UNITED FEDERATION OF PLANETS

FORM TST-6- TEMPORAL DISPLACEMENT IMPACT ASSESSMENT (PAST)

for temporal displacements to the future, file form TST-7a

Filing officer information

Name:

Rank:

Starfleet ID:

Duty vessel:

Stardate of initial temporal displacement:

Stardate temporally displaced to:

Stardate returned to, if applicable:

Displacement involved (circle appropriate): ship / crew / both

Displacement was (circle appropriate): accidental / intentional

Number of Starfleet personnel displaced:

Number deceased while displaced:

Number of non-Starfleet individuals displaced:

Number deceased while displaced:

Answer these questions as completely as possible:

1. List all past-resident individuals encountered during displacement (using red pen, circle names of all past-resident individuals killed during displacement):

2. Using a 1-6 scale (1 unimportant, 6 critical), rank all individuals listed in question 1 in terms of their importance to known history:

3. Describe, in as much detail as possible, all interactions with past-resident individuals during displacement (attach additional sheets if needed):

4. Was any knowledge of future events or technology imparted to past-resident individuals during displacement?

If yes, list future events or technology discussed:

5. Were any present-resident individuals left behind in the past?

If yes, list their names and (if relevant) Starfleet IDs:

6. Were any past-resident individuals brought forward to the present?

If yes, provide as much identification data as possible:

7. Were any physical technological artifacts from the present left behind in the past?

If yes, list:

8. In your professional opinion, is it likely that a branching timeline was created by this displacement?

If yes, is it likely that this timeline is dystopian?

9. Rank, on a scale of 0-6 (0 is minimal, 6 is severe), your impact on the course of known history during the displacement:

THANK YOU FOR YOUR COMPLIANCE WITH STARFLEET TEMPORAL DISPLACEMENT REGULATIONS. YOU WILL BE CONTACTED FOR FURTHER DEBRIEFING WITHIN 10 BUSINESS DAYS OF SUBMISSION OF THIS FORM.