(e)
(f)
(g)
(h)
(i)
(j)
(k)
(l)
Branch of service
Parent command
Name, address and relationship of next of kin
Status of notification of next of kin
Critical, serious, or minor injury, if determined
Description of injury, expressed in lay terminology
Treatment and evacuation sequence
Factors which may preclude public release, if any
(5) Persons involved but not injured.
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Name
Rank/rate
Date of birth
Social Security number
Branch of service
Parent command
How involved
(6) Brief estimate of the extent of the damage to major equipment. This
information is important to the CIB in determining the method of handling your
particular incident. If the CO objects to releasing this item, so state, and give a brief
reason for the objection.
(7) Does the commander desire the CIB to provide PAO assistance at the
scene of the incident?
(8) In using this format, omit reference to those items that are not applicable.
Indicate as unknown those pertinent items for which this word applies. A follow-up
should be sent as soon as additional facts are known.
AIV-4
