FORM 6120.1 • OMB NO.

3147-0001 • EXPIRES 04-30-2027

NATIONAL TRANSPORTATION SAFETY BOARD • PILOT/OPERATOR AIRCRAFT ACCIDENT/INCIDENT

REPORT Use this form (Form 6120.1) to report civil and public aircraft accidents and incidents

BASIC INFORMATION
Accident/Incident Location Accident/Incident Date/Time
Nearest City/Place: _________________________________________
Sandy Shores ________
State: SA Date: ______________________
01/27/2025 Local Time: _________________
02:44
ZIP: ________________
20018 Country: ___________________________________________
USA mm/dd/yyyy HH:MM

Latitude: ____________________
1664.153 Longitude: _____________________
162601.524 Time Zone: _________________
UTC
(Enter in decimal degrees or degrees:minutes:seconds) Collision with Other Aircraft: Midair On-ground None

AIRCRAFT INFORMATION
Registration Number: ____________________
UNK ✔ IFR-Equipped and Certified
Commercial Space Flight
Manufacturer: _________________________________________________________
Buckingham Unmanned Aircraft
Model: _________________________________________________________________
Valkyire MaximumGrossWeight: 18,500 lbs.
Serial Number: _____________________________
UNK Weight at Time of Accident/Incident: lbs.
Year of Manufacture: _______________________
0 Numberof Seats: 12 Flight Crew Seats: ___________
2
Amateur-Built: Yes If Yes: Original Design Cabin Crew Seats: 2 Passenger Seats: _____________
8
No Kit/Plans Make: Number of Engines: ___________
2
Category of Aircraft Type of Airworthiness Certificate Landing Gear Engine Type (Select one)
(Select one) (Check all that apply) (Check all that apply) Reciprocating Liquid Rocket
Airplane Standard Special Retractable High Skid Turbo Shaft Solid Rocket
Balloon Normal Restricted Tricycle ✔ Skid Turbo Prop Hybrid Rocket
Blimp/Dirigible Aerobatic Limited Tailwheel Ski/Wheel Turbo Jet None
Glider Balloon Provisional Emergency Float Hull Turbo Fan Unknown
Gyroplane Commuter ✔ Special Flight Float Ski Electric
Helicopter Transport Experimental Amphibian
Powered Lift ✔ Utility Special Light-Sport Other Launch/Recovery System
None Fuel System Type (Reciprocating)
Rocket Experimental Light-Sport Unknown
Ultralight Carburetor Fuel Injected
Unknown Certificate of Authorization or Waiver (COA)
None ✔ Unknown

Engine Serial Date of Mfg. Rated Power Total Time Since:

Engine Engine Manufacturer Engine Model/Series Number Horsepower or Time Inspection Overhaul
(mm/dd/yyyy) Lbs. of Thrust (hours) (hours) (hours)
Eng. 1 General Electric T700-GE-401C
Eng. 2 General Electric T700-GE-401C
Eng. 3
Eng. 4

Last Inspection Type Additional Equipment

□ ADS-B □
✔ Handheld GPS
100-Hour □ Airframe Parachute □
✔ Heads Up Display
AAIP □
✔ Angle of Attack Indicator □
✔ Night Vision Goggles
Annual □ Autopilot □
✔ Onboard Weather
Continuous Airworthiness □ Autopilot/FMS, Model__________ □
✔ Primary Flight Display
Condition Inspection □
✔ Coupled Flight Director □ SAS, Number of Axes: ____ Model: _______
□ Data Recorder □ Satellite Tracking Device
Unknown
✔ ✔

□ Device Stall Warning System □

✔ Stall Warning System
Date of Last Inspection: ________________ □
✔ Electronic Flight Bag or Handheld Device □
✔ Video Recording Device
mm/dd/yyyy □
✔ Electronic Multifunction Display □
✔ Wire Strike Detection
□ Electronic Primary Flight Display □ Wire Strike Protection
Airframe Total Time: __________________hrs □
✔ Flight Management System
✔

