Section 1 – JCU Buyer to Complete

JCU Booking Officer	Name
Contact Number
Email
Date/s of Operation
Location (and Staging Point)
Aircraft Arrival and Take off Time
Task Description
Task Description - Environment	What environment(s)/area(s) will the flight(s) occur in?
Low Level Offshore Mountainous Remote bushland	Rainforest Hostile environment¹ Other (please describe)
Task Requirements	Doors Off	Over-water (floats required)	Sling Load
Preferred Aircraft Type
Approx. Hours Required
Known Passengers – details including individual weights and operational roles, and any relevant medical conditions.	Number of Passengers: Pax. Name Approx. Weight Medical Conditions
Other information i.e. equipment and weight of any equipment to be carried
Contact officer on the day of operation (Phone/UHF Channel)

Section jcu.edu.au 2 – Supplier to Complete

Aircraft Operator’s Company Name
Address
Air Operator’s Certificate No.	Copy Attached
Aerial Work Certificate No.	Copy Attached
Is your organisation at least 5 years accident free?	Yes No	If No, please provide details:
Insurances (please provide copies)	Insurance Type Policy No. Value Carriers Liability Insurance $ Public Liability Insurance $ Aircraft Hull $ Workers Compensation As per law
Quotation	Aircraft 1	Aircraft 2
Rego
Aircraft Type
Registered Aircraft Operator
Aircraft Base Location
Wet Hourly Rate (EX GST)	$	$
Approx. Ferry Time to The Charter Starting Location (Minutes Each Way)
Approx. Ferry Cost to The Charter Starting Location ($ Cost Each Way)	$	$
Estimated Total Cost (EX GST)	$	$
Notes / Additional Costings
Preferred pilot experience:	If the experience is substantially less than these recommended hours, it is considered inappropriate to continue with the proposed activity.
1. Preferable 2,000+ hours total flight time (pilot in command), minimum of 1,500 hours
2. For low level work 1,000 hours low level flying experience – preferred.
Pilots Name	Licence Number	Total Flight Time PIC (hrs)	Total Flight Time in Last 6 mths (hrs)	Total Time Piston (hrs)	Total Time Turbine (hrs)	Low Level Flying Experience (hrs)	Sling Load Experience (hrs)

Section jcu.edu.au 2 – Supplier to Complete

Equipment – What safety equipment does the proposed aircraft have?
First Aid Kit	Yes	No	N/A
Fire Extinguisher	Yes	No	N/A
Survival equipment, tailored to environment	Yes	No	N/A
Satellite Flight Following (JCU contact to be provided with access)	Yes	No	N/A
Emergency Pop-Out Flotation Devices (for overwater Part 133 and Part 138 operations)	Yes	No	N/A
Life Raft (for overwater Part 133 and Part 138 operations)	Yes	No	N/A

Aircraft operators authorised representative responsible for information on this document:

Name	Signature
Position	Date

JCU Use Only: Registered aircraft verified: Yes No Registered operator verified: Yes No Pilot meets requirements: Yes No Date: __________________________________________________ Verified by: _____________________________________________