OMB control number
Air Force Safety Automated System (AFSAS) Preliminary Mishap/Incident Reporting
OMB 0701-0164 · DOD/AF.
OMB 0701-0164
Information is collected of those Air Force & DoD personnel involved in mishaps and witnesses (could be members of the general public) to include names, age, and medical information (Injury Severity, Injured Body Part, and Injury Type). Information is collected for the purpose of reporting mishaps, and to have valid and reliable data in order to determine safety trends, implement the ORM process, prevent mishaps, preserve AF assets, and to save lives.
The latest form for Air Force Safety Automated System (AFSAS) Preliminary Mishap/Incident Reporting expires 2023-08-31 and is listed under ICR 202002-0701-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form AF 978 Supervisor's Preliminary Mishap/Incident Report | Form |
| 0701-0164_PIA_8.14.2020.pdf | Supplementary Document |
 0701-0164_DraftSORN_5.10.2019.docx | Supplementary Document |
| 0701-0164_SSA_8.25.2023.docx | Supporting Statement A |
 Supervisor's Preliminary Mishap/Incident Report |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202308-0701-003 | Extension without change of a currently approved collection | 2023-08-31 | Approved with change | |
| 202002-0701-001 | New collection (Request for a new OMB Control Number) | 2020-07-14 | Approved without change |