Application for drone use at QEIIMC
Approval from the Queen Elizabeth II Medical Centre Trust is required to undertake drone operation and filming within the QEIIMC Campus.
Applicant Details
Name
*
First Name
Last Name
Phone
*
Email
*
example@example.com
Position
Company details
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
*
Email
*
example@example.com
ABN
QEIIMC Contact
Name
*
First Name
Last Name
Department
*
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Production Details
Title of works
*
Type of filming/activity
*
Proposed Date
*
-
Day
-
Month
Year
Date
Location (e.g. PCH, SCGH)
Flight duration
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Class of drone (kgs)
*
Privacy considerations
*
Tenant to provide details of how activitiy will be managed
Spotter's details
*
Confirmation of exclusion zone
*
Location where the drone flight will take off/land
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Compliance and attachments
Are you compliant with CASA requirements
*
Yes
No
Proof of compliance with Civil Aviation Safety Authority (CASA) requirements
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of
Provide your completed Job Safety Analysis (JSA)/Preflight checklist and risk assessment
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Supply the operators Remote Pilot Licence (RePL)/Remotely Piloted Aircraft (RPA) and Aeronautical Radio Operator Certificate (AROC)
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of
Attach your insurance certificate
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Provide your CASA Drone registration
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of
Have communications occurred with relevant authorities (e.g. QEII Medical Centre Helipad site at Perth Children's Hospital)
*
Yes
No
Provide confirmation that communication with relevant authorities has occurred
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I/We declare that the information provided above is true and correct
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
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