FS-5700-21a Helicopter Data Record

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Overview

FS-5700-21a, Part 1
FS-5700-21a, Part 2 (Fire Card)
FS-5700-21a, Part 3(Heli Data)
FS-5700-21a, Part 4 (Heli Calc)
Instructions

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Sheet 1: FS-5700-21a, Part 1

FS-5700-21a, Part 1 (03/2008)

OMB 0596-0015 (Omission of Exp. date approved by OMB)

USDA - Forest Service

1. Contract/Rental Agreement No: Insert current Contract or Rental Agreement Number. 1. Contract/Rental Agreement No.

HELICOPTER DATA RECORD

2. Item No.

2. Item No: Some Contracts have multiple awards. Insert the Item Number from Section B of the contract for this base.

3. Designated Base

3. Designated Base: Designated Base is as listed in Section B of the Contract. For CWN Aircraft the Base will be the Operators Home Base.

(Reference FSH 5709.16)

4. Region/Area

4. Region/Area: This is the Region for the Contract, not the Issuer of the Card.

SECTION I - Operator & Aircraft Information (Fill in Blanks)

1. Operator

2. Address (Street, City, State & ZIP Code)

1. Operator: Many Operators have different names than on the Aircraft Registration Certificate. Enter the Operators Company Nameas listed on the Contract, not the name on the Registration. This will eliminate confusion with entries found in the Federal Aviaiton Resources Database.

2. Address: Use the address as listed on the Contract.

3. Phone No.

4. Make and Model

5. FAA Registration No.

6. Manufacturer's Serial No.

7. Hobbs Reading

3. Phone No: Include the Area Code

4. Make and Model: Self Explanatory, i.e. Bell 407

5. FAA Registration No: Self Explanatory. If Foreign, enter appropriate Registration Number, i.e. C-FYHK.

FSDefaultUser: Self-Explanatory

7. Hobbs Reading: Hobbs at time of Inspection.

8. Max Gross Weight

9. Max Gross Weight

10. No. of Passengers

11. Type Fuel

12. Fuel Flow (Cruise)

(Internal)

8. Max Gross Weight: Certificated Maximum Gross Weight From Flight Manual for Internal Loads. Ensure Flight Supplements checked if appropriate.

(External)

9. Max Gross Weight: Maximum Gross Weight from Flight Manual for Jettisonable External Loads. Ensure Flight Manual Supplements checked.

10. No. Passengers: Max seats, excluding pilot(s)

12. Fuel Flow (Cruise): See Section J of the Contract for the Hourly Fuel Consumption.

FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA

13. Authorized Uses (Initial appropriate boxes)

13. Authorized Uses: Initial as required per the Contract. Line through items not Authorized for, on the Card placed in the Aircraft.

Expires (Fill in the Blank)

December-00

(Line Through Unapproved Uses)

a.

Passenger & Cargo

h.

Fire Suppression - Interagency

o.

Approved Left Seat Ops

13o. Approved for Left Seat Ops: Verify approved by STC and Flight Manual Supplement in Flight Manual.

b.

Low Level Reconnaissance

i.

Fire Suppression - Local

p.

Approved MEL (MMEL Rev No.

13p. Approved MEL: Verify against Operators Ops Spec D095. Enter MMEL Revion Number used to develop MEL. )(D95)

c.

Cargo Only (Restricted Category)

j.

Water/Retardant Bucket

q.

Other

13q - 13u. Other: For other requirements listed in Contract.

d.

External Load (Sling)

k.

Fixed Tank

Tanker No.(

Fixed Tank: Tanker Numbers are assigned to Type 1 helicopters only. )

r

Other

e.

Rappelling

l.

Longline/Remote Hook

s.

Other

f.

Aerial Ignition

m.

Rapid Refuel

CCR

Splash

13m. Rapid Refuel: On Card placed in Aircraft, Initial Block or Circle item as required for Closed Circuit Refuel (CCR) or Spash Refuel. Verify Procedure listed in Ops Manual.

t.

Other

g.

Manager May Ride (Type 1 Only)

13p. Manager May Ride Point-to-Point: For Type I & II only if approved by Contract. Not Applicable to Restricted Category Helicopters.

n.

Air Attack

Type(

13n. Air Attack: Complete, if to be carded for Air Attack, otherwise enter N/A Enter Type "I, II, III, or IV" depending on configuration. )

u.

