THE AUSTRALIAN UFO RESEARCH NETWORK

THE AUSTRALIAN UFO RESEARCH NETWORK

2004

UFO REPORT FORM

YOUR REFERENCE STATE

This form has been designed to assist us in the interpretation of the phenomenon which you observed. Therefore, your assistance in completing and returning this report form will be appreciated.

Please use block letters (Delete where inapplicable)

1. Full name (Mr, Mrs, Ms, Miss, Master):

_________________________________________________________________________________

2. Address:

_________________________________________________________________________________

Postcode: Phone No/s

_________________________________________________________________________________

3. Date of observation: Day of week:

_________________________________________________________________________________

Time of observation: AM / PM

_________________________________________________________________________________

4. Duration: How did you establish the time and duration?

__________________________________________________________________________________________________________________________________________________________________

5. What was your exact position and location?

Age: ( Adult, if 21 or over) Occupation:

__________________________________________________________________________________________________________________________________________________________________

6. Please relate your experience in your own words. Please use block letters or type. If extra space is required, use a separate sheet.

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SKETCH: Please sketch the object/s and include shape and colour of any features

________________________________________________________________________________

Please CIRCLE the appropriate answers to the questions below, even if you have covered them in your narrative of question 6. If two or more answers are

applicable in any one question please circle both/more.

__________________________________________________________________________________________________________________________________________________________________

7. WHERE WERE YOU WHEN YOU FIRST OBSERVED THE PHENOMENON?

Outdoors Indoors In a car In an aircraft Other:

8. WERE YOU LOOKING THROUGH:

Windscreen Glass Double glass Curtains Spectacles Other:

9. HOW WAS THE PHENOMENON OBSERVED?

Naked eye Binoculars Telescope Radar Other:

10. WHAT WERE YOU DOING WHEN YOU FIRST OBSERVED IT?

Lying down Sitting Standing Driving Other:

11. HOW DID IT COME TO YOUR ATTENTION?

Heard sound Saw a light Someone called it to your attention Animals reacted Electrical Interference

Other :

12. WHAT WAS IT’S APPEARANCE?

A. How many objects where there?

B. *How large was it’s apparent size? Star sized Moon sized Larger than these

Other

C. What was it’s shape?

__________________________________________________________________________________________________________________________________________________________________

D. What was it’s colour?

__________________________________________________________________________________________________________________________________________________________________

E. Was it clearly outlined? Yes No

F. Did it separate into parts? Yes No How many parts?

Please describe:

*NOTE ON APPARENT SIZE: If in doubt, the easiest way to determine this is to hold a suitable object (e.g. coin, ball, orange, etc.) at arms length, and quote the familiar object that just

covers your estimate or memory of the size of the object in question. (You could quote this object in 12. A. Other ).

13. DID YOU NOTICE ANY OF THE FOLLOWING:

Lights, Steady lights ,Pulsating lights, Seams Windows, Antenna Appendages

_________________________________________________________________________________________________________________________________________________________________

Other (Please describe)

__________________________________________________________________________________________________________________________________________________________________

14. WHAT DID IT DO?

Moved across the sky Hovered in the sky Hovered near the ground Rotated Moved in straight line

Moved erratically Changed direction Landed Took off Other:

_______________________________________________________________________________

How was it lost to view?

__________________________________________________________________________________________________________________________________________________________________

In what direction?

__________________________________________________________________________________________________________________________________________________________________

At what angle to the horizon?

__________________________________________________________________________________________________________________________________________________________________

Could you estimate it’s speed and distance?

Was it above or below any clouds, mountains or near any other reference point that could give an indication of height / altitude:

__________________________________________________________________________________________________________________________________________________________________

15. WHERE WAS IT WHEN FIRST SEEN?

A. North South East West North-east South-east North-west South-west

B. High in the sky Tree top level On the ground

C. At what angle to the horizon?

16. DID IT PASS IN FRONT OF OR BEHIND ANYTHING?

A. In front Yes No Clouds Tree Hills Other

B. Behind Yes No Clouds Tree Hills Other

17. WHERE WAS IT WHEN LAST SEEN?

A. North South East West North-east South-east North-west South-west

B. High in the sky Tree top level On the ground

C. At what angle to the horizon?

18. On the diagrams below please show the angle of observation and compass direction of start (put A) and finish (put B) of observations. _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

19. WERE THERE ANY EFFECTS ON THE FOLLOWING?

Radio Television Engines Lights Clocks Animals Witnesses

Other, Please describe:

20. DID YOU NOTICE ANY PHYSICAL EFFECTS OR EVIDENCE?

Illness Electromagnetic Imprints Residue Vegetation change Smoke Vapour trail Noise Vibrations

__________________________________________________________________________________________________________________________________________________________________

Heat Cold Smell Other

__________________________________________________________________________________________________________________________________________________________________

Please describe:

__________________________________________________________________________________________________________________________________________________________________

21. WHAT WERE THE WEATHER CONDITIONS AT THE TIME?

Clear Partly cloudy Full cloud cover Rain Smog Hazy Windy Sunny Electrical storms Cyclones

Other:

__________________________________________________________________________________________________________________________________________________________________

22. DID YOU SEE ANY OF THE FOLLOWING AT THE TIME OF YOUR OBSERVATION?

Aircraft Balloons Birds Search lights Moon Stars Planets Satellites

__________________________________________________________________________________________________________________________________________________________________

Other:

_________________________________________________________________________________________________________________________________________________________________

23. DID YOU SEE ANYTHING UNUSUAL FOLLOWING SOON AFTER THE OBSERVATION?

Aircraft Military on ground Other unusual activity:

24. DESCRIBE THE AREA OF OBSERVATION:

City, Suburban, Rural, Industrial, Commercial, Residential Isolated

Other, Please describe:

__________________________________________________________________________________________________________________________________________________________________

25. DID THE OBSERVATION TAKE PLACE NEAR ANY OF THE FOLLOWING?

Reservoir, Lake River, Sea Military installation, Power station, Power lines

Other (How close?)

__________________________________________________________________________________________________________________________________________________________________

26. WHAT WAS YOUR REACTION OR STATE OF MIND DURING THE SIGHTING?

27. IS THERE ANY PHOTOGRAPHIC EVIDENCE? No Yes

Please describe:

28. Please give names and addresses of any OTHER witnesses:

29. Do you have any qualifications which might help you to identify what you saw?

No Yes: Please describe:

Do you have above / average knowledge of:

Astronomy Meteorology Satellites Aircraft Other

_________________________________________________________________________________________________________________________________________________________________

30. have you read UFO MAGAZINES/ WATCHED TV PROGRAMMES ABOUT UFOS?

Considerable Some None at all

31. DID YOU RECOVER ANY MATERIAL OF ANY TYPE THAT ORIGINATED FROM THE OBJECT?

No Yes Please describe:

32. Do you know of any other observations? No Yes

(If yes we would appreciate hearing of them on a separate sheet of paper. Thank you.)

If we publish this report in Newsletters, Research documents or elsewhere, may we use your name in connection with it ? YES NO

__________________________________________________________________________________________________________________________________________________________________

(If no, then no personally identifiable information shall be released to any other person, governmental agency or media organisation. The only persons with

access to this information shall be investigators of UFO organisations).

_________________________________________________________________________________

Today’s date Signature

PLEASE RETURN THIS FORM TO, OR TO YOUR LOCAL UFO GROUP IN YOUR AREA SEE AUSSIE LINKS

Thankyou for taking the time to fill this form out

The Australain UFO Research Network

PO BOX 738

Beaudesert QLD 4285

Australia

Tel 1800 77 22 88