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                         Preliminary Report Form
view or print report form in DOC or PDF format


1.

Date reported: _________________  Time: ___________________
2. Date of occurrence:_____________  Time: ___________________
3. Nature of report: __UFO __Apparition __Animal __Other:_____________
4. Witnessed by:  Name: ______________________________________________
 Address: __________________________________________________________
 City: ____________________________ State: _________ Zip: __________
  Home Phone: (____) ______________  Business Phone:(____)___________
5. Additional Witnesses:
   a. Name:________________________ Address: _______________________
      Phone: (____) _______________          _______________________
   b. Name:________________________ Address: _______________________
      Phone: (____) _______________          _______________________
   c. Name:________________________ Address: _______________________
      Phone: (____) _______________          _______________________
6. Geographic location of incident:
      Nation: _____________________ State/Province: ________________
      County: _____________________ Nearest City/Town: _____________
7. Exact location (Road/Nearest landmark, etc.) [Example: Near mile marker #71 on I-35]
___________________________________________________________________
8. Is there an Airport/Air Base/Military Base within a radius of 10 miles?
 __Yes  __No. If “yes,” name of facility: _________________________
9. Estimated distance from observer’s location to Subject being reported:
___________________________________________________________________
10. How many Subjects were there? _________________________________________
11. Describe the Subject(s) in detail (if more space is needed, continue at end of form): ___________________________________________________________________

___________________________________________________________________

___________________________________________________________________


12.

Was/were the Subject/s moving? ___Yes ___No

If moving, in what direction? __N __S __E __W __NE __NW __SE __SW
Elevation: ________________________________
Azimuth: __________________________________

13.

How long did the incident last? ____Seconds ____Minutes ____Hours

14.

Were any sounds associated with the incident? ___Yes ___No
Any odors? ___Yes ___No
If “yes,” describe: _______________________________________________

___________________________________________________________________

Were any other physical attributes associated with the event? _____

___________________________________________________________________

___________________________________________________________________


15.

Summary of what happened (continue at end of form if necessary):
___________________________________________________________________

___________________________________________________________________

___________________________________________________________________


16.

Background of witness: ____________________________________________

___________________________________________________________________


17.

Any other information you believe would be useful? ________________

___________________________________________________________________


18.

Does witness wish name to be kept confidential? __Yes __No

19.

Signature of witness: _____________________________________________

Date: ____________________________


20.

Investigator’s name (print): ______________________________________

Investigator’s signature: _________________________________________

Date: ____________________________

 
Use space below for additional information:

 

 

 

 
 

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