□ Other, Specify:
Hours measured at (Select one)
ELT Installed: Yes No If Yes: Propeller 1 Fixed Pitch
Last Inspection Time of Accident/Incident Controllable Pitch
ELT Manufacturer: ________________________
Type of Maintenance Program (Select One) Ground Adjustable
Model or Part No.: ________________________
Annual Manufacturer: ____________________________
Conditional (Amateur-built only) TSO No.: C91 (121.5 MHz) C91a (121.5 MHz) Model: ___________________________________
Manufacturer's Inspection Program
Other Approved Inspection Program C126 (406 MHz)
(AAIP) Continuous Airworthiness Was ELT still mounted in aircraft? ○ Yes ○ No
Was ELT still connected to antenna? ○ Yes ○ No
Propeller 2 Fixed Pitch
Other, specify: Controllable Pitch
Did ELT activate? ○ Yes ○ No
Ground Adjustable
Description of Fire Extinguishing System If activated: Did ELT aid in locating aircraft? Yes No
None If not activated: Indicate Reason: □ Impact Damage Manufacturer: ____________________________
Specify: □ Fire Damage □ Battery Expired/Damaged □ Unknown Model: ___________________________________

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OWNER/OPERATOR INFORMATION
Registered Aircraft Owner
Name: Los Santos County Sheriffs Department Fractional Ownership Aircraft: ○ Yes ○ No
City: LS State: SA
ZIP: 20018 Country: USA

Operator of Aircraft □ The Operator is also the Registered Owner □ Same address as Registered Owner
Name: Doing Business As: LAW ENFORCEMENT
City: State: Air Carrier/Operator Designator (4-character code): LSSD
ZIP: Country:

Operating Certificates Held Regulation Flight Conducted Under Revenue Operation for FAR 121, 125, 129, 135
(Check all that apply) (Select one for each group)

None FAR 91 FAR 129 FAR 415 Scheduled or Commuter Domestic

Flag Carrier Operating Certificate (FAR 121) FAR 103 FAR 133 FAR 431 Non-Scheduled or Air Taxi International
Supplemental FAR 121 FAR 135 FAR 435
Air Cargo FAR 125 FAR 137 FAR 437
Foreign Air Carriers (FAR 129) FAR 450 Passenger
✔ Rotorcraft External Load (FAR 133) FAR 91 Special Flight Cargo
Commuter Air Carrier (FAR 135) Non-US, Commercial Mail Contract Only
On-Demand Air Taxi (FAR 135) Non-US, Non-commercial
Commercial Air Tour (FAR 136) Purpose of Flight for FAR 91, 103, 133, 137 (Select one)
Agricultural Aircraft (FAR 137) Public Aircraft (Select one)
Pilot School (FAR 141) Armed Forces
Certificate of Authorization or Waiver (COA) Aerial Application Firefighting
Federal
Commercial Space Transportation Aerial Observation Flight Test
State
Experimental Permit Air Drop Glider Tow
Local Air Race/Show Instructional
Commercial Space Transportation License
✔ Other Operator of Large Aircraft Unknown Banner Tow Other Work Use
Business Personal
Executive/Corporate Positioning
External Load Skydiving
Revenue Sightseeing Flight Air Medical Flight Ferry Unknown
Yes No Yes No

AIRPORT INFORMATION (Fill in if accident/incident occurred on approach, landing, takeoff, departure, or within 3 miles of an airport)

Airport Name: __________________________________________________

Sandy Shores Airfield Distance From Airport Center: __________________
0.53 sm.
Airport Identifier: ________________________________________________
SSA Direction From Airport: _____________________
342.00 degrees true
Proximity to Airport: Off Airport/Airstrip On Airport/Airstrip N/A Airport Elevation: __________________________
150.00 ft. MSL

Runway Information Condition of Runway/Landing Surface (Check all that apply)

