SMS FlightCan Version: 1.1 Copyright © 2015 FoxThree Aviation Consulting LLC

Operator: Hy-Vee, Inc. Flight DepartmentSMS Safety Manager: Kyle KellySafety Manager Contact - Email: kkelly@hy-vee.com, Phone: (515) 795-6690

SMS FlightCan Overview:

This SMS FlightCan Data Collection tool was developed to provide your flight department an online method to collect and store flight data for future evaluation in support of implementing a healthy safety culture as part of your daily flight operations. This is not a Flight Risk Analysis Tool (FRAT), rather a data collection portal that promotes safety while maximizing your time in the cockpit. Data you enter here, along with an attached copy of your weight and balance and weather briefing, will assist in mitigating unsafe conditions. Items with a red * are required.

Please complete the following information for each flight of the day. Section 1: Aircraft and Flight Plan

Date*

Date

Aircraft*

Departure Airport*

Arrival Airport*

Alternate Airport

Departure Other

Arrival Other

Alternate Other

PIC*

PIC E-mail

SIC*

SIC E-mail

PIC Other

PIC E-mail Other

SIC Other

SIC E-mail Other

Has Weight and Balance been calculated and within acceptable limits?*

YesNo

Has current weather briefing been reviewed for departure, arrival and alternate airports?*

YesNo

Has the crew reviewed the planned route and applicable instrument procedures for this intended flight?*

YesNoN/A

Has the crew reviewed applicable performance factors for this intended flight?*

YesNoN/A

Is passenger manifest complete and are all listed passengers on-board?*

YesNoN/A

Have passengers been provided a safety briefing applicable to the make/model aircraft they are traveling in?*

YesNoN/A

Section 2: Document UploadPlease have your Weather Briefing and Weight & Balance available and ready to upload to your Safety Manager using the upload links below.

WEATHER BRIEFING - Click "Select File" below and attach your WEATHER BRIEFING

Select File

WEIGHT & BALANCE - Click "Select File" below and attach your WEIGHT & BALANCE

Select File

Section 3: Safety Reporting

Please use this section to address any safety concerns and/or provide input to your Safety Manager.

Thank You! Please click submit below to send this information to Eric Tange, your Safety Manager. Remember to complete the SMS FlightCan for each flight of the day.