OPERATIONS MANUAL SUPPLEMENT - Declaration and Acceptance Check
Appendix A - Annex F: Acceptance checklist and NOTOC
DANGEROUS GOODS ACCEPTANCE AND LOADING CHECKLIST IAW 92.153 and 92.155 and 92.163
If any question is answered "NO", do not accept shipment and return to person offering the DG for carriage
TRANSPORT AND DOCUMENTATION
Two copies of this form available? (1 for PIC and 1 automatically or manually filed. )
Yes
No
N/A
Goods permitted for air transport IAW the Technical Instructions?
Yes
No
N/A
Certification Statement for CAR 92.105 and 92.163 signed?
Yes
No
N/A
IDENTIFICATION
Proper Shipping Name and/or Technical Name
Yes
No
N/A
UN or ID number
Yes
No
N/A
Class or Division and for Class 1 Compatibility group
Yes
No
N/A
Packing Group
Yes
No
N/A
QUANTITY AND TYPE OF PACKING
Quantity of dangerous goods is within limit per package
Yes
No
N/A
Letter in packaging specifications designating Packaging Group agrees with the DG offered
Yes
No
N/A
PACKAGING
Packaging (combined or single package) is permitted by the applicable packing instruction
Yes
No
N/A
Packaging does not contain different dangerous goods which require segregation from each other
Yes
No
N/A
Package/ container inspected and no leaking immediately prior to loading per CAR 92.163(1)(i)
Yes
No
N/A
Package/ container inspected and no signs of damage immediately prior to loading per CAR 92.163
Yes
No
N/A
LABELING AND MARKINGS
Package marking agrees with details on associated documentation and IAW CAR 92.57
Yes
No
N/A
Package marking is clearly visible
Yes
No
N/A
DG Acceptance:
I confirm that I have inspected the DG package(s) and the Dangerous Goods Transport Document IAW the checklist above, and that the shipment is acceptable for carriage by air in WHL aircraft.
Name
First Name
Last Name
Date
-
Day
-
Month
Year
Date
NOTOC
Date
-
Day
-
Month
Year
Date
Uplift location
Drop-off location
Dangerous Goods:
Loader's Acknowledgement:
I confirm that the DG listed above has been loaded in the locations indicated, that when loaded was free from any damage, leakage or contamination, and that I am aware of the hazardous nature of the DG.
Name
First Name
Last Name
Date
-
Day
-
Month
Year
Date
Email
Confirmation and a link to this form will be sent to this email address
Pilot-in-command acknowledgement:
I confirm that I have received the above information.
Name
First Name
Last Name
Date
-
Day
-
Month
Year
Date
FOR EMERGENCY RESPONSE DRILLS REFER TO THIS SUPP (ANN. H) IN iBOOKS ON THE AIRCRAFT iPAD
When completed this form meets the requirements of CAR 92.105 and 92.153 and 92.163. Retain on file for 6 months.
Revision 1: 01.11.23
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