Investigators say Ornge failed to protect the health and safety of its helicopter pilots.
The report relates to the May 31st crash in northern Ontario where 4 crew members died in a remote area near Moosonee.
The helicopter was on its way to pick up a patient in a remote northern community early in the morning.
Federal investigators say Ornge failed to adequately educate the pilots on the health and safety hazards associated with northern operations, among other problems.
They are asking the agency to fix the problems by the end of May.
The Transportation Safety Board is still investigating the crash.