Runway ID: Length: ft. Width: ft. ✔ Dry Snow-Compacted Water-Calm
Holes Snow-Crusted Water-Choppy
Runway/Landing Surface (Check all that apply) Ice Covered Snow-Dry Water-Glassy
□ Asphalt □ Grass/Turf □ Ice □ Snow Rough Snow-Wet Wet
□
✔ Concrete □ Gravel □ Macadam □ Water Rubber Deposits Soft
□ Dirt □ Helideck □ Metal/Wood □ Unknown Slush-Covered Vegetation Unknown
□ Elevated Heliport □ Helistop □✔ Off-site landing area

Approach/Departure Segment (Select one)

Taxi VFR Departure On Instrument Approach Downwind Low Approach
Takeoff IFR Departure Procedure/Clearance Landing Base Go Around
Initial Climb Final Aborted Landing (after touchdown)
Crosswind Unknown

IFR Approach (Check all that apply) VFR Approach (Check all that apply)
✔ None None

ADF/NDB PAR MLS Practice Traffic Pattern ✔ Stop and Go

SDF Sidestep LDA GPS Straight-In Touch and Go
VOR/TVOR ILS ASR Unknown Valley/Terrain Following Simulated Forced Landing
VOR/DME Localizer Only Visual Go Around Forced Landing
TACAN LOC-back course Contact Full Stop Precautionary Landing
RNAV Circling Unknown

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“FLIGHT CREWMEMBER 1” INFORMATION

“Flight Crewmember 1” Responsibilities at the Time of Accident/Incident
○ Captain ○ First Officer ○ Pilot ○ Co-Pilot ○ Student Pilot ○ Flight Instructor ○ Check Pilot ○ Flight Engineer ○ Other Flight Crew
“Flight Crewmember 1” was pilot flying Yes No

“Flight Crewmember 1” Identification

First Name: __________________________________________________ City of Residence: _____________________________________
Middle Initial: _________ State: _________________ ZIP: _______________
Last Name: _________________________________________________ Country: _____________________________________
Age at time of Accident/Incident: ________ Date of Birth: ____________________ (mm/dd/yyyy)
Certificate Number: ____________________
Degree of Injury Seat Occupied Restraint Type Inflatable Restraints
None Serious Left Front Unknown Available Used
Unknown Fatal Right Rear None None
Not Installed
Minor Center Single Lap only Lap only
Installed
3-point 3-point
Pilot Certificate(s) (Check all that apply) Not Deployed
4-point 4-point Deployed
□ None □ Flight Instructor □ Commercial 5-point 5-point Unknown
□ US Military □ Private □ Recreational Unknown Unknown
□ Airline Transport □ Foreign □ Sport
□ Student □ Flight Engineer Supplemental Restraint, specify:

Principal Occupation Medical Certificate Medical Certificate Validity Date of Last Medical
Pilot None Class 3 Unknown Without limitations/waivers Unknown
Other Class 1 BasicMed With limitations/waivers N/A ____________
Unknown Class 2 Special Issuance mm/dd/yyyy
Driver’s License (Sport Pilot only)
Medical Certificate Limitations Medical Certificate Special Limitations

Personal Flight Equipment (Check all that apply)

□ Fire resistant flight suit □ Helmet □ Laser protective visor/glasses □ Personal locator beacon(s) (PLB) □ Fire resistant gloves
□ Helmet visor □ Night vision goggles □ Personal flotation □ Other:

Date of Last Flight Review Flight Review Aircraft

or Equivalent, Including
FAR 121/135 Checks: __________________ Make: ______________________________________________________________________________
mm/dd/yyyy Model: ______________________________________________________________________________
Airplane Rating(s) Other Aircraft Rating(s) Instrument Rating(s) Instructor Rating(s)
(Check all that apply) (Check all that apply) (Check all that apply) (Check all that apply)
Single-Engine Land None None None Instrument Airplane
Single-Engine Sea Airship Airplane Airplane Single-Engine Instrument Helicopter
Multiengine Land Balloon Helicopter Airplane Multiengine Helicopter
Multiengine Sea Glider Powered Lift Gyroplane Glider
Gyroplane Powered lift Sport
Helicopter
Powered Lift
Type Ratings and Applicable Logbook Endorsements Student Endorsements (Include dates)

