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GACA الهييه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] HELIPORT SAFETY INSPECTOR ON-SITE VERIFICATION CHECKLIST (GACAR PART 138) <table><tr><td>Heliport Name:</td><td colspan="3"></td></tr><tr><td>Heliport Reference Code</td><td></td><td>Heliport Operator</td><td></td></tr><tr><td>Inspection Type</td><td></td><td>Inspection Date</td><td></td></tr><tr><td>Report Number</td><td></td><td>Report Date</td><td></td></tr><tr><td>Name of Heliport Safety Inspector</td><td></td><td>Signature</td><td></td></tr><tr><td>Name of Heliport Certification Project Manager</td><td></td><td>Signature</td><td></td></tr></table> GENERAL INSTRUCTION 1. This form of on-site inspection must be filled by GACA Heliport Safety Inspectors/Heliport Certificate Project Manager. 2. This form shall be used for the on-site verification of various documents and operating procedures during the Heliport site visit and process of Heliport certification, and thereafter for surveillance and un-announced on-site verification inspections. 3. Heliport safety inspectors, on completion of on-site verification of documents and operating procedures for area of his/her expertise, shall complete and submit this form to heliport certificate project manager. 4. For any clarification, the General Manager (Aerdrome Standards) of General Authority of Civil Aviation, Kingdom of Saudi Arabia, may be contacted. GACA-AVSES-AGA-F036 Rev: 3, Date: 27 Aug 25 Page 1 of 7 GACA الهييه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] HELIPORT SAFETY INSPECTOR ON-SITE VERIFICATION CHECKLIST (GACAR PART 138) <table><tr><td>GACAR 138REFERENCE APPENDIX A-1(1)</td><td>ITEMS FOR ON SITE VERIFICATION</td><td>CONTINUANCE</td><td>NON-COMPLIANCE</td><td>NOTE-REMARKS</td></tr><tr><td colspan="5">5.1 Promulgation of aeronautical information</td></tr><tr><td>(a)</td><td>Whether service is available to promulgate Aeronautical Information;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(b)</td><td>Whether procedures are defined for promulgation of Aeronautical Information;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(c)</td><td>Whether defiendform is used for promulgating the AIP.</td><td>□</td><td>□</td><td>□</td></tr><tr><td colspan="5">5.2 Control of access</td></tr><tr><td>(a)</td><td>Whether heliport plan shows all access points in the movement area;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(b)</td><td>Whether Procedure for inspection of access points and fence available;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(c)</td><td>Whether warning signs are provided at all access points;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(d)</td><td>Whether procedures are available for vehicle control at access point for operational area.</td><td>□</td><td>□</td><td>□</td></tr><tr><td colspan="5">5.3 Emergency planning</td></tr><tr><td>(a)</td><td>Whether heliport operator as developed HEP;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(b)</td><td>Whether Procedure exists to describe various type of emergency tasks in the HEP;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(c)</td><td>Whether updated contact list of organisation and persons are available;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(d)</td><td>Whether procedures exist in AEP for appointing of commander and the responsibilities;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(e)</td><td>Whether reporting mechanism available in HEP in event of emergency;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(f)</td><td>Whether emergency equipment testing and frequency is defined and maintained;</td><td>□</td><td>□</td><td>□</td></tr><tr><td>(g)</td><td>Whether frequency of regular exercise is defined in HEP and regularly conducted;</td><td>□</td><td>□</td><td>□</td></tr></table> GACA-AVSES-AGA-F036 Rev: 3, Date: 27 Aug 25 Page 2 of 7 GACA الطبيه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] HELIPORT SAFETY INSPECTOR ON-SITE VERIFICATION CHECKLIST (GACAR PART 138) <table><tr><td>(h)</td><td>Check whether trainings are specified in HEP and provided at required RFF staff.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.4 Rescue and firefighting (RFF) services</td></tr><tr><td>(a)</td><td>Whether RFF policy and Categories are defined in HEP;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Whether RFF in-charge role and safety accountably are defined in heliport operation Manual/Procedures;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check whether procedures are available in case of a depletion of heliport RFF category of the heliport;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check whether HOM clearly define procedures for operating higher category helicopters than declared RFF category.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(e)</td><td>Check extinguishing agents are available as per declared RFF category of the heliport;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(f)</td><td>Check operation procedures provide monitoring of helicopter movement and alerting system to RFF;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(g)</td><td>Check adequacy of response time are defined for various locations of heliport;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(h)</td><td>Check whether service agreements are available and where RFF services are provided by external agencies;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(i)</td><td>Whether HEP have provision to meet emergency requirements where heliport are in or near water areas;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(j)</td><td>Check whether heliport operator maintain competency process for RFF personnel;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(k)</td><td>Whether HEP define arrangements of accident/emergency response in near vicinity of the heliport;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(l)</td><td>Whether HEP define RFF procedures for low visibility operations at heliport.