HEALTH & SAFETY

QUESTIONNAIRE

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Farm Name

Farm Address

Contact Name

Position (for example, owner, manager, safety manager)

Email

I understand my responsibility to ensure all known hazards are identified and disclosed

Wires and Aviation Hazards

Hazards to Groundcrew

I understand it is my responsibility to obtain necessary permits (eg spraying scrub, fire permits) and show them to the pilot prior to the job commencing

I understand it is my responsibility to notify pilot of any sensitive boundaries such as crops or orchards

I understand it is my responsibility to notify neighbours, staff and contractors that the helicopter will be operating. I have also informed the pilot of any concerns neighbours have raised and any staff or contractors that will be working and need to be avoided

I understand that some chemicals have "restricted entry intervals" (which means stock/people shouldn't access this area without appropriated protective equipment) and I have familiarised myself with those applicable to chemical I am requesting to be applied

Accidents / Incidents: I agree to report any accidents/incidents that arise as a result of helicopter operations

Do you have anything else to add to ensure we stay safe on your property?

Pilot if known

DISCLAIMER : By submitting this form the client assures the following: 1. The client (or representative) has complied with their own responsibilities under the Health and Safety at Work Act 2015. 2. The client agrees to comply fully with the safety procedures of Rotor Work Limited. Induction and safety briefings on safe operations will be provided by our staff.

Address

Thank you for completing our Health & Safety Questionnaire

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