Airplane Instrument Multi-

Flight Time (Enter All This Make Single Airplane Lighter engine Tail-
hours for each box) Aircraft & Model Engine Multiengine Night Actual Simulated Rotorcraft Glider Than Air Rotorcraft wheel
Total Time
Pilot in Command (PIC)
Time as Instructor
This Make/Model
Last 90 Days
Last 30 Days
Last 24 Hours

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“FLIGHT CREWMEMBER 2” INFORMATION

“Flight Crewmember 2” Responsibilities at the Time of Accident/Incident
○ Captain ○ First Officer ○ Pilot ○ Co-Pilot ○ Student Pilot ○ Flight Instructor ○ Check Pilot ○ Flight Engineer ○ Other Flight Crew
“Flight Crewmember 2” was pilot flying Yes No

“Flight Crewmember 2” Identification

First Name: __________________________________________________ City of Residence: _____________________________________
Middle Initial: _________ State: _________________ ZIP: _______________
Last Name: _________________________________________________ Country: _____________________________________
Age at time of Accident/Incident: ________ Date of Birth: ____________________ (mm/dd/yyyy)
Certificate Number: ____________________
Degree of Injury Seat Occupied Restraint Type Inflatable Restraints
None Serious Left Front Unknown Available Used
Unknown Fatal Right Rear None None
Not Installed
Minor Center Single Lap only Lap only
Installed
3-point 3-point
Pilot Certificate(s) (Check all that apply) 4-point
Not Deployed
4-point Deployed
□ None □ Flight Instructor □ Commercial 5-point 5-point
□ US Military □ Private □ Recreational Unknown
Unknown Unknown
□ Airline Transport □ Foreign □ Sport
□ Student □ Flight Engineer Supplemental Restraint, specify:

Principal Occupation Medical Certificate Medical Certificate Validity Date of Last Medical
Pilot None Class 3 Unknown Without limitations/waivers Unknown
Other Class 1 BasicMed With limitations/waivers N/A ____________
Unknown Class 2 Driver's License (Sport Pilot Only) Special Issuance mm/dd/yyyy

Medical Certificate Limitations Medical Certificate Special Limitations

Personal Flight Equipment (Check all that apply))

□ Fire resistant flight suit □ Helmet □ Laser protective visor/glasses □ Personal Locator Beacon(s) (PLB) □ Fire resistant gloves
□ Helmet visor □ Night vision goggles □ Personal flotation □ Other:

Date of Last Flight Review Flight Review Aircraft

or Equivalent, Including
FAR 121/135 Checks: __________________ Make: ______________________________________________________________________________
mm/dd/yyyy Model: ______________________________________________________________________________
Airplane Rating(s) Other Aircraft Rating(s) Instrument Rating(s) Instructor Rating(s)
(Check all that apply) (Check all that apply) (Check all that apply) (Check all that apply)
Single-Engine Land None None None Instrument Airplane
Single-Engine Sea Airship Airplane Airplane Single-Engine Instrument Helicopter
Multiengine Land Balloon Helicopter Airplane Multiengine Helicopter
Multiengine Sea Glider Powered Lift Gyroplane Glider
Gyroplane Powered lift Sport
Helicopter
Powered Lift
Type Ratings and Applicable Logbook Endorsements Student Endorsements (Include dates)

Airplane Instrument Multi-

Flight Time (Enter All This Make Single Airplane Lighter engine Tail-
hours for each box) Aircraft & Model Engine Multiengine Night Actual Simulated Rotorcraft Glider Than Air Rotorcraft wheel
Total Time
Pilot in Command (PIC)
Time as Instructor
This Make/Model
Last 90 Days
Last 30 Days
Last 24 Hours

