Project Blue Book Special Report (second copy)

I.!.-I
TENTATIVE
OBSERVERS QUESTIONNAIRE
SECTION A
1. When did you see the object:
1.1 Date: Day
1.2 Time of Day:
Month Year
A.M. or P.M. ( C i r c l e One)
Hrs. Min.
1.3 Time Zone: (Circle One):
a. Eastern
b. Central
c. Mountain
d. Pacific
e. Other
( C i r c l e One): a. Daylight Saving
b . Standard
C i r c l e one of t h e following t o i n d i c a t e how c e r t a i n you a r e of
your answer t o t h e above q u e s t i o n 1 . 2 :
a. Certain
b. Fairly certain
c. Not very sure
d. Just a guess
2. Where were you when you saw the object:
Po stal Addre ss
Additional Remarks:
City or Town State Country
3. Where were you located when you saw the object:
(Circle One): a. Inside a building d.
b. In a car e.
c. Outdoors f.
In an airplane
At sea
Other
3.1 Were you:
(Circle One) a. In the business section of a city?
b . In the residential section of a city?
c. In open countryside?
d. Flying near an a i r f i e l d ?
e. Flying over a city?
f. Flying over open country?
g. Qtfaasr '
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