Approved For Release 2005/07/20 : CIA-RDP81R00560R000100060001-5
TENTATIVE
OBSERVERS QUESTIONNAIRE
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SECTION A
1. When did you see the object:
1.1 Date: ____________ ____________ ____________
Day Month Year
1.2 Time of Day: ____________ ____________ A.M. or P.M. (Circle One)
Hrs. Min.
1.3 Time Zone: (Circle One):
a. Eastern d. Pacific
b. Central e. Other ____________
c. Mountain
(Circle One): a. Daylight Saving
b. Standard
1.4 Circle one of the following to indicate how certain you are of your answer to the above question 1.2:
a. Certain c. Not very sure
b. Fairly certain d. Just a guess
2. Where were you when you saw the object:
Postal Address City or Town State Country
Additional Remarks: ____________
3. Where were you located when you saw the object:
(Circle One): a. Inside a building d. In an airplane
b. In a car e. At sea
c. Outdoors f. 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 airfield?
e. Flying over a city?
f. Flying over open country?
g. Other ____________
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Approved For Release 2005/07/20 : CIA-RDP81R00560R000100060001-5