Please help us help you by completing the Annual Safety Survey. Information about your unit and safety issues is vital to help ALEA serve your safety needs. This will help us address issues pertaining to aircraft that you operate and your opinions about the most likely causes of accidents. This can be anonymous if that's your wish, but please take a few minutes to reply.

Thank you in advance for your support.

Keith Johnson
ALEA Safety Program Manager

Agency/Unit Name:

Your name (optional):

Your email address (optional):

AIRCRAFT

Fixed-wing hours flown in 2004:

Helicopter hours flown in 2004:

Number, make & model aircraft operated in 2004:

PERSONNEL

Please indicate the total number of each position assigned to your unit in 2004:

Pilots TFO’s Sgt's Lt’s

Capt Mechanics Other

SAFETY PROGRAM

Do you have a Safety Officer?

If so what is their name:

Has your Safety Officer taken the ALEA Safety Course or similar training?

Do you have a formal written Safety Program?

Do you receive and are you displaying
ALEA Safety Posters?

Have you read the Safety First Newsletters, and do you display them somewhere?

MISHAPS 2004

Number of Unit Incidents in 2004:

Number of Unit Accidents in 2004:

Nature of mishap(s) including make and model aircraft:

TYPE OF MISSIONS
(choose all the apply)

Patrol Surveillance Traffic Rescue SWAT
Transport Other

SAFETY CONCERNS

What are your top 3 safety concerns (most probable causes of accidents):

ALEA Safety First Program 2005 Safety Survey