Contact Info:

Department Name

Your Name

Phone Number Contact for further Info

E-mail address

Department Address

Date Needed

Time

Event:
 

Total Event Time:

Other Event (Explain)

Helicopter Dispatch Procedure:
 

 
Landing Zone Information:

Radio Frequency

Call Sign    

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

Size (min 100x100 required)

Landing Zone Marked with:

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:

Flight Completed  (Yes, No & Why)