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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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