Other

14. Approved By (Signature)

15. Title

16. Region

17. Date

14. Approved By: Print and Sign on card issued to Operator.

Aircraft Inspector

SECTION II - Airframe Information (Fill in the Blanks)

SECTION III - Engine Information (Fill in the Blank)

1. Total Airframe Time

1. Make & Model

2. Date of Last Annual/ Complete Phase Inspection

2. Total Time

#1

#2

3. Last Inspection Type

Time:

3. Hours Since New or O/H

#1

#2

4. On "Approved" Maintenance Program**

4. On "Approved" Maintenance Program: Enter Type Inspection Program, i.e. AAIP, Bell 100 Hr., Eurocopter, etc.

TBO

3. TBO: Check against Operators Op Spec D102

HSI

HSI: Enter HSI time from D102 of Ops Specs.

(AAIP approved in Ops Spec D73)

(Ops Spec D102)

5. Airworthiness & Registration

4. Hours Since HSI

#1

#2

6. Date of Last Actual Weighing (24 Months **)

6. Date of Last Actual Weighing: Must be within 2 years for most Contracts, or as required by the FAR's. 24 months for Interagency Fire.

5. Maintenance Records

#1

#2

Equipped Weight

Equipped Weight: Actual Equipped Weight from Current Weight & Balance Record. Must be within 1% of the Bid Weight.

Bid Weight

Bid Weight: The weight the Operator bid the Aircraft per Section B of the Contract.

7. Flight Manual Rev No.

7. Flight Manual Rev No: Enter Revision Number of Flight Manual in Aircraft.

Date:

7. Flight Manual Rev Date: Enter Revision Date of Latest Change of Flight Manual.

SECTION IV - Operating Certificates (Fill in the Blanks)

8. Time Change, S/B & AD Listing **

8. Time Change & AD Listing: Must be maintained with aircraft.

1. 14 CFR 133 Certificate No.

1. 14 CFR 133 Certificate No: Part 133 - External Load Certificate Number

9. Maintenance Records

Expiration Date

Part 133 Certificate Expiration Date: Part 133 Operating Certificates are valid for 2 years.

10. Flight Instruments (Condition)

2. 14 CFR 135 Certificate No.**

1. 14 CFR 135 Certificate No: Part 135 - External Load Certificate Number

11. Engine Instruments (Condition)

3. 14 CFR 137 Certificate No.

1. 14 CFR 137 Certificate No: Part 137 - External Load Certificate Number

SECTION V - Equipment (X appropriate boxes)

Satisfactory

Satisfactory

Yes

No

Yes

No

1. Hobbs Installation **

13. Cargo Hook **(Last Inspected

13. Cargo Hook: Enter Date last Inspected. Normally required every 2 years, or as required by the Contract. Interagency Fire Requirement )

2. Free Air Temperature Gauge **

Keeperless Hook

3. Seat Belt (All) **

3. Seat Belts: Must be marked either TSO C22 Safety Belts, C114 Torso Restraint Systems, or have a Military Desigantion Number. Interagency Fire Requirement

14. Personnel Access Step **

4. Shoulder Harness (All after 01/01/06) **

4. Shoulder Harnesses: Although not necessarily required by the FAR's, This is Required for All Aircraft. Shoulder harnesses are not required to have a TSO number/tag, but must be inspected and the inertia reels operationally checked. After 01/01/2006 all positions will require shoulder harnesses. Interagency Fire Requirement

15. Water/Retardant Bucket **

(** Either 16 or 17)

5. First Aid Kit **

5. First Aid Kit: Required for All Aircraft. Minimum requirements can be found in Section J of the Contract. Interagency Fire Requirement

Type

Gallons

16. Water/Retardant Bucket: Enter Type Bucket and Capacity. Verify Model Number on Control Head dataplate matches Model Number on Bucket. Interagency Fire Requirement either Bucket ot Fixed Tank.

6. Survival Kit **

6. Survival Kit: Usually required for all Special Mission aircraft. Minimum requirements can be found in Section J of the Contract. Interagency Fire Requirement

16. Fixed Retardant Tank **

7. Dual Control (For Pilot Check) **

7. Dual Control: As required by Section B or C of the Contract. Interagency Fire Requirement

Type

Gallons

17. Fixed Retardant Tank: Enter Model and Capacity, and verify capacity meets minimum size required by Contract. Interagency Fire Requirement either Fixed Tank or Bucket.

