Safety Orientation / PR Visit

Safety Orientation / PR Request Form

Organization:
Street Address:
State:
Zip Code:
Contact Person:
e-mail Address:
Phone #:
Fax #:
Location of Event (include address and description of landing area if aircraft requested):
Date of Event (mm/dd/yyyy):
Time of Event (hh:mm AM or PM):
Delay:
Enter Time:
Did AirMed ever attend this event in the past?		Yes
		No
If Yes , date attended:
Type of Organization:
Expected Attendance #:
Type of Request:
Request Comments / Additional Comments::
If you do not receive a response within 7 days or if you have any questions please call 706-868-2371.Final confirmation is contingent on your acceptance of the items outlined below and completion of the information requested and return of same to Airmed: 1. The landing area is suitable for landing the helicopter. 2. You or your organization has secured permission from the owner of the property referenced above for the visit with the helicopter and will take appropriate action and be responsible for securing the area for the arrival of the aircraft to include appropriate personnel to keep people clear of the landing area and removal or securing of all loose equipment and non-permanent or portable objects that might be blown about by the rotor wash of the aircraft. 3. Availability of the aircraft at the requested time is determined by transport mission requirements, weather, and aircraft maintenance factors which may necessitate delay or cancellation of the visit at the last minute. 4. Our Communications Center will coordinate notification of actual arrival time, where possible, prior to the scheduled arrival time. The information provided on this form is accurate to the best of my knowledge and, if an aircraft visit is requested, I accept responsibility for compliance with items 1 and 2 as listed above.













		I Agree
		I Disagree