## Vertical Access UAS Flight Checklist

UAS Operations

Vertical Access LLC

PO Box 4135, Ithaca, NY 14852

Tel: 607 257 4049 / Fax: 607 257 2129

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## Unmanned Aircraft System (UAS):

Site Specific Safety Plan

Building or Site Name

City, State

Vertical Access LLC

PO Box 4135, Ithaca, NY 14852

Tel: 607 257 4049 / Fax: 607 257 2129

This Safety Plan includes three sections: a Work Description, a Hazard Analysis, and a

Rescue Plan.



### Work Description

Dates of Site Work:

Job Site Address:

Job Site Contact:

Project Client:

Client Contact:

VA Project No.:

VA Personnel: Personnel for VA UAS operations will consist of at least two (2) personnel, a

Pilot in Command (PIC) and Visual Observer (VO). Other personnel assisting with UAS

operations will be referred to as technicians.

Name Title Field Contact Emergency Contact

J.M. PIC xxx.xxx.xxxx S.K. xxx.xxx.xxxx (mob.)

J.H. VO/Tech xxx.xxx.xxxx M.N. xxx.xxx.xxxx (mob.)

K.F.D. VO/Tech xxx.xxx.xxxx R.D. xxx.xxx.xxxx (mob.)

K.S.D VO/Tech xxx.xxx.xxxx J.M. xxx.xxx.xxxx (mob.)

E.K. VO/Tech xxx.xxx.xxxx R.O. xxx.xxx.xxxx (mob.)

K.L. VO/Tech xxx.xxx.xxxx S.G. xxx.xxx.xxxx (mob.)

B.d.M. VO/Tech xxx.xxx.xxxx G.P. xxx.xxx.xxxx (mob.)

K.O. VO/Tech xxx.xxx.xxxx W.O. xxx.xxx.xxxx (mob.)

K.S. VO/Tech xxx.xxx.xxxx D.S. xxx.xxx.xxxx (mob.)Permits:

Federal Aviation Administration (FAA) Exemption No.: _______________

Certificate of Waiver or Authorization (COA): _______________________

Notice to Airmen: ______________________________________________

Scope of Work: D escribe scope of work: particular use of UAS

Flight Zone: D escribe flight area and its parameters

.

Flight Plan: Describe what the flight(s) will accomplish and how many flights will be

required to accomplish the mission.

UAS Platform: Identify the make and model of the UAS to be used for the mission. Include

information and manuals specific the aircraft.



### Hazard Analysis

Prior to any UAS operations, VA will develop a predetermined flight zone, gaining access

and permissions from any affected properties, organizations, and/or persons. VA w ill assess

the flight zone for any potential hazards that hinder the overall safe operations of the UAS

mission.

Once on site, VA personnel will reassess the flight zone to ensure safety and identify any

unforeseen hazards. Weather will also be asses sed on a twice

- daily basis on site and as

needed with changing weather patterns. Flights will not occur or will be suspended if

weather conditions affect the overall safety of the mission. Adverse weather conditions may

include, but are not limited to, pr ecipitation, limited visibility due to fog or clouds, winds

over 15 knots, and lightning.



### Emergency Plan

In the unlikely event of an emergency, Vertical Access will develop an

emergency plan relevant to the specific flight zone. Availability of eme rgency

services, medical facilities, and relevant safety offices are listed below.

EMS: 911 service is/is not available at the job site.Non

- Emergency Medical Facility:

List name and address of nearest ER facility. Attach or insert map.

OSHA Emergency: 800.321.6742 (To report an imminent life threatening situation or

fatality)

OSHA Regional Office: [choose the appropriate office info and delete the rest]

Regional Office 1 (MA, CT, RI, ME, VT, NH)

JFK Federal Building, Room E340

Boston, Massac husetts 02203

617.565.9860 (office)

617.565.9827 (fax)

Regional Office 2 (NY, NJ )

201 Varick Street, Room 670

New York, New York 10014

212.337.2378 (office)

212.337.2371 (fax)

Regional Office 3 (PA, DE, DC, MD, WV, VA)

U.S. Department of Labor/OSHA

The C urtis Center

- Suite 740 West

170 S. Independence Mall West

Philadelphia, PA 19106

- 3309

215.861.4900 (office)

215.861.4904 (fax)

Regional Office 4 ( KY, TN, NC, SC, GA, AL, MS, FL)

61 Forsyth Street, SW, Room 6T50

Atlanta, Georgia 30303

404.562.2300 (office)

404.562.2295 (fax)

Regional Office 5 (MN, WI, MI, OH, IN, IL)

230 South Dearborn Street, Room 3244

Chicago, Illinois 60604

312.353.2220 (office)

312.353.7774 (fax)Pilot Log: Vertical Access UAS - Pilot NameDateTimeLocationPICVODurationAircraftWeatherWindFlight TypeObservationsTakeoffs/LandingsAircraft Log: Vertical Access - Phantom 2DateTimeLocationPICVOFlight DurationWeatherWarningsIncidentsTakeoffs/LandingsMaintenance Log: Vertical Access - Phantom 2DateTimeTechnicianAircraft HoursScheduled MaintenanceRepairsPart ReplacementDetails