Title Page

  • Conducted on

  • Prepared by

Description of Operation

  • Project or Department:

  • Responsible Pilot in Command:

  • Date or expected frequency of mission(s):

  • Specific Location:

  • Description of Operation:

  • As necessary, include a sketch or diagram showing the planned sUAS flight path or area of operations. Sketch should include home point, observation points, applicable right of ways and property lines, and known hazards.

  • Attachments:

Explain Risk Mitigation measures for all Medium (yellow) and High (red) risks.

  • Complexity of Mission:

  • DOC experience with mission type:

  • Controlled Airspace:

  • Private Property:

  • Daylight:

  • Wires/Trees/Structures:

  • Drone Distance from Operator:

  • Proximity to Roads:

  • Proximity to Radio Towers:

  • Nearby Airport/Heliport:

  • Pedestrians/distraction:

  • Over Water:

  • GPS/Radio Dead Spots:

Overall Site Risk Rating

  • Fill in highest rating from the above inspection:

Signature

  • Responsible PIC:

  • Drone Manager:

  • Superintendent?

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