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ADDITIONAL FLIGHT CREWMEMBERS (Exclusive of cabin crew, complete the following information.)
Additional Crewmember Information Seat Occupied Injury
Left Rear None
First Name: City of Residence: Center Single Minor
Right Unknown Serious
Middle Initial: State: Zip:
Front Fatal
Unknown
Last Name: Country:
Personal Flight Equipment (Check all that apply)
□ Fire resistant flight suit □ Helmet □ Laser protective visor/glasses □ Personal locator beacon(s) (PLB) □ Fire resistant gloves
□ Helmet visor □ Night vision goggles □ Personal flotation □ Other: __________________________________________
Pilot Certificate(s) (Check all the apply) Restraint Type Inflatable
□ None □ Flight Instructor □ Commercial □ US Military Available Used Restraints
□ Private □ Recreational □ Airline Transport □ Foreign ○ None ○ None
□ Student □ Sport □ Flight Engineer ○ Lap Only ○ Lap Only □ Not Installed
○ 3-point ○ 3-point □ Installed
Type Rating/Endorsement for Total Flight Time at the Time ○ 4-point ○ 4-point □ Not Deployed
Accident/Incident Aircraft? of this Accident/Incident: hrs. ○ 5-point ○ 5-point □ Deployed
○ Unknown ○ Unknown □ Unknown
□ Yes □ No
Supplemental Restraint, specify:

Additional Crewmember Information Seat Occupied Injury

○ Left ○ Rear ○ None
First Name: City of Residence: ○ Center ○ Single ○ Minor
○ Right ○ Unknown ○ Serious
Middle Initial: State: Zip: ○ Front ○ Fatal
○ Unknown
Last Name: Country:
Personal Flight Equipment (Check all that apply)
□ Fire resistant flight suit □ Helmet □ Laser protective visor/glasses □ Personal Locator Beacon(s) (PLB) □ Fire resistant gloves
□ Helmet visor □ Night vision goggles □ Personal flotation □ Other: __________________________________________
Pilot Certificate(s) (Check all the apply) Restraint Type Inflatable
□ None □ Flight Instructor □ Commercial □ US Military Available Used Restraints
□ Private □ Recreational □ Airline Transport □ Foreign ○ None ○ None
□ Student □ Sport □ Flight Engineer ○ Lap Only ○ Lap Only □ Not Installed
○ 3-point ○ 3-point □ Installed
○ 4-point ○ 4-point □ Not Deployed
Type Rating/Endorsement for Total Flight Time at the Time hrs. ○ 5-point ○ 5-point □ Deployed
Accident/Incident Aircraft? of this Accident/Incident: ○ Unknown ○ Unknown □ Unknown
□ Yes □ No Supplemental Restraint, specify:

PASSENGER(S) / OTHER PERSONNEL (Include cabin crew; continue on separate sheet, if necessary.)
Number of Passengers ___________
Passenger Information Seat Injury Restraint Type Inflatable Age
Restraints
Available Used
First Name: City: ○ Left ○ None ○ None ○ None □ Not □ Under 5
○ Center ○ Minor ○ Lap Only ○ Lap Only Installed years
Middle Initial: State: Zip: ○ Right ○ Serious ○ 3-point ○ 3-point □ Installed
○ Unknown ○ Fatal ○ 4-point ○ 4-point □ Not If under 5
Last name: Country: ○ Unknown ○ 5-point ○ 5-point Deployed years,
Row: ○ Unknown ○ Unknown □ Deployed ○ Child
○ Crew ○ Passenger ○ Other □ Unknown Restraint
Supplemental Restraint, specify: ○ Lap-Held
○ Unknown
Personal Flight Equipment (Check all that apply)
□ Fire resistant flight suit
□ Helmet
□ Laser protective visor/glasses
□ PLB
□ Fire resistant gloves
□ Night vision goggles
□ Helmet visor
□ Personal flotation
□ Other: ______________________

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Available Used
First Name: City: ○ Left ○ None ○ None ○ None □ Not □ Under 5
○ Center ○ Minor ○ Lap Only ○ Lap Only Installed years
Middle Initial: State: Zip: ○ Right ○ Serious ○ 3-point ○ 3-point □ Installed
○ Unknown ○ Fatal ○ 4-point ○ 4-point □ Not If under 5
Last name: Country: ○ Unknown ○ 5-point ○ 5-point Deployed years,
Row: ○ Unknown ○ Unknown □ Deployed ○ Child
○ Crew ○ Passenger ○ Other □ Unknown Restraint
Supplemental Restraint, specify: ○ Lap-Held
Personal Flight Equipment (Check all that apply) ○ Unknown
□ Fire resistant flight suit
□ Helmet
□ Laser protective visor/glasses
□ PLB
□ Fire resistant gloves
□ Night vision goggles
□ Helmet visor
□ Personal flotation
□ Other: ______________________

