Air Care & Mobile Care - Greater Cincinnati Emergency Medical Transport

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AirCareandMobileCare.com is a resource developed by the Health Alliance for emergency health care professionals in Greater Cincinnati.

Request an Air Safety Education Presentation

All red items are required.You will be contacted for further information if not listed on the form. To ensure scheduling of your helicopter safety program, please complete all items. We will call your department to verify your visit.

Contact Info:

Department Name

Your Name

Phone Number Contact for further Info

E-mail address

Department Address

Date Needed

Time

Event:

Safety Training
Prom Drill
Public Safety Day
PR / OpenHouse

Total Event Time:

Other Event (Explain)

Helicopter Dispatch Procedure:

Wait for phone call
Auto Dispatch

Landing Zone Information:

Radio Frequency

Call Sign

Location & Obstructions (wires, trees, buildings ect.)

Size (min 100x100 required)

Landing Zone Marked with:

Cones

Strobes

Flares

Vehicles

Other:

Contact Person Name & Phone (For contact on day of event)

Please review the form for accuracy prior to submission:

For Air Care use Only:

Flight Nurse:

On/Off Duty:

Primary Aircraft
Secondary Aircraft

Flight Completed (Yes, No & Why)