Operator Review Form.docx Page 1 of 12 

# UAS OPERATOR REVIEW FORM

Completed by : Date:

1. COMPANY NAME

Address: Telephone:

Fax:

Email:

1. MANAGEMENT

Name Title

1. OPERATOR DOCUMENTS Attach a copy of the following: 4

Operations Certificates, COA, Form

333

Maintenance Approval Certificates

Drug and Alcohol Program

REGULATORY AUTHORITY followed: FAA, JAA,

CAA, or Other (name): FAA

1.4. FLIGHT INFORMATION YES NO

1.4.1 Date(s) and time(s) of proposed flights

1.4.2 Alternate date(s) and time(s)Operator Review Form.docx Page 2 of 12 1.4.3 Type / purpose of operation

1.4.4 Hazard to persons or property See ATTACHED JHA

1.4.5 Emergency response plan

1.4.6 Flight plan, boundaries, altitudes See attached flight plans

1.4.7 NOTAM required

1.5. UAS INFORMATION

Registration

No. Make/Model Yr.

Manuf. Serial # Owned/Lea

sed A/C Hours

1. COMPANY STAFF

Permanent Pilots Observers Technicia

ns

Part Time Pilots Observers Technicia

ns

1.7 UAS DESCRIPTION YES NO

1.7.1 UAS Category

1.7.2 Measurements: body diameter rotor diameter

1.7.3 Weights: Payload MGTOW Empty

1.7.4 Type of propulsion

1.7.5 Propulsion time of flight

1.7.6 Fuel / oil system capacity

1.7.7 Electric propulsion system: power output separate electric source

1.7.8 Method of launch (runway, hover, catapult, hand):Operator Review Form.docx Page 3 of 12 1.7.9 Method of recovery (runway, hover, belly / skid)

1.7.1

0 Navigation system : how does it determine position

How does it navigate

1.7.1

1 Redundant systems (flight controls, avionics)

1.7.1

2 Visual detectability (High visibility paint)

1.8. UAS EQUIPMENT YES NO

1.8.1 Autopilot

1.8.2 Ballistic Parachute System (BRS)

1.8.3 Ice detection

1.8.4 Position / Ant

- collision lights

1.8.5 Fail Safe termination system

1.8.6 Transponder / ADS

- B

1.9 UAS CONTROL SYSTEM YES NO

1.9.1 Controller auto launch / recovery

1.9.2 Instrumentation (capable of displaying attitude info, control, and navigation)

1.9.3 Does the system automatically diagnose and monitor status?

1.9.4 Visual / audio alarms and warnings

1.9.5 Control station security?

1.9.6 How is the control station powered?

SECTION 2 OPERATIONS

1. COMMUNICATION LINKS DESCRIPTION YES NO

2.1.1 Control frequencies

2.1.2 Line of sight (LOS) or Beyond line of sight (BLOS)

2.1.3 Range of LOS frequenciesOperator Review Form.docx Page 4 of 12 2.1.4 Satellite communication

2.1.5 Indications of lost links

- “ off flags?

2.1.6 Frequency security / interference prevention

2.1.7 Redundant control links

2. ATC COMMUNICATIONS YES NO

2.2.1 ATC Communication method

time delay

2.2.2 Method of communicating with other airspace users

Backup comm with ATC or other users

2.2.3 Communication system between pilots and ground support Non

- aided

Verbal

3. SENSE AND AVOID YES NO

2.3.1 Automatic (Equipment) or visual (man)?

2.3.2 Control station security?

4. PAYLOAD YES NO

2.4.1 Description

2.4.2 Purpose

2.4.3 Operation limitations

2.4.4 Method of securement

2.4.5 Operational impact on pilot (camera optics, views)

2.4.6 Redundant control links

PILOT INFORMATION

Training records will be checked during the review

.

CERTIFICAT

E FLIGHT HOURS

TYPE & AIRCRAFT TYPE MUL

TI TO

TA

L TOTA

L TOTAL

NAME NUMBER RATINGS MEDICA

L UAS

TIME PIC PIC SIC TIMEOperator Review Form.docx Page 5 of 12 1.5. OPERATIONS MANUAL YES NO

Operations Manager qualifications / roles and responsibilities

Pilot qualifications / roles and responsibilities

Observer qualifications / roles and responsibilities

Payload operator qualifications / roles and responsibilities

Maintenance qualifications / roles and responsibilities

Method of Operational Control

Weather limits: ceiling visibility

Personnel flight and duty times

Personnel use of PPE Minimum PPE

Reporting hazards, incidents, and accidents

Disposal of environmentally sensitive items

Flight near environmentally sensitive

2.6 UAS Flight Manual YES NO

2.6.1 Limitations

2.6.2 Normal operations

2.6.3 Emergency proceduresOperator Review Form.docx Page 6 of 12 2.6.4 Emergency checklist

2.6.5 Performance

2.6.6 Systems

- Navigation

2.6.7 Systems

– Payload

2.6.8 Systems monitoring

2.6.9 Records and retention

2.7 UAS Maintenance Manual YES NO

2.7.1 UAS normal maintenance

2.7.2 Preventative maintenance instructions

2.7.3 Component maintenance instructions

2.7.4 Inspections schedules

2.7.5 Reports and records

2.7.6 Reliability records

2.7.8 Software requirements

2.7.9 Method to determine airworthiness

SECTION 3

- SAFETY

1. SAFETY PROGRAM Accident data for the previous five (5) years*

Year Aircraft

Type No.

Accidents No. Fatal

Accidents No.

Serious

Injuries No.

Fatalities Annual

Flight

Hours Annual

Takeoffs

YES NOOperator Review Form.docx Page 7 of 12 Do you have a written Safety Management System (SMS)?

