Health & Safety Form

Health & Safety Form

Southern Wide Helicopters
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 Name Last Name
Contact Number *

Area Code Phone Number
Farm Name *
Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Postal Address *if different from above

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email For Accounts *
example@example.com
Personal email *if different from above
example@example.com
Managers Name

First Name Last 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? *

Yes No
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? *

Yes No
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? *

Yes No
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? *

Yes No
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? *

Yes No
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 notified No
Optional Notes
Do you understand the withholding periods associated with the chemicals Southern Wide Helicopters are applying? *

Yes No N/A
If you have supplied us with an agrichemical that has expired or not true to label you understand the risks relating to this? *

Yes No
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? *

Yes No N/A
Do you have any vineyards/orchards or organic farmers near your property?

Yes No
If 'Yes' please provide details
Do you have anything else to add to ensure we stay safe on your farm? *

Yes No
Optional Notes
Upload your Farm Health & Safety plan

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Upload your Farm Map

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Upload Any Relevant Pictures

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Take Photo
I name of person submitting* accept Southern Wide Helicopters Terms of Trade
View our Terms of Trade
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