Title Page
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Conducted on
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Prepared by
Description of Operation
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Project or Department:
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Responsible Pilot in Command:
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Date or expected frequency of mission(s):
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Specific Location:
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Description of Operation:
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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.
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Attachments:
Explain Risk Mitigation measures for all Medium (yellow) and High (red) risks.
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Complexity of Mission:
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DOC experience with mission type:
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Controlled Airspace:
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Private Property:
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Daylight:
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Wires/Trees/Structures:
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Drone Distance from Operator:
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Proximity to Roads:
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Proximity to Radio Towers:
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Nearby Airport/Heliport:
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Pedestrians/distraction:
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Over Water:
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GPS/Radio Dead Spots:
Overall Site Risk Rating
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Fill in highest rating from the above inspection:
Signature
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Responsible PIC:
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Drone Manager:
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Superintendent?