Does it address the following eleven elements?

SMS Management Plan

Safety Promotion

Document and Data Information Management

Hazard Identification and Risk Management

Occurrence and Hazard Reporting

Occurrence Investigation and Analysis

Safety Assurance Oversight Programs

Safety Management Training Requirements

Management of Changes

Emergency Preparedness and Response

Performance Measurement and Continuous Improvement

If no SMS in place describe your program (or attach description):

SECTION 4

- TECHNICAL

1. MAINTENANCE STAFF NAME Years in Aviation Business

Director of Maintenance

Chief Inspector

2. POLICY AND PROCEDURES YES NO

Does your company have an approved Maintenance Policy and Procedures manual?

Current revision Number and Date? Available in English?

Does your company hold appropriate regulatory approval as a maintenance facility?

Are you an authorized Manufacturers Service/Repair Station?

List types authorized:

3. TECHNICIAN RECRUITMENT YES NOOperator Review Form.docx Page 8 of 12 What is the present technician to aircraft ratio?

What are company employment minimum experience and qualifications for

Technicians?

Are part

- time or contract technicians hired?

How are these technicians trained and currency checked?

4. TRAINING

- TECHNICIANS YES NO

Do you have a written company program?

Does it include Type course(s)? (either manufacturer or operator)

Does it include periodic written testing on Operator ’ s manuals?

Does it include a course on human factors?

What is the frequency of recurrent training? (1/3yr. min.)

Briefly describe the program or attach one page description:

5. TECHNICIAN INFORMATION You may supply this data in a format currently in use by your organization.

Name Type of

License Type

Aircraft

Experience Date

License

Issued Manufacturers

Schools

Completed Years

Aviation

ExperienceOperator Review Form.docx Page 9 of 12 6. AIRCRAFT YES NO

Which of the following programs are used to inspect your UAS:

Manufacturer inspection program? Describe:

Approved UAS inspection program? Describe:

Are UAS overhauled and repaired in accordance with the manufacturer ’ s procedures and

recommendations?

Are extensions used for:

Component life, Calendar life, Overhaul interval, Inspections?

If yes, list pre

- authorized percentage:

Is there an internal process established to authorize extensions?

Is the following information recorded in the appropriate logbook for components that

have been replaced:

Serial Numbers? Yes No Part Numbers? Yes No TSO? Yes No

What process do you use to track and schedule inspections, component overhauls,

airworthiness directives and mandatory service bulletins:

Deferred defects: Are target dates set to rectify?

Are inoperative equipment placards used?

Do you have written procedures?

Additional installed equipment: Do you have appropriate documentation (field approvals,

supplemental type certificates, etc.)?

Do you comply with manufacturer service bulletins?

Do you comply with airworthiness directives from the aircraft ’ s country of certification?

Does the weight and balance match the installed equipment listing?Operator Review Form.docx Page 10 of 12 Is a summary listing (status sheet) of airworthiness directives available for each aircraft?

7. OVERHAUL AND REPAIR

Name of aircraft vendors that perform the following maintenance:

Airframe: Engines:

Components:

Electrical: Radio:

8. TECHNICAL LIBRARY YES NO

Is the location of the Technical Library accessible to all users?

Who is responsible for keeping manuals current?

9. HANGAR MAINTENANCE AREAS YES NO

Will the facility support your company ’ s largest UAS?

Is it clean and in good state of repair?

Is ground equipment available and serviceable?

Is there a flammable(s) storage area?

Are eye wash / shower stations provided?

Are spill kits provided?

Are fire extinguishers available?

Are they regularly inspected and tagged?

Frequency?

10. WORKSHOPS YES NO

Does the company operate workshops?

Describe:Operator Review Form.docx Page 11 of 12 Are testing equipment and measuring tools calibrated annually?

Recorded? N/A

11. STOCK ROOM YES NO

Is it temperature/humidity controlled?

Are materials stored and marked properly?

Are stock control limits established?

Are parts (certified) inspected on receipt by a licensed person?

Are separate receiving, dispatching, and quarantine areas established?

Are shelf life items (elastomeric, adhesives, etc.) monitored for expiration dates?

Does the company maintain a register of on

- site hazardous materials and quantities?

Are rubber goods stored IAW manufacturers ’ recommendations? (tires, hoses)

Are parts properly tagged?

Are original issue documents available?

Do hardware stock items (bolts, nuts, etc.) have authenticity documents?

12. AIRCRAFT FUEL SERVICES YES NO

Who provides aircraft fuel services:

If contracted, are periodic audits conducted by operator personnel?

Frequency? Written report available?

Are personnel trained in proper fuel handling and quality assurance?

Has a program been established for filter changes?

Frequency:

Do records and markings on filter canisters reflect time changes?

How often are fuel sumps on supply tanks drained and fuel inspected for

contamination?Operator Review Form.docx Page 12 of 12 Are records available?

Are ground wires in good condition (wires not broken, clips functional)?

Are hoses and nozzles in good condition? (hoses not cracked, no leaks, nozzles no

leaks, cap in place)

Do you conduct remote site refueling operations?

Are tanks and delivery points properly identified by type of fuel?

Are grounding points marked?

Are aircraft fuel sumps, fuel supply tanks, filters and nozzles sampled daily and

tested for water?

Are samples retained for 24 hours?

Test for water? Paste? Capsules?

Are aircraft fuel sumps drained daily?

Are differential pressure checks completed and recorded?

Do you have written procedures for fuel systems maintenance?

Does it include daily, weekly, semi

- annual, and annual testing/recording procedures?

ADDITIONAL COMMENTS