Titelseite
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Dokument Nr.
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Prüfungstitel
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Standort
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Durchgeführt am
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von
Prüfung
1. Inspection Review
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1.a Previous Inspection performed
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1.b Has the last inspection report been reviewed
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1.c Are there outstanding actions?
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1.d Heliport Manual
2. Location Information
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2.a Adresse
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2.b Name of the Locator
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2.c Locator Identifier
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2.d Phone Switchboard
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2.e Phone Emergency Room
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2.f Air to Ground Frequency
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2.g Helipad Responsible
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2.h E-Mail
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2.i WGS 84 Coordinates
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2.k National Grid
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2.l Elevation AMSL (m and ft)
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2.m Other Information
3. Physical Characteristics
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3.a Ground Ambulance Transfer necessary?
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3.b Type of Heliport
- Ground Heliport
- Elevated Heliport
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3.c Heliport Categorie
- Heliports
- Hospital
- Public Interest Site
- Mountain Landing
- Goverment
- Fuel Station
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3.e Environment m
- Congested
- Congested Hostile
- Hostile
- Open Area
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3.f Performance requirements
- Performance Class 1
- Performance Class 2e
- Performance Class 3
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3.g Flights Rules
- VFR Day
- VFR Day & Night
- VFR Day,Night &IFR
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3.h Reference Helicopter
- AW109
- AW169
- EC135
- EC145
- Bell429
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3.i Maximum allowable mass in kg
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3.j Surface
- Aluminum
- Asphalt
- Concrete
- Grass
- Steal Grid
- Other
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3.k Size of Touchdown and Liftoff Area ( TLOF) in m (0.83D)
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3.l Size of Final Approach and Takeoff Area (TLOF) in m (1D)
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3.m Size of Safety Area (SA) in m (2D)
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3.n Safety Area Surface with Load Bearing
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3.o Safety Net
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3.p Overrun Bar
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3.q In Ground Effect Performance
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3.r Markings in Accordance to ICAO AN14 Volume 2
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3.s Heated TLOF
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3.t Snow Removal Plan
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3.u Fuel Retention Reservoir
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3.v Conflict with Helicopter Exhaust and Air Condition
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3.w Overviews of the Location
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3.x Additional Information Concerning Physical Characteristics
4. Lightning
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4.a Location Identification Beacon
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4.b Approach Light System
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4.c TLOF Lightning
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4.d Wind Cone Indicator Light
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4.e FATO Lights
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4.f Light activating Chanel
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4.g Selective Code for Light activating
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4.h Emergency Power Supply
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4.i Obstacle Lighting
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4. L Other Information
5. Takeoff and Approach Axis
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5.a Takoff Surface for PC1: 4.5%
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5.b Main Departure Directions
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5.c Curved Approach Axis
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5.e Main Approach Directions
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5.f Approach and Departure in the Main Wind Direction
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5.g Go around Possibility
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5.h Special Procedures or Training required
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5.i Other Information
6. Rescue-, Fire Fighting- and Ground Equipments
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6.a Evacuation Plan published
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6.b Location Evacuation reviewed
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6.c Fire- and Rescue Equipment in Accordance to ICAO
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6.d Fire- and Rescue Equipment in Accordance to National Regulations
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6.e Extinguisher in Place, clearly marked for the Type of Fire
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6.f Extinguisher recently serviced
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6.g Extinguisher clear of Obstruction
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6.h Entrance and Exit Doors clearly Marked
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6.i Adequate Direction notices for emergency Exits at the Landing Location
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6.j Emergency- and Fire Alarm System functioning correctly
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6.k Distance of nearest Water-supply for the Fire Fighting Foam connection
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6.l Rescue Protection gear equipment
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6.m Content of Rescue Kit
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6.n Intervention Time for Rescue-, Fire Service in Minutes
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6.o Description Manual for the Emergency Evacuation of the serving helicopters
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7.a Wind direction Indicator
7. Infrastructure
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7.b Access to Hospital Description
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7.c External / Internal Telefon Connection
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7.d Location Plan
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7.e Information of nearest Fuel Station
8. Aeronautical Information
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8.a Noise restrictive Areas
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8.b Alternate Landing Sites Information
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8.c Information Published at Helipad.org
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8.c Nearest Weather Information ( ATIS, WebCam)
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8.d Airspace - , Aeronautical Information
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8.d Other Information
9. Sign off
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Signature of the Location Representative
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Signature of the Auditor
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