PSRS Reporting Forms are available from the following sources:

Paper Copies

• At convenient locations in your medical facility: nurses' stations, staff lounges, and other sites easily accessible to staff.
• From NASA at the following address:
  PSRS
  P.O. Box 4
  Moffett Field, CA 94035-0004

Internet Copies

• By downloading from this site by clicking here.

Please fill out all sections of the form as completely and accurately as possible with a blue or black ink pen. In the narrative section, describe what happened in your own words.

Reporter Return Receipt NASA will return this part of the form to you as proof that your report has been received. NASA does not retain any of the information you provide on the reporter receipt strip, but this information allows NASA to contact you for additional information about your report if clarification is needed. General Information This section asks for background information about your position, experience, and general event characteristics. Narrative A blank space is provided for describing in your own words what happened and any safety lessons you may have learned from the experience. The back of the form provides additional space for the narrative.

Official paper copies of the PSRS Reporting Form are pre-addressed and postage free. Just fold the form, seal with tape or a staple, and mail it. The form will be sent to the NASA address above.

If you download a form from the PSRS website, print out the form, place it in an envelope, and mail it to the NASA address above using your own stamp.