8. Lighting - Night Operation **

17. Bucket/Door SW on Collective **

18. Bucket/Door SW on Collective: Required for All Aircraft. Interagency Fire Requirement

9. High Visibility Marking Main Rotor **

9. High Visibility Marking Main Rotor: Check Section J of the Contract for approved Paint schemes. Interagency Fire Requirement

18. Long-Line - Remote Hook

14. Long-Line: Verify number and length of longlines required per the Contract.

10. Extended Height Gear **

10. Extended Height Gear: As required by Section B or C of the Contract. If Available. Interagency Fire Requirement

(Last Inspected

14. Remote Hook: Enter Date last Inspected. Normally required every 2 years, or as required by the Contract. )

11. Convex Mirror **

19. Closed Circuit Refueling

21. Closed Circuit Refueling: As required by Section B or C of the Contract.

12. Locking Fuel Cap

12. Locking Fuel Cap: As required by Section B or C of the Contract. Interagency Fire Requirement

20. Defuel Capability

22. Defuel Capability: As required by Section B or C of the Contract.

** Required for Interagency Fire

21. Rappel Anchor (Last Inspected

23. Rappel Anchor: Verify anchor inspected in accordance with Instructions for Continued Airworthiness (ICA). )

N Number

0

Make & Model

0

Inspection Date:

12/30/99

FS-5700-21a, Part 1 (03/2008)

OMB 0596-0015 (Omission of Exp. date approved by OMB)

SECTION V (Continued) - Equipment (X appropriate boxes)

Satisfactory

Satisfactory

Yes

No

Yes

No

22. Fire Extinguisher **

36. HAZMAT Book (w/CurrentExemption Letter)

35. HAZMAT Book: Required for ALL Aircraft. Ensure current Exemption Letter with Handbook.

25. Baggage Compartment or Cargo Racks **

25. Baggage Compartment or Cargo Racks: As required by Section B or C of the Contract. Usually minimum of 15 cu. Ft. required. Interagency Fire Requirement

37. Procurement Document in aircraft

36. Procurement Document in Aircraft: Required for ALL Contracts.

26. Baggage Compartment Mod.

26. Baggage Compartment Mod: As required by Section B or C of the Contract.

38. Security Devices

Security Devices: Must have two independent electrical and/or mechanical devices. Must be incorporated into preflight checklists. Locked doors or windows are not acceptable.

28. Particle Separator/Air Flitration System

1.

33. Wire Cutter Kit

2.

34. White Strobe **

3. Incorporated into preflight checklist

34. Conspicuity/Pulse Lights

39. Public Address/Siren System

35. Ops Specs/Operations Manual in aircraft

Operations Manual: Required by contract.

40. Other

** Required for Interagency Fire

41. Other

SECTION VI - Service Truck (X appropriate boxes)

Yes

No

Yes

No

1. Capacity**

U.S. Gallons

13. Fuel Hoses (Approved Type)**

13. Fuel Hoses: see current Contract for requirements and eligible types. Interagency Fire Requirement

2. Type Truck

14. Mechanized Reel

14. Mechanized Reel: If required by Contract.

3. License No.

15. Ground & Bonding Cables **

15. Ground & Bonding Cables: In accordance with NFPA 407 and Contract. Interagency Fire Requirement

4. Condition

4. Condition: General Condition, cleanliness, security of tanks, etc. NO LEAKS ALLOWED

16. Fuel Filtering System **

5. Fire Extinguishers (2 each 20-B,C) **

5. Fire Extinguisher: Verify quantity and capacity against Contract. Normally minimum of 2 each with a rating of 20-B:C. See NFPA 10 Standards for Portable Fire Extinguishers. Interagency Fire Requirement

17. Date Filter Changed **

17. Date Filter Changed: Some Contracts require the filter be chnaged at time of inspection, others in accordanc ewith manufacturer's recommendation. See Contract. Interagency Fire Requirement

6. Placarded - 49 CFR 172 **

6. Placarded - 49 CFR 172: Verify placard "1863" on all four sides. Interagency Fire Requirement

18. Spare Filters **

FSDefaultUser: Usually one spare filter required. Interagency Fire Requirement

7. Marked w/Type Fuel - 3 Inch Letters **

7. Marked w.Fuel Type: Placarded on sides and rear. Interagency Fire Requirement

19. Gas Engine Protection

19. Gas Engine Protection: Shielded ignition and approved Spark Arrestor Muffler.

8. No Smoking Signs - 3 Inch Letters **

8. No Smoking Signs: Placarded on sides and rear. Interagency Fire Requirement

20. FM Radio

20. FM Radio: If required by Contract.

9. Sump & Drain **

9. Sump & Drain: Check sample - Clean and Clear. Interagency Fire Requirement

21. Spill Kit ** (

)Gallons Minimum

21. Spill Kit: Usually at least 5 gallon spill kit required. See Contract. Interagency Fire Requirement

10. Fuel Meters **

22. Filter Manufacturer's Manual

23. Filter Manufacturer's Manual: Required for all fuel filters.

11. Differential Pressure Gauge(s)

23. Record for recording sump draining **

12. Nozzle Screen/Dust Cap **

12. Nozzle Screen/Dust Cap: 100 Mesh or finer in fuel nozzle, and duct cap installed. Interagency Fire Requirement

24. Cell phone for FSV Driver

13. Deadman Control (Required for CCR)

24. Other

SECTION VII - Avionics (X appropriate boxes or Annotate N/A for items Not Required)