Available Used
First Name: City: ○ Left ○ None ○ None ○ None □ Not □ Under 5
○ Center ○ Minor ○ Lap Only ○ Lap Only Installed years
Middle Initial: State: Zip: ○ Right ○ Serious ○ 3-point ○ 3-point □ Installed
○ Unknown ○ Fatal ○ 4-point ○ 4-point □ Not If under 5
Last name: Country: ○ Unknown ○ 5-point ○ 5-point Deployed years,
Row: ○ Unknown ○ Unknown □ Deployed ○ Child
○ Crew ○ Passenger ○ Other □ Unknown Restraint
Supplemental Restraint, specify: ○ Lap-Held
Personal Flight Equipment (Check all that apply) ○ Unknown
□ Fire resistant flight suit
□ Helmet
□ Laser protective visor/glasses
□ PLB
□ Fire resistant gloves
□ Night vision goggles
□ Helmet visor
□ Personal flotation
□ Other: ______________________

Available Used
First Name: City: ○ Left ○ None ○ None ○ None □ Not □ Under 5
○ Center ○ Minor ○ Lap Only ○ Lap Only Installed years
Middle Initial: State: Zip: ○ Right ○ Serious ○ 3-point ○ 3-point □ Installed
○ Unknown ○ Fatal ○ 4-point ○ 4-point □ Not If under 5
Last name: Country: ○ Unknown ○ 5-point ○ 5-point Deployed years,
Row: ○ Unknown ○ Unknown □ Deployed ○ Child
○ Crew ○ Passenger ○ Other □ Unknown Restraint
Supplemental Restraint, specify: ○ Lap-Held
Personal Flight Equipment (Check all that apply) ○ Unknown
□ Fire resistant flight suit
□ Helmet
□ Laser protective visor/glasses
□ PLB
□ Fire resistant gloves
□ Night vision goggles
□ Helmet visor
□ Personal flotation
□ Other: ______________________

FLIGHT ITINERARY INFORMATION

Last Departure Point Time of Flight Information Destination Type Flight Plan Filed
Departure
Airport ID: LSX Flight Number: Airport ID: ○ None ○ VFR/IFR
○ Company ○ IFR
City: LOS SANTOS Time: Operating as Flight City: VFR ○ Unknown
HH:MM _____________
AIR RESCUE 5 ○ Military
State: SA State: VFR
○ VFR
Time Zone:
Country: USA Country:
Activated? ○ Yes ○ No
○ Unknown

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Type of ATC Clearance/Service (Check all that apply)

□ Certificate of Authorization □ Special VFR
✔
□ Special IFR □ VFR Flight Following □ Cruise

□ VFR □ IFR □ VFR On Top □ Traffic Advisory □ Unknown / NA

□ None

Airspace where the accident/incident occurred (Check all that apply)

□ Class A □ Class G □ Military Operations Area (MOA) □ Special
□ Class B □ Demo Area □ Airport Advisory Area □ Air Traffic Control Area
□ Class C □ Warning Area □ Jet Training Area □ Unknown
□ Class D □
✔ Prohibited Area □ TRSA
□ Class E □ Restricted Area □ FAR 93 Altitude of In-Flight Occurrence: 1 ft. MSL