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.5 Inspection of the Movement area</td></tr><tr><td>(a)</td><td>Check whether frequency for inspection are defined in HOM and reporting systems provided;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Whether procedures frequency of clearing/sweeping of movement area are available;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Whether inspection of movement area and FOD/Debris removal are provided;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Whether Procedure exists to assess and report FATO and TLOF surface characteristics when wet or contaminated;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(e)</td><td>Check whether Procedure exists to promulgate information to ATS.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.6 Maintenance of the Movement Area</td></tr></table> GACA-AVSES-AGA-F036 Rev: 3, Date: 27 Aug 25 Page 3 of 7 GACA ال necesita العامه للطيران المدني General Authority of Civil Aviation [Non-Text] HELIPORT SAFETY INSPECTOR ON-SITE VERIFICATION CHECKLIST (GACAR PART 138) <table><tr><td>(a)</td><td>Whether procedure exists and implemented to promulgate FATO and TLOF characteristics or facility withdrawal;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check Procedure to assess adequacy and action required for maintenance provided;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check maintenance plan for Visual aids, lighting, electrical systems implemented;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check maintenance plan for fencing, obstacles and its lighting are implemented;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(e)</td><td>Check arrangements of reporting unsafe occurrence are provided.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.7 Hazardous meteorological conditions and snow and ice control</td></tr><tr><td>(a)</td><td>Whether Procedure are provided. Check implementation;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.8 Visual Aids</td></tr><tr><td>(a)</td><td>Check about the responsibility for preventive maintenance of Visual Aids.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check about the responsibility for maintenance of Electrical Systems</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check about brilliancy settings and flashing frequencies as applicable;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check about the routine and Emergency maintenance tasks</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(e)</td><td>Check procedures for routine inspections of various lighting systems;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(f)</td><td>Check procedures obstacle lighting maintenance and upkeep;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(g)</td><td>Check for maintenance reports and work control in operational area</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(h)</td><td>Check formal coordination procedure and agreed objective if heliport operator is not in charge of maintenance of Visual Aids and Electrical system.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.9 Apron Management (To be seen when an Apron Management Service is provided)</td></tr><tr><td>(a)</td><td>Check the procedure and its implementation to ensure coordination with ATS, if ATS provided;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check the procedure for parking stand allocations, if more the one parking stands;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check procedure for engine start and fueling at parking stand.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.10 Helicopter Stand/Apron Safety Management (Check where ASM is provided)</td></tr></table> GACA-AVSES-AGA-F036 Rev: 3, Date: 27 Aug 25 Page 4 of 7 GACA ال necesita للطيران المدني General Authority of Civil Aviation [Non-Text] HELIPORT SAFETY INSPECTOR ON-SITE VERIFICATION CHECKLIST (GACAR PART 138) <table><tr><td>(a)</td><td>Check means and procedures for rotor thrust protection.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check safety precautions during helicopter refueling operations.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check arrangements for helicopter stands/apron sweeping and cleaning.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check arrangements for reporting incidents and accidents on a helicopter stand/apron.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(e)</td><td>Check arrangements for assessing the safety compliance of all personnel working on the helicopter stands/apron.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(f)</td><td>Check arrangements for the use of heliport when helicopter stand is part of TLOF.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.11 Vehicles on the movement area</td></tr><tr><td>(a)</td><td>Check details of the applicable traffic guidelines for vehicle movements (including speed limits and the means of enforcing the rules).</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check criteria for drivers to allow and operate vehicles on the movement area.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check arrangements of communicating with air traffic control, in case ATC is part of heliports.