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[]
[null,null,null,"HELICOPTER AIR AMBULANCE MANDATORY FLIGHT INFORMATION REPORT"]
[]
[null,null,null,"INSTRUCTIONS"]
[null,"Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number.  The OMB Control Number for this information collection is 2120-XXXX.  Public reporting for this collection of information is estimated to be approximately 6-16 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information.  All responses to this collection of information are mandatory according to Public Law 112-95.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence Ave. SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ASP-110."]
[null,"This Data Collection Worksheet is the method authorized by the FAA Administrator for collection of Helicopter Air Ambulance Operations Flight Activity Data.  Each Helicopter Air Ambulance Operator authorized by Operations Specification paragraph A021 must submit a report regarding their flight operations as directed below. This collection effort is mandated by Congress via Section 306 of the FAA Modernization and Reform Act of 2012.  "]
[null,"This is a multi-page Micorsoft Exel 2003 .xls workbook, compatible with most installed Excel systems.  The DETAILED INSTRUCTIONS, BY TOPIC below will explain how to properly complete this form.  Make entries on the \"REPORT\" and \"ACCIDENT DESCRIPTION\" tabs of this template.  Select from the tabs appearing near the bottom margin of this page to access those worksheets.  Return to this page by selecting the \"INSTRUCTIONS\" tab."]
[null,"Unless otherwise specified by your Principal Inspector, your reporting period will be the calendar year beginning January 1st and ending December 31st of the same year.  Submit your report within the 30 day period following the end of the reporting period.  "]
[null,"The following file naming convention MUST be observed, submittals that are not identified in the following manner may not be accepted.  The file name shall start with the calendar year of the reporting period, followed by the company designator, and end with \"HAA\".  For example:  a company with designator ABCD1234, reporting for calendar year (CY) 2015 would name their submittal file: \"CY2015ABCD1234HAA.XLS\".  Make submittals via e-mail attachment and send your email to:                                                                                                                                               "]
[{"$nulls":4},"<9-AFS-HELICOPTERAIRAMBULANCEDATA@FAA.GOV>"]
[]
[null,"If you have any difficulty and need further assistance, please contact you Principal Operations Inspector.  "]
[null,"TOPIC",null,"DETAILED INSTRUCTIONS, BY TOPIC"]
[null,"REPORTING PERIOD- ",null,"Enter the reporting period as follows:  Enter first date of reporting period, inclusive, in BEGINS cell.  Enter last date of reporting period, inclusive, in ENDS cell.  "]
[null,"COMPANY IDENTITY- ",null,"Enter Operator Name in NAME cell, enter FAA designator code (full 8 characters) in DESIGNATOR cell."]
[null,"IFR OPERATIONS- ",null,"Report the total number of flights made during which helicopters were operated under IFR in the IFR FLIGHTS cell.  Report the total number of flight hours during which helicopters performed Helicopter Air  Ambulance operations under IFR in the IFR HOURS cell."]
[null,"UNUSED TRANSPORTS-  ",null,"Report in the UNUSED TRANSPORTS cell, the total number of incidents (not flightst) in which a helicopter was not directly dispatched and arrived to transport patient(s) but was not utilized for patient transport . (EG: helicopter arrives to transfer patient to another facility or from an accident scene to the trauma center, but for whatever reason, transport was not possible or needed)."]
[null,"ACCIDENTS- ",null,"List number of accidents which occurred during performance of Helicopter Air Ambulance operations in ACCIDENTS cell.  If one or more accidents occurred during the reporting period, describe the accident on the ACCIDENT DESCRIPTION Worksheet attached, (see third TAB below). "]
[null,"FLIGHTS ACCEPTED VS. DECLINED-  ",null,"Report total number of flight requests that were ACCEPTED BY THE OPERATOR, by type (Scene response, Inter-facility Transfer, Organ Transport, Repositioning, or Ferry (Maintenance)).  Report total number of flight requests that were DECLINED BY THE OPERATOR, by type. "]
[null,"TIME OF DAY- ",null,"List the aggregate number of flights which were lauched by time of departure (UTC), rounded to the nearest hour, within the FLIGHTS cell under TIME OF DAY."]
[null,"BASE LOCATIONS- ",null,"List each base by FACILITY identifier if available, or Base name, and CITY, and STATE."]
[null,"FLIGHT ACTIVITY by HELICOPTER USED-  ",null,"List each helicopter separately columnwise, by registration number N#.  For each N#, indicate the total number of HAA FLIGHTS made by that helicopter within the reporting period total and the total number of flight HOURS logged performing HAA operations by that same helicopter within the reporting period."]
