ASAP Reporting Process

The primary method of reporting is through our online reporting system at: www.medallionsafety.org.

If, for some reason you can’t use that method, you may fax the following information to the Medallion office at
(907) 743-8051. The third alternative is to call the Medallion office at (907) 743-8050 and provide the information listed below.

As soon as you have access, enter the report online.

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                                 FAX Report

Company Name: _____________________________

Flight Number: ______________ Tail Number: ________________

Duty Assignment (Circle one):    Capt    FO    FA    Dispatcher    Mechanic

Other_______________

Date/time of occurrence __________________

Date/time of this report ___________________

Descriptive comments (use additional sheets as necessary)

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

Name (Required): ________________________