WEATHER INFORMATION AT THE ACCIDENT/INCIDENT SITE

Source of Pilot Weather Information Weather Observation Facility
(Check all that apply)
□ National Weather Service □ Company Facility ID:
□ Flight Service Station □ Military Observation Time:
□ TV/Radio □ Internet Time Zone:
□ Automated Report □ None Distance from Accident Site: nm
□ Electronic Flight Bag-Application: □ Unknown Direction from Accident Site: degrees true
________
□ On-Board Weather
Basic Conditions Lowest Cloud Condition Light Condition
○ VMC Height
○ IMC _____________ ft. AGL ○ Dawn ○ Dusk ○ Dark Night ○ Unknown
○ Unknown ○ Day ○ Night ○ Bright Night
Sky/Lowest Cloud Condition Ceiling Ceiling Height
ft. AGL
○ Clear ○ Thin Broken ○ None (Clear) Temperature: (˚C) or (˚F)
○ Few ○ Thin Overcast ○ Broken
○ Partial ○ Unknown ○ Overcast Dewpoint: (˚C) or (˚F)
Obscuration ○ Obscured
○ Scattered ○ Indefinite
○ Unknown

Altimeter Setting: Wind Direction Wind Speed Wind Gusts Visibility

□ Calm □ Not Gusting miles
□ Variable □ Light and Variable or RVR: feet
(Hg) ,or or
(mb) or Speed: kts
RVV: miles
Direction: Speed: kts
Density Altitude: ft.
degrees true
Type of Precipitation (Check all that apply) Restriction to Visibility (Check all that
apply)
□ None □ Drizzle □ Freezing Rain □ None □ Fog
□ Rain □ Ice Pellets □ Snow Shower □ Blowing Dust □ Ground Fog
□ Snow □ Snow Pellets □ Ice Pellets Shower □ Blowing Sand □ Haze
□ Hail □ Snow Grains □ Freezing Drizzle □ Blowing Snow □ Ice Fog
□ Rain Showers □ Ice Crystals □ Blowing Spray □ Smoke
□ Dust □ Unknown
Icing Forecast Intensity of Precipitation Icing Actual Turbulence (Check all that apply)
Amount Type ○ Light Amount Type Type Severity
○ None ○ N/A ○ Moderate ○ None ○ N/A □ None □ Light
○ Trace ○ Rime ○ Heavy ○ Trace ○ Rime □ Clean Air □ Moderate
○ Light ○ Clear ○ N/A ○ Light ○ Clear □ Terrain-Induced □ Severe
○ Moderate ○ Mixed ○ Unknown ○ Moderate ○ Mixed □ Convective □ Extreme
○ Severe ○ Unknown ○ Severe ○ Unknown Turbulence
○ Unknown ○ Unknown
NOTAMs (D and FDC), AIRMETs, SIGMETs, PIREPs in effect at the time of the accident/incident:

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DAMAGE TO AIRCRAFT AND OTHER PROPERTY

Aircraft Damage Aircraft Fire Aircraft Explosion
○ None ○ Substantial ○ None ○ Both Ground and In-Flight ○ None ○ Both Ground and In-Flight
○ Minor ○ Destroyed ○ In-Flight ○ Fire at Unknown Time ○ In-Flight ○ Fire at Unknown Time
○ Unknown ○ On-Ground ○ Unknown ○ On-Ground ○ Unknown
Description of Damage to Aircraft and Other Property (Use additional sheet, if necessary.)

NARRATIVE HISTORY OF FLIGHT (Please type or print in ink.)

Describe what occurred in chronological order, including circumstances leading to and nature of accident/incident. Describe terrain and
include wreckage distribution sketch if pertinent. Attach extra sheets if needed. State departure time and location, services obtained, and
intended destination. Provide as much detail as possible.
At some point prior to the incident, a large-scale fight erupted within the grounds of the San Andreas State Prison, involving multiple
inmates. Reports indicated that at least five or six inmates sustained stab wounds during the altercation, requiring urgent medical
intervention. The situation prompted immediate responses from the San Andreas Department of Corrections and Rehabilitation (SADCR),
the Los Santos Fire Department (LSFD), and the Los Santos County Sheriff's Department (LSSD).

SADCR personnel, led by Sergeant Nathan Arriaga and Lieutenant Evelia Benites, quickly secured the affected areas, particularly the
basketball court, where most of the injured inmates were located. Officers coordinated efforts to restrain the involved inmates while
maintaining control of the broader prison population. Despite their best efforts, the number of injured and the scale of the incident strained
the available resources.

