AMAS

Chief Pilot / Supervisor Report


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Date of Report Request:

Name of Individual Being Monitored:
 

Date of Birth of Individual Being Monitored:
 

Employee ID (if applicable):

Please address the following:

Airman Performance and Competence

Crew Interaction

   
Mood

Presence of any other concerns, such as excessive sick leave or missing monitoring meetings

 

Further comments are appreciated to assist with oversight and monitoring by IMS and Psychiatrist:
(Consider asking questions such as: How has your life or program improved over the past 6 months?)

 

I agree to notify the IMS of any changes.

Today's Date:

Position or Job Title:  

Leave this empty:

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Signature Certificate
Document name: Chief Pilot / Supervisor Report
lock iconUnique Document ID: a96220b3ec8ac80bc3b3e9409a03c7148e9da242
Timestamp Audit
March 4, 2022 1:53 pm MDTChief Pilot / Supervisor Report Uploaded by IMS Records - imsrecords@aviationmedicine.com IP 180.195.200.90
March 17, 2022 12:51 pm MDTIMS Records - imsrecords@aviationmedicine.com added by Caitlin Bruton - cbruton@aviationmedicine.com as a CC'd Recipient Ip: 69.129.92.41
March 17, 2022 12:54 pm MDTIMS Records - imsrecords@aviationmedicine.com added by Caitlin Bruton - cbruton@aviationmedicine.com as a CC'd Recipient Ip: 69.129.92.41
April 13, 2022 2:01 pm MDTIMS Records - imsrecords@aviationmedicine.com added by Caitlin Bruton - cbruton@aviationmedicine.com as a CC'd Recipient Ip: 69.129.92.41
June 16, 2023 1:22 pm MDT Document owner cbruton@aviationmedicine.com has handed over this document to imsrecords@aviationmedicine.com 2023-06-16 13:22:10 - 70.176.10.239
June 16, 2023 1:22 pm MDTIMS Records - imsrecords@aviationmedicine.com added by IMS Records - imsrecords@aviationmedicine.com as a CC'd Recipient Ip: 70.176.10.239