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 print this page and fax
the following information to the Medallion office at 907.743.8051. (If you wish to type the information, download this ASAP Report Form.) Otherwise, 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: _________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________.

Name (Optional): ________________________