Procedure Identification Aerodrome Name Community Name ICAO Identifier Procedure Sponsor Name Contact Name & Position Mailing Address Organization’s Telephone Facsimile Email Procedure Designer Name Contact Name & Position Mailing Address Organization’s Telephone Facsimile Email Procedure Maintenance The sponsor must ensure that a plan is in place for the periodic review and amendment of the instrument procedure to meet TP 308 standards. The sponsor must ensure that a plan is in place for both the commissioning flight check and periodic flyability flight checks. The sponsor must identify the contact person / group responsible for the periodic maintenance. procedure’s Name Contact Name & Position Mailing Address Organization’s Telephone Facsimile Email Intended User(s) (If additional space is required, attach separate sheet) User Company Contact Name & Position Mailing Address Telephone Facsimile Email User Company Contact Name & Position Mailing Address Telephone Facsimile Email Disclaimers and Signature Obstruction Evaluation Plan The sponsor is responsible to ensure initial assessment of any obstructions that would affect this procedure as – well as obstructions resulting from the ongoing land use process. Aerodrome / Airspace Plan The procedure must be submitted according to the procedure has been designed at a – NAV ’s submission criteria. If site that does not yet reside in the Canada Air Pilot (CAP), the must be provided. The submission must address site’s applicable coordinates classification of airspace (controlled / uncontrolled) and include an analysis of impact on currently published instrument procedures at the site or adjacent sites. Environmental The sponsor shall ensure that the procedure has been designed in accordance with local environmental policies concerning – wildlife, noise, and any other applicable criteria. NOTAM Plan The sponsor shall develop a NOTAM Plan identifying the contact information for the responsible Flight Information Centre (FIC). – Compliance to change data such as fixes, altitudes or minimums via NOTAM action will continue to be the responsibility of the sponsor. Cancellation The sponsor must provide 70 days notice to NAV concerning cancellation of the procedure. – I have completed this form, read and understood the disclaimers and will include this form in the design submission package. Sponsors Representative Signature Date (print)
Procedure Identification Aerodrome Name Community Name ICAO Identifier Procedure Sponsor Organization’s Name Contact Name & Position Mailing Address Telephone Facsimile Email Procedure Designer Organization’s Name Contact Name & Position Mailing Address Telephone Facsimile Email Procedure Maintenance The sponsor must ensure that a plan is in place for the periodic review and amendment of the instrument procedure to meet TP 308 standards. The sponsor must ensure that a plan is in place for both the commissioning flight check and periodic flyability flight checks. The sponsor must identify the contact person / group responsible for the procedure’s periodic maintenance. Organization’s Name Contact Name & Position Mailing Address Telephone Facsimile Email Intended User(s) (If additional space is required, attach separate sheet) User Company Contact Name & Position Mailing Address Telephone Facsimile Email User Company Contact Name & Position Mailing Address Telephone Facsimile Email Disclaimers and Signature Obstruction Evaluation Plan – The sponsor is responsible to ensure initial assessment of any obstructions that would affect this procedure as well as obstructions resulting from the ongoing land use process. Aerodrome / Airspace Plan – The procedure must be submitted according to NAV ’s submission criteria. If the procedure has been designed at a site that does not yet reside in the Canada Air Pilot (CAP), the site’s applicable coordinates must be provided. The submission must address classification of airspace (controlled / uncontrolled) and include an analysis of impact on currently published instrument procedures at the site or adjacent sites. Environmental – The sponsor shall ensure that the procedure has been designed in accordance with local environmental policies concerning wildlife, noise, and any other applicable criteria. NOTAM Plan – The sponsor shall develop a NOTAM Plan identifying the contact information for the responsible Flight Information Centre (FIC). Compliance to change data such as fixes, altitudes or minimums via NOTAM action will continue to be the responsibility of the sponsor. Cancellation – The sponsor must provide 70 days notice to NAV concerning cancellation of the procedure. I have completed this form, read and understood the disclaimers and will include this form in the design submission package. Sponsors Representative (print) Signature Date
F-IPD-123%20Sponsors%20Responsibility%20Form%20-%20EN.docx