Military Reports System

CASEVAC - Casualty Evacuation Request

Date & Time (DTG)*

Call Sign (Requesting Unit)*

Pickup Location (Grid Reference)*

Radio Frequency*

Precedence* Select Precedence URGENT - Within 2 hours PRIORITY - Within 4 hours ROUTINE - Within 24 hours

Special Equipment Required

Number and Type of Patients*

Security at Pickup Site* Select Security Status No enemy in area Possible enemy in area Enemy in area (approach with caution) Armed escort required

Pickup Method* Select Method Hoist Land Ladder

Nationality*

NBC Contamination* NBC Status None Nuclear Biological Chemical

Submitted By*

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