USPA IORM ]O I lll. Equiprnent ol Deceased /), -.,. I /, ( u Manulacturer: ittt -t--rr* l\latn canopy: \Aodel. Cru rJc
USPA FORM 30 I lll Equipnrent ol Deceased M.t trt t'tt rt tt[ly Harness Main contatner Reserve cailcpy Reserve container Stattc Ltne Man uf act ur er {)u",, l-l,tn oare pat:xnri - A):'ft, L/irrc [,rr(.^r''] - | .- et Type: (pin, breakcord, drrect bag) - Type snap faslener r"rodel,-)t/;llo f /r''.,ls"..i"r nr,.no" , 't l!'/ av wnom: ,U,/;l tl:ffi::tiilit this lype canopv. "-L 1 O c.rno,t,cn LY-trC Lt . -- Manuracrurer:,-i--:, :^,- Modet Ctq*"t!l*fserialnumber:5l5E ii-a]J:7? 'n"t, lJ ff Date packed: By Whotn: .- Pi:ctchut;?i Conciirion: - GOit!- - - Manuracturer: Condrlron 'r'tv se,iar n..,.n".. {PS-f-l',rl-I]? :' ;-, - t-ttSiu .. Seriai number t Lj.t-ji Modet, Lla;L[1Ht;-;";;;;t;;:.{$f!ll. Autontaltc opener 1rt worn). lvianufacturer. I\uflQ Model. , ---- Serial number: Calrb!'ated by whom?: - When? ,--- Where? t,tsttuments: l,'j"#;..", -- i i e- Condition , L: ILit't.r.i. "\ l-w-! l-l-f -iLD!4t - - - ii.o", rtU,urvftE f.;;"' "r., ",,--uttELru-A--- Point of at?achment in aircraft:-- Static linc assisi tYt)e: Personat equtpment: |lelmet type. Ltg PZ { . LCrC Eye_proteoion (UC i1t t Go1y1l+ S rrrns stovos -- l liJLtJt Equrpnent chech2 c.)A3 By Whonrr Coinr/}ents. Pieasq state'any delails reeardinq the deceased's eouiomenl lhal is relevant to lhis renorr Gear had been nodlfied for rlpcord. Rtpcord had red plllow type handle and was nounted on right nrain llft web. ' ii Vl I l. De;cription of Accident After a nornal freefall, at 41000 feet, deceaEed pulled a handle thought to be nain rlpcord (red plllow type) when lnstead deceased pulled the cutaway handle (red plllow type). Deceaged contlnued to fall flat and atable for 15-17 eecondr, then at about 500 feet, deceaeed rolled over on her back and pulled neln rlpcord. The nain eanopy reached I lne etretch and aeparated fron the harnege Juet prlor to tnpact. The raaerve ripcord wae found ln the paeket. i; RecommenJrtlcns Thie fatallty occurred at the drop zone when there was Ilttle or no aupervleion on the DZ. Neither nyself, tnetructor or Junpmaster were present. Both (blank) and I have talked to the DZ ohfner ebout the supervteton problen. lle feel the sltuatlon hae treatly inproved aa there ie a new lnstructor runnlng the Etattc llne protrag and he ie avallable durlng the week. PAGE 30