade, or fades very slowly (taking many minutes, hours, or days to fade out).
Physical effects

Did you experience any adverse physical effects from the exposure?
Did not experience adverse physical effects
Eye(s) discomfort or pain
Feeling of shock
Headache
Watering eye(s)
Disorientation or dizziness
Physical effect (other)

Did you rub your eye(s) after the exposure?

No significant rubbing
Rubbed them a little
Rubbed them vigorously

Did you have an eye exam after the laser incident?

Yes
No

Laser incident reporting
Did you report the incident to Air Traffic Control (ATC)?

Did not report to ATC
Reported via aircraft radio communication
Reported via phone call
Reported via walk-in to FAA ATC facility
Other (specify)
Did you report the laser incident to an FAA Flight Standards (AFS) field office?

Example of field office: FSDO, CMO, CHDO
Did not report to AFS
Reported via aircraft radio communication
Reported via phone call
Reported via walk-in to FAA AFS field office
Other (specify)
FAA AFS field office name and office location

Additional information
Did you have any prior knowledge or training on the hazards and effects of lasers aimed at a pilot/crew
member?

None
Basic information about the hazards and effects of lasers
Detailed, specific information such as how to recognize and recover from laser illuminations
Simulator training or similar exposure to laser-like illuminations in an aviation training
environment
Other (specify)
Additional information

ATC Facilities' use only
Domestic Incidents Network

Did you report the laser incident to the Domestic Incidents Network (DEN)?
Yes
No
Local law enforcement agency you contacted

Include the agency's phone number.

Was an arrest made?

No arrest, or arrest unlikely

Maybe, still working the case
Yes, arrest was made
Arrest status is unknown
Other (specify)

SUBMIT

U.S. DEPARTMENT OF TRANSPORTATION
Federal Aviation Administration
800 Independence Avenue, SW
Washington, DC 20591
866.835.5322 (866-TELL-FAA)
Contact Us

GET IMPORTANT INFO/DATA

REVIEW DOCUMENTS

Accident & Incident Data

Aircraft Handbooks & Manuals

Airport Data & Information Portal (ADIP)

Airport Diagrams

Charting & Data

Aviation Handbooks & Manuals

Flight Delay Information

Examiner & Inspector

Supplemental Type Certificates

FAA Guidance

Type Certificate Data Sheets (TCDS)

Performance Reports & Plans

LEARN ABOUT NEXTGEN

VISIT OTHER FAA SITES

Next Generation Air Transportation System (NextGen)

Airmen Inquiry

NextGen Today

Airmen Online Services

NextGen Programs and Resources

N-Number Lookup

Performance Reporting and Benefits

FAA Mobile
FAA Safety Team
Frequently Asked Questions

POLICIES, RIGHTS & LEGAL
About DOT
Budget and Performance
Civil Rights
FOIA
Information Quality
No FEAR Act
Office of Inspector General
Privacy Policy
USA.gov













Web Policies and Notices
Web Standards