LA Number
Film
Date(s)
Loca�on address
Start Time
End Time
Airspace
Class*
UAS QUESTIONNAIRE
Drone packet is due by 12PM (noon) of the jurisdictional permit application deadline date for the LA containing drone activity.
Produc�on Company: _____________________________________________________________
Produc�on Title: _____________________________________________________________
UAS Company: _____________________________________________________________
Permit Group Number: _____________________________________________________________
*IF YOU ARE FLYING IN CLASS B, C, D, OR E AIRSPACE, ATC AUTHORIZATION IS REQUIRED FOR ALL UAS ACTIVITY
AND INCLUDED IN THE DRONE PACKET
PART 107 REQUIREMENTS
Certificate #: ________________ Visual Observer Yes _____ No_____
Name of Remote Pilot: _______________________ Remote Pilot Phone #:______________________________
PLEASE INCLUDE THE FOLLOWING:
• Copy of Remote Pilot’s Certificate • Copy of UAS Registration Certificate for each UAS listed above
• Copy of UAS Registration Certificate for each UAS listed above • Description of Planned Operations
• Current Knowledge Test, if Airman Certificate is more than 2 years old
WAIVERS
If you are requesting any of the following activity, please check all that apply and furnish proof of waiver from the FAA
upon submission of this document to FilmLA.
Flight altitude restrictions (§107.51) Operating multiple small UAS’ (§107.35)
Operating from a moving vehicle (§107.25)
UAS ON LOCATION INFORMATION
ANY RESTRICTED AREAS OR TEMPORARY FLIGHT RESTRICTIONS? Yes _____ No_____
UAS Make & Model:__________________________________ UAS “N” # or registration #:__________________________
UAS Make & Model:__________________________________ UAS “N” # or registration #:__________________________
UAS Make & Model:__________________________________ UAS “N” # or registration #:__________________________
UAS Make & Model:__________________________________ UAS “N” # or registration #:__________________________
REV 12/11/23
FOR MORE THAN 4 LOCATIONS, PLEASE SUBMIT AN ADDITIONAL QUESTIONNAIRE/PACKET
G-
