Air Medical Weight and Balance Verification Log

Mission-specific form for verifying patient weight, crew weight, equipment payload, fuel status, and aircraft weight and balance limits before air medical transport.

Mission Details

• Mission Date
• Mission Number
• Aircraft Tail Number
• Base / Departure Location
• Verification Type

Load and Occupant Weights

• Patient Weight (lb)
• Patient Weight Source
• Crew Count
• Total Crew Weight (lb)
• Equipment / Payload Weight (lb)
• Special Items Included in Payload

Fuel and Aircraft Limits

• Fuel on Board (lb)
• Planned Takeoff Weight (lb)
• Maximum Takeoff Weight (lb)
• Center of Gravity Within Limits?
• Center of Gravity Reference Method

Verification and Exceptions

• Within Approved Weight Limits?
• Reason for Limit Exceedance or Restriction
• Load Adjustment Action Taken
• Verifier Name
• Verifier Role
• Verification Signature