LifeFlight of Maine Industry Register
This form is designed to enter your industry information into a spreadsheet for cataloging purposes. This spreadsheet will be evaluated regularly and follow-up emails or phone calls may be made to check status of the site. Please contact Jon Roebuck ("JR") at jroebuck@emhs.org update any site information, or call 888-421-4228, The LifeFlight of Maine flight desk, and leave message for Jon.

If you wish to attach photographs of these locations or satellite imagery please send it to the aforementioned email addresses. If you do include photographs please take them from the center out, 1 to the north, south, east and west.

Company Name *
The name of your company
Your answer
Type of Industry *
The type of industry your company is involved in. (Recreation, Manufacturing, Forestry or Other)
Your answer
Company Address *
What is the address of the main office of the company
Your answer
Company Phone Number *
What is the main office phone number
Your answer
Company's Primary Person of Contact *
Name of the company's person of contact
Your answer
E-Mail Address *
E-mail address of the primary person of contact
Your answer
Site Name *
What name do you have for this site, or name you would like to use
Your answer
Industry Site Location *
What town or township is the site in
Your answer
Site Address
What is the address of the site, if other than above
Your answer
Site Directions *
Directions to the site
Your answer
Site Telephone Number
What (if any) is the telephone number to the site?
Your answer
Site Radio Frequencies
Are there any special radio frequencies for this site (If so please provide the actual numeric frequency, and PL tone if applicable)
Your answer
Latitude *
What is the latitude of the site location - Example N44 44.44 (this example is in Degrees minutes & decibel minutes format WGS 84 map datum)
Your answer
Longitude *
What is the longitude of the site location - Example 68 23.432 (this example is in Degrees minutes & decibel minutes format WGS 84 map datum)
Your answer
Site Description
A description of the site.
Your answer
Job Site Start Date *
What is the date expected to begin at this location
Your answer
Job Site End Date
What is the date expected to complete at this location (Static sites leave blank)
Your answer
Special Medical Concerns of Workers on Site
Are there any special medical concerns of workers associated with this site
Your answer
Closest EMS provider
Closest ambulance service
Your answer
Closest Hospital
What is the closest hospital or clinic
Your answer
Closest Airport
What is the closest airport to this site, this includes public and private airstrips
Your answer
Additional Information
Any other information you care to provide in reference to this site
Your answer
Alternate Use
Can your site be used as an emergency rendezvous point for emergencies other than your company
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