[]
[null,"EXAMPLE:"]
[null,"REPORTING PERIOD",null,null,null,"IFR OPERATIONS",{"$nulls":6},"FLIGHTS ACCEPTED VS. DECLINED"]
[null,"BEGINS","ENDS",null,null,"IFR FLIGHTS",null,473,"IFR HOURS",null,210.6,null,"TYPE",null,null,"ACCEPTED","DECLINED"]
[null,"2014-01-01","2014-12-31",{"$nulls":9},"SCENE RESPONSE",null,null,7502,17]
[{"$nulls":12},"INTER-FACILITY TRANS.",null,null,28534,42]
[null,"COMPANY IDENTITY",{"$nulls":5},"UNUSED TRANSPORTS",null,null,1,null,"ORGAN TRANSPORT",null,null,144,3]
[null,"NAME","Helicopter Air Ambulance Co.",{"$nulls":9},"REPOSITION",null,null,18761,35]
[null,"DESIGNATOR","HAAC1234",{"$nulls":6},"ACCIDENTS",0,null,"FERRY",null,null,248,0]
[{"$nulls":12},"TOTAL",null,null,55189,97]
[null,"TIME OF DAY (UTC)",null,null,null,"FLIGHT ACTIVITY BY HELICOPTER"]
[null,"DEPARTED","FLIGHTS","DEPARTED","FLIGHTS","N#",null,"FLIGHTS","HOURS","N#",null,"FLIGHTS","HOURS","N#",null,"FLIGHTS","HOURS"]
[null,null,1135,{"$nulls":4},1784,1410,null,null,0,0,null,null,0,0]
[null,"0000-0059",410,"1200-1259",null,"N","123HA",1024,820,"N",null,null,null,"N"]
[null,"0100-0159",725,"1300-1359",null,"N","124HA",760,590,"N",null,null,null,"N"]
[null,"0200-0259",null,"1400-1459",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"0300-0359",null,"1500-1559",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"0400-0459",null,"1600-1659",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"0500-0559",null,"1700-1759",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"0600-0659",null,"1800-1859",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"0700-0759 ",null,"1900-1959",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"0800-0859",null,"2000-2059",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"0900-0959",null,"2100-2159",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"1000-1059",null,"2200-2259",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"1100-1159",null,"2300-2359",null,"N",null,null,null,"N",null,null,null,"N"]
[null,"BASE LOCATIONS",null,null,null,"N",null,null,null,"N",null,null,null,"N"]
[null,"FACILITY","CITY",null,"STATE","N",null,null,null,"N",null,null,null,"N"]
[null,"KDCA","ARLINGTON",null,"VA","N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
[{"$nulls":5},"N",null,null,null,"N",null,null,null,"N"]
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{"sheet":"REPORT PG 2  ACCIDENTS","index":2,"n_rows":46,"n_cols":19,"rows_kept":46,"cut":false,"hidden":false,"merged":[[41,8,45,18],[42,1,42,2],[42,3,42,5],[43,1,43,2],[43,3,43,5],[44,1,44,2],[44,3,44,5],[45,1,45,2],[45,3,45,5],[41,1,41,2],[41,3,41,5],[35,1,35,2],[35,3,35,5],[35,8,39,18],[36,1,36,2],[36,3,36,5],[37,1,37,2],[37,3,37,5],[38,1,38,2],[38,3,38,5],[39,1,39,2],[39,3,39,5],[29,1,29,2],[29,3,29,5],[29,8,33,18],[30,1,30,2],[30,3,30,5],[31,1,31,2],[31,3,31,5],[32,1,32,2],[23,3,23,5],[8,13,8,14],[32,3,32,5],[33,1,33,2],[33,3,33,5],[24,3,24,5],[25,3,25,5],[26,3,26,5],[27,3,27,5],[9,13,9,14],[10,1,10,17],[8,6,8,8],[21,1,21,18],[23,8,27,18],[23,1,23,2],[24,1,24,2],[25,1,25,2],[26,1,26,2],[27,1,27,2],[19,3,19,18],[19,1,19,2],[17,3,17,18],[12,3,12,18],[13,3,13,18],[14,3,14,18],[15,3,15,18],[16,3,16,18],[18,3,18,18]],"flags":["formulas_cached_only"]}
{"$rows_empty":7}
[null,"ACCIDENT SUMMARY:",{"$nulls":16},"PG 2 OF 2"]
[{"$nulls":5},"Company",{"$nulls":5},"Reporting Period","From: "]
[{"$nulls":5},"Designator",{"$nulls":6},"To: "]
[null,"Instructions:"]
[]
[null,null,"NTSB Number-","Enter the accident identification number assigned by the NTSB."]
[null,null,"Date-","Enter the date of occurrence of the accident."]
[null,null,"Registration Number-","Enter the registration number of the helicopter involved."]
[null,null,"Make/Model Aircraft- ","Enter the helicopter make and model."]
[null,null,"Type of Flight-","Enter the type of flight from the drop-down menu."]
[null,null,"Event Severity-","Enter the severity of the accident in terms of aircraft damage (Destroyed, major, minor) and Casualties (fatalities, injuries, no injuries)"]
[null,null,"Location-","Enter the GPS geo-coordinates or the radial and distance from the nearest VOR."]
[null,"Brief Description-  \n\n ",null,"Describe the circumstances leading to the accident. Include the approximate time of day, adverse weather, terrain or obstructions, apparent mechanical failure if any, pilot flight time since reporting for duty that day, approval for use of NVIS, number of persons aboard, number of fatalities (if applicable), and any other pertinent information."]
[]
[null,"IF AN ACCIDENT OCCURRED WITHIN THE REPORTING PERIOD, PLEASE ENTER FOLLOWING INFORMATION (FROM NTSB PRELIMINARY ACCIDENT SUMMARY):  If no accidents were suffered, enter \"NONE\" in the first NTSB No. Cell."]
[]
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[null,"REGISTRATION #"]
[null,"MAKE/MODEL"]
[null,"EVENT SEVERITY"]
[null,"LOCATION "]
[]
[2,"NTSB No.",{"$nulls":5},"BRIEF DESCRIPTION: "]
[null,"REGISTRATION #"]
[null,"MAKE/MODEL"]
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[null,"LOCATION "]
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[3,"NTSB No.",{"$nulls":5},"BRIEF DESCRIPTION: "]
[null,"REGISTRATION #"]
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[4,"NTSB No.",{"$nulls":5},"BRIEF DESCRIPTION: "]
[null,"REGISTRATION #"]
[null,"MAKE/MODEL"]
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[null,"LOCATION "]