Sergeant Arriaga communicated with LSFD to request medical support. Due to delays in ground units, officers on-site were instructed to
begin first aid and triage for the injured inmates. Coordination with other SADCR officers ensured uninvolved inmates were relocated to
secure areas to provide a safe environment for LSFD personnel upon their arrival. From my understanding, LSFD Paramedics from
Station 52 were already on scene and stabilizing victims, when the LSFD Incident Commander (IC) requested Air Ambulance MEDEVAC
services from the Los Santos County Sheriff's Department.

During the response, LSSD's Air Rescue 5 requested permission to land at the facility to assist with medevac operations, citing the critical
condition of several inmates. Sergeant Arriaga explicitly denied the request, stating at 21:24:05 that "I can't authorize a helicopter to land in
or around the prison at this time. You'll have to find an LZ away from the prison perimeter." Despite these instructions, Air Rescue 5
insisted that they had the authority to land as needed, per LSFDs request.

Tensions escalated when Sergeant Arriaga firmly responded at 21:25:14, stating, "Don't put me in a position to tell my officers to fire on
your helicopter. You will /not/ land near the facility. How copy?" Despite this, further communication from SADCRs Watch Command
(Evelia Benites) at 21:26:06 acknowledged that the only sufficient landing area was in the prison yard where injuries were located, while
also emphasizing that other locations had obstructions, LT Benites instructed the SEB Deputy on scene, who was communicating with the
aircraft to coordinate a landing, that they could land in the parking lot outside the facility, which is free of obstacles and obstructions.

After continued back-and-forth communication, at 21:27:20, Air Rescue 5 acknowledged an alternative landing location at the front parking
lot outside the prison walls, stating, "OK, we'll be setting it down at the parking lot in front of the facility. Unless you've got a better spot for
landing, ma'am." However, in direct contradiction to this agreement, Air Rescue 5 instead landed on the basketball court inside the prison
walls, where injured inmates were still being secured. It is unknown how many victims were airlifted away at the time of writing this report.

OPERATOR/OWNER SAFETY RECOMMENDATION (How could this accident/incident have been prevented?)

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MECHANICAL MALFUNCTION/FAILURE (If more space is needed, continue on a separate sheet.)

Was there Mechanical Malfunction/Failure? □ Yes □ No Total Time/ Cycles On Part
(If yes, list the name of the part, manufacturer, part no., serial no., and describe the failure.)
Hours

Cycles

Time Since This Part Inspected/Overhauled

Hours

FUEL & SERVICES INFORMATION

Fuel on Board at Last Takeoff Fuel Type
(Convert from pounds, as necessary) ○ 100 Low Lead ○ Jet A ○ Unleaded AV
○ Automotive ○ Jet A-1 ○ Other, specify
Gallons
Other Services, if any, prior to departure:

EVACUATION OF AIRCRAFT
Was an emergency evacuation of the aircraft performed? □ Yes □
✔ No

Method of Exit – Describe how the occupants exited and how many occupants evacuated each location:

OTHER AIRCRAFT – COLLISION (If air or ground collision occurred, complete this section for other aircraft.)
Aircraft Registration Number Manufacturer: Damage to Other Aircraft:
□ Destroyed □ Minor
Model: □ Substantial □ None

Registered Owner of Other Aircraft Pilot of Other Aircraft

Name: Name:

City: City:

State: ZIP: State: ZIP:

Country: Country:

ADDITIONAL INFORMATION (Additional space for answers to any question.)

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I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.
I understand that the information provided may be subject to public release.
Date of this report: Name of Pilot/Operator:

Signature:
mm/dd/yyyy
-or- □ Check here to electronically sign this document

If a person other than Pilot/Operator is filing this report

Name: LOU TAYLOR Title: DEPUTY DIRECTOR

Signature:

-or- □ Check here to electronically sign this document

FOR NTSB USE ONLY

NTSB Accident/Incident No. Reviewed by NTSB AS Division Name of Investigator Date Report Received
01272025 LOU TAYLOR 01/29/2025

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