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Client Hazard Notification Form
Client/Property Name(s) & Addresses
(Required)
Owner/Authorized Manager Completing this Notification
(Required)
Position
(Required)
Email Address
(Required)
I understand my responsibility to ensure all known hazards are identified and made known to the pilot and crew. When possible, I will supply maps detailing hazards:
(Required)
Yes
How will you identify WIRES and other aviation hazards such as, but not limited to, aerials, electric fence wires, phone line and powerlines?
(Required)
Supplied by Tabula (Tracmap) online map (preferred)
Paper map / photo of a paper map showing hazards (suitable)
I will explain over the phone / in person with or without maps within 24 hours of operation start
Do you have any Organic properties that bound onto your property or come within 500 meters?
(Required)
Organic property that bounds onto the operational property(s)
Organic farm within 500 meters of the operational property(s)
No organic properties in the immediate area surrounding my property(s)
Do you have any Sensitive Boundaries (Internal or External)?
(Required)
No
Yes – Orchards in proximity
Yes – Other (Please Explain)
Sensitive Boundaries could include kiwi fruit orchards, crops, native plantings
Sensitive Boundaries Explanation
Hazards to Ground Crew such as, but not limited to; tracks, terrain, livestock. Check all that are relevant and notify us of any specific instructions.
(Required)
Tracks unsuitable for a 4x4 ute
Dangerous livestock
Difficult water access (spraying operations)
Low hanging wires
Rough terrain
Other (please explain)
Please list any other hazards (Ground & Air) we could encounter while providing our service to you.
Do you understand your responsibilities regarding neighbour, staff and contractor notification?
(Required)
Yes, I will notify all of the above before any applicable Heli A1 operations begin
No, I will require help to understand my requirements
Please confirm the following points are understood and that you accept that they are either done, or you understand your exposure and risks if they are not adhered to.
(Required)
If you have supplied the agrichemical(s) that have expired you understand the risk relating to this
A spray plan will be provided to the pilot with all additional risks identified
Withholding periods/Restricted Entry Intervals are understood and will be adhered to
If you or your representative have instructed the pilot and/or groundcrew to apply the chemical differently to the manufactures recommendations, you understand the risks, possible ineffectiveness or crop damage this may cause and take full liability for this.
You (the client) will be liable as the PCBU and principal under the HSWA 2015 and the Civil Aviation Act.
If you are aware of new hazards, or hazards not mentioned on this questionnaire you must notify a Heli A1 pilot or Safety Manager before work is next completed on your property.
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