Health & Safety Form

You will be emailed a link to the details you have given in this form. Please update through the email if any of the details/hazards change.

Your Name*

First NameLast Name

Contact Number*

Area CodePhone Number

Farm Name*

Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Postal Address *if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email For Accounts*

example@example.com

Personal email *if different from above

example@example.com

Managers Name

First NameLast Name

Managers Contact Number

Alternative Contacts (add up to 3)

Do you have any overhead wires on your property?*

Yes and they are marked on the map attached(You can upload a map at end of form)No

Details of overhead wires if farm map not available

Do you have any electric fence wires above fence level on your property?*

Yes and they are marked on maps attached(You can upload a map at end of form)No

Do you have any other hazards our pilots need to know about? such as horses on the boundary or an un-marked aerial?*

YesNo

If Yes, please provide details.

Do your neighbours have any hazards we need to know about that you know of? Eg aerials, wires, horses, sensitive crops?*

YesNo

If Yes, please provide details.

Do you have any hazards our ground crew need to know about before going onto your property like wet tracks etc?*

YesNo

If Yes, please provide details.

Do you understand the legal requirement that you need to notify all effected neighbours that aerial agricultural services are happening near/against their property?*

YesNo

Are there any details we need to know about regarding your neighbors? Eg they want a certain buffer zone?

Do you have beehives on your property? If Yes can you please notify the pilot prior to the job commencing?*

YesNo

Could you have any other contractors on your property and will they be notified about the helicopter operation taking place?*

Yes and they will be notifiedNo

Optional Notes

Do you understand the withholding periods associated with the chemicals Southern Wide Helicopters are applying?*

YesNoN/A

If you have supplied us with an agrichemical that has expired or not true to label you understand the risks relating to this?*

YesNo

If you the client have instructed the pilot to apply chemical differently to the manufacturers recommendations you understand the risks and possible ineffectiveness or crop damage that may occur?*

YesNoN/A

Do you have any vineyards/orchards or organic farmers near your property?

YesNo

If 'Yes' please provide details

Do you have anything else to add to ensure we stay safe on your farm?*

YesNo

Optional Notes

Upload your Farm Health & Safety plan

Browse Files

Upload your Farm Map

Browse Files

Upload Any Relevant Pictures

Browse Files

Take Photo

I name of person submitting* accept Southern Wide Helicopters Terms of Trade

View our Terms of Trade