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check vehicles provided with two-way communication that operate on the movement area.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.12 Wildlife Hazard Management</td></tr><tr><td>(a)</td><td>Arrangements and method for dispersal of bird and other wildlife.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check measure to discourage birds and other wildlife.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check arrangements for assessing wildlife hazards.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check arrangements for implementing wildlife control programs.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(e)</td><td>Check the procedure for monitoring the corrective action to be taken subsequently.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(f)</td><td>Check the procedure for reporting Wildlife incidents to GACA</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.13 Obstacles</td></tr><tr><td>(a)</td><td>Check arrangements for monitoring the height of buildings or structures within the boundaries of the obstacle limitation surfaces (OLS).</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check arrangements for controlling new developments in the vicinity of heliports.</td><td>□</td><td>□</td><td>□</td><td></td></tr></table> GACA-AVSES-AGA-F036 Rev: 3, Date: 27 Aug 25 Page 5 of 7 GACA الطبيه العامه للطيران المدني General Authority of Civil Aviation [Non-Text] HELIPORT SAFETY INSPECTOR ON-SITE VERIFICATION CHECKLIST (GACAR PART 138) <table><tr><td>(c)</td><td>Check the reporting procedure and actions to be taken in the event of the appearance of unauthorized obstacles.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check arrangements for removal of an obstacle inside and outside heliport area.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.14 Removal of Disabled Helicopters</td></tr><tr><td>(a)</td><td>Check details of the capability for removal of a disabled helicopters at heliport and reporting procedures.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.15 Dangerous Goods on Heliport</td></tr><tr><td>(a)</td><td>Check arrangement for special areas for dangerous goods on heliport</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check RFF staff are trained.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.16 Low Visibility Operations</td></tr><tr><td>(a)</td><td>Check procedures for obtaining and disseminating meteorological information, including (RVR) and surface visibility.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check protection at heliport FATO during LVP if such operations are permitted.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check the procedure for action to be taken when LVP is in process</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">5.17 Protection of site for radar, navigation aids and MET equipment</td></tr><tr><td>(a)</td><td>Check the procedures for protection</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td colspan="6">II: ON-SITE VERIFICATION OF THE SAFETY MANAGEMENT SYSTEM</td></tr><tr><td>(a)</td><td>Check whether heliport operator has appointed an Accountable Executive and Head of safety;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(b)</td><td>Check safety policy is described in SMSM and Safety Procedures;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(c)</td><td>Check whether head of safety is independent of operational tasks and report to accountable executive;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(d)</td><td>Check Procedure and methods of Training;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(e)</td><td>Check Procedures for complying with regulatory requirements relating to accidents, incidents and mandatory occurrence reporting;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(f)</td><td>Check hazard analysis and risk assessment procedures;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(g)</td><td>Check management of change and change approvals;</td><td>□</td><td>□</td><td>□</td><td></td></tr></table> GACA-AVSES-AGA-F036 Rev: 3, Date: 27 Aug 25 Page 6 of 7 GACA ال necesita de la subjet al medem General Authority of Civil Aviation [Non-Text] HELIPORT SAFETY INSPECTOR ON-SITE VERIFICATION CHECKLIST (GACAR PART 138) <table><tr><td>(h)</td><td>Check internal safety audit system exist;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(i)</td><td>Check whether procedure describes who conducts the analysis, when and how the hazards are monitored, what actions are subsequently taken, and the criteria leading to the analysis.</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(j)</td><td>Check documentation Management and Reporting;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(k)</td><td>Check Safety-related committees are established;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(l)</td><td>Check Safety promotion Policy;</td><td>□</td><td>□</td><td>□</td><td></td></tr><tr><td>(m)</td><td>Check responsibility for ensuring and monitoring safety by the contractors and third parties operating on the heliport.</td><td>□</td><td>□</td><td>□</td><td></td></tr></table> Remarks, if any: <table><tr><td colspan="3">DETAILS OF GACA HELIPORT SAFETY INSPECTORS</td></tr><tr><td>Name</td><td>Signature</td><td>Date</td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td></tr><tr><td colspan="3">DETAILS OF GACA HELIPORT CERTIFICATION PROJECT MANAGER</td></tr><tr><td>Name</td><td>Signature</td><td>Date</td></tr><tr><td></td><td></td><td></td></tr></table> GACA-AVSES-AGA-F036 Rev: 3, Date: 27 Aug 25 Page 7 of 7