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
Type of Industry *
The type of industry your company is involved in. (Recreation, Manufacturing, Forestry or Other)
Company Address *
What is the address of the main office of the company
Company Phone Number *
What is the main office phone number
Company's Primary Person of Contact *
Name of the company's person of contact
E-Mail Address *
E-mail address of the primary person of contact
Site Name *
What name do you have for this site, or name you would like to use
Industry Site Location *
What town or township is the site in
Site Address
What is the address of the site, if other than above
Site Directions *
Directions to the site
Site Telephone Number
What (if any) is the telephone number to the site?
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)
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)
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)
Site Description
A description of the site.
Job Site Start Date *
What is the date expected to begin at this location
Job Site End Date
What is the date expected to complete at this location (Static sites leave blank)
Special Medical Concerns of Workers on Site
Are there any special medical concerns of workers associated with this site
Closest EMS provider
Closest ambulance service
Closest Hospital
What is the closest hospital or clinic
Closest Airport
What is the closest airport to this site, this includes public and private airstrips
Additional Information
Any other information you care to provide in reference to this site
Alternate Use
Can your site be used as an emergency rendezvous point for emergencies other than your company
Clear selection
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