Form AV-14 "Uas Flight Plan/Approval Form" - Pennsylvania

What Is Form AV-14?

This is a legal form that was released by the Pennsylvania Department of Transportation - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2021;
  • The latest edition provided by the Pennsylvania Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AV-14 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Transportation.

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Download Form AV-14 "Uas Flight Plan/Approval Form" - Pennsylvania

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AV-14 (8-21)
UAS FLIGHT PLAN / APPROVAL FORM
www.penndot.gov
FLIGHT PERSONNEL & EQUIPMENT
Remote PIC:
UAS Make:
PennDOT Cert. #:
Model:
Addl Aircraft:
Mission Assistant:
YES
NO
Observer:
YES
NO
IF THIRD PARTY
Organization Name:
PennDOT Requestor:
FLIGHT INFORMATION
Date(s):
Project Name:
Location:
Purpose of Flt:
Municipality:
Projected # Flts:
RISK ASSESSMENT
Pilot Experience/Msn Readiness
Controlled Airspace
Nearby Airport/Heliport
Experienced w/> 50 hours
Class G
None nearby > 3 mile
L
L
L
Some exp. w/< 50 hours
M
Restr/Prohibited < 1 mile
M
Nearby 1-3 miles
M
M
H
H
< 25 hours
Class B-E
Close Proximity < 1 mile
Wires/Trees/Structures
Proximity to Roads
Proximity to People/Workers
Not present
Not over open roads
Not present
L
L
L
M
M
L
Nearby > 100'
Open roadway < 40'
> 50' away
M
H
M
Present
Over open roads
< 50' or overflight
Drone Distance from Operator
Private Property
Over Water
Vertical Dist < 300'
N/A or Permission
Not over water
L
L
L
M
L
L
Vertical Dist > 300'
Nearby > 50'
< 25' over water
M
M
M
Hor Dist. > 800 feet
Over or < 10 feet
> 25' over water
Take off/Landing Area Safety
Daylight
RF or Magnetic Interference
No issues
Daytime only
Unlikely
L
L
L
M
M
M
Limited space
During Dawn / Dusk
Possible
H
H
H
Congested or w/obstructions
Nighttime
Likely
Winds
Visibility
Loss of GPS or RF Signal
Winds < 15 mph
Greater than 5 miles
Unlikely
L
L
L
M
M
M
Winds 15-25 mph
Between 3-5 miles
Possible
H
H
H
Winds > 25 mph
Forecast < 3 miles
Likely
Private Property Coordination Rqd?
YES
NO
Airport/Heliport Coordination Rqd?
YES
NO
Fill in highest rating from above
On-site Pre-visit Review Made?
YES
NO
Overall Risk
CERTIFICATION
UAS Remote PIC Signature:
Title:
PennDOT Signature:
Title:
Instructions: Remote PIC is responsible for obtaining PennDOT approval and coordinating flight activities as appropriate before flight.
Include sketches or diagrams as necessary to detail area of operation and proposed flight path(s).
Sketch should include launch and recovery points, observation points, applicable right of ways and property lines, and known hazard areas.
Enter mitigation measures on page 2 for all 'Moderate' and 'High' risks listed above. Enter Residual Risk level after controls.
Assess forecast winds/precip/visibility/cloud base above, and again with updated forecast immediately prior to each mission.
AV-14 (8-21)
UAS FLIGHT PLAN / APPROVAL FORM
www.penndot.gov
FLIGHT PERSONNEL & EQUIPMENT
Remote PIC:
UAS Make:
PennDOT Cert. #:
Model:
Addl Aircraft:
Mission Assistant:
YES
NO
Observer:
YES
NO
IF THIRD PARTY
Organization Name:
PennDOT Requestor:
FLIGHT INFORMATION
Date(s):
Project Name:
Location:
Purpose of Flt:
Municipality:
Projected # Flts:
RISK ASSESSMENT
Pilot Experience/Msn Readiness
Controlled Airspace
Nearby Airport/Heliport
Experienced w/> 50 hours
Class G
None nearby > 3 mile
L
L
L
Some exp. w/< 50 hours
M
Restr/Prohibited < 1 mile
M
Nearby 1-3 miles
M
M
H
H
< 25 hours
Class B-E
Close Proximity < 1 mile
Wires/Trees/Structures
Proximity to Roads
Proximity to People/Workers
Not present
Not over open roads
Not present
L
L
L
M
M
L
Nearby > 100'
Open roadway < 40'
> 50' away
M
H
M
Present
Over open roads
< 50' or overflight
Drone Distance from Operator
Private Property
Over Water
Vertical Dist < 300'
N/A or Permission
Not over water
L
L
L
M
L
L
Vertical Dist > 300'
Nearby > 50'
< 25' over water
M
M
M
Hor Dist. > 800 feet
Over or < 10 feet
> 25' over water
Take off/Landing Area Safety
Daylight
RF or Magnetic Interference
No issues
Daytime only
Unlikely
L
L
L
M
M
M
Limited space
During Dawn / Dusk
Possible
H
H
H
Congested or w/obstructions
Nighttime
Likely
Winds
Visibility
Loss of GPS or RF Signal
Winds < 15 mph
Greater than 5 miles
Unlikely
L
L
L
M
M
M
Winds 15-25 mph
Between 3-5 miles
Possible
H
H
H
Winds > 25 mph
Forecast < 3 miles
Likely
Private Property Coordination Rqd?
YES
NO
Airport/Heliport Coordination Rqd?
YES
NO
Fill in highest rating from above
On-site Pre-visit Review Made?
YES
NO
Overall Risk
CERTIFICATION
UAS Remote PIC Signature:
Title:
PennDOT Signature:
Title:
Instructions: Remote PIC is responsible for obtaining PennDOT approval and coordinating flight activities as appropriate before flight.
Include sketches or diagrams as necessary to detail area of operation and proposed flight path(s).
Sketch should include launch and recovery points, observation points, applicable right of ways and property lines, and known hazard areas.
Enter mitigation measures on page 2 for all 'Moderate' and 'High' risks listed above. Enter Residual Risk level after controls.
Assess forecast winds/precip/visibility/cloud base above, and again with updated forecast immediately prior to each mission.
PennDOT UAS FLIGHT PLAN / APPROVAL FORM - Page 2
Mitigation measures should be explained for each 'Moderate' to 'High' risk listed on page 1. Use additional pages as necessary.
HAZARD MITIGATION MEASURES
Hazard
Action
Residual Risk
Overall Residual Risk
Notes/Comments/Coordination Measures
List all participating mission personnel and coordination activities with private property, businesses, and airports/heliports.
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