Pass

Fail

Pass

Fail

1. ELT - Battery Due Date

(

)

19. Audio Controls ** (No.

)

2. ELT 91.207 Complied With

2. ELT 91.207 Complied With: Verify Annual Inspection Complied with IAW 91.207d (1-4).

20. Transmitter Selectors

3. ELT TSO# **

91a

126

3. ELT TSO #: Either TSO 91a, or after January 31, 2009, TSO 126a. Interagency Fire Requirement

21. Receiver Selectors

4. #1 VHF-AM Comm. Transceiver **

720

760

22. Microphone/Drop Cords (U-92A/U**)

5. #2 VHF-AM Comm. Transceiver

720

760

23. Transceiver PTT

6. #1 VHF-FM Comm. Transceiver **

(Type

5, 7, & 8: VHF-FM Comm. Transceiver Check operation and identify type. Only "Fire" Approved radios authorized for Special Mission. Current Approved radios can be found at: http://www.fs.fed.us/fire/niicd/avionics/index.html One required for Interagency Fire )

24. Rappel Audio Control & Drop Cord

7. #2 VHF-FM Comm. Transceiver

(Type

)

25. ICS Hot Mic/VOX (Pilot/Copilot **)

8. Aux FM Provisions **

8. Aux FM Provisions: Verify 10-pin connector operation and VHF-FM antenna installed. Not required if an additional FM is installed (FM-2).

26. ICS PTT **

9. GPS (Panel Mounted ** / Handheld)

9. GPS: Identify whether Portable or Panel Mounted. Air Attack Type I & II must be panel mounted.

27. Rear Seat PTT (2 Aft Cabin Exits **)

(Mark IFR / VFR as applicable)

9. (Cont) IFR/VFR: Identify whether VFR or IFR Approved.

------------------------

10. GPS Database (Expiration Date

10. GPS Database: Enter Expiration of Database. If IFR Approach required by contract, database must be no older than 28 days. Under no circumstances may it be more than 1 year old.

)

28. Avionics Placarding

11. Transponder **(Per 91.413) (Due

)

29. General Condition

12. Altimeter/Static** (Per 91.411)(Due Date

)

30. Avionics Records, Diagrams & Schematics

13. Magnetic Compass Placard

31. Accessory Power (3 Pin) **

31. Accessory Power (3 Pin): Verify correct power and polarity. Interagency Fire Requirement

14. TCAS/TCAD

14. TCAS/TCAD: If Required by Contract.

32. Cargo Hook Connector (9 pin) **

32. Cargo Hook Connector (9 Pin): Verify correct power and polarity. Protected by 50 amp circuit breaker, or as required by Contract. Interagency Fire Requirement

15. Automated Flight Following System

15. Automated Flight Following: If Required by Contract.

33. Other

16. Verify AFF Operational

34. Other

17. Additional GPS Antenna

35. Other

18. GPS Dataport

36. Other

17. Other

37. Avionics Inspection Completed By:

18. Other

** Required for Interagency Fire

Notes/Discrepancies:

SECTION VIII - (Forest Service Inspector Use Ony)

Card Issue Date:

Fed Resources Database Updated

Copy filed with Contract and/or CO

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Sheet 2: FS-5700-21a, Part 2 (Fire Card)

FS-5700-21a, Part 2 (03/2008)

OMB 0596-0015 (Omission of Exp. date approved by OMB)

USDA - Forest Service

1. Contract/Rental Agreement No.

0

INTERAGENCY FIRE

2. Item No.

0

HELICOPTER DATA RECORD

3. Designated Base

0

(Reference FSH 5709.16)

4. Region/Area

0

SECTION I - Operator & Aircraft Information (Fill in Blanks)

1. Operator

2. Address (Street, City, State & ZIP Code)

1. Operator: Many Operators have different names than on the Aircraft Registration Certificate. Enter the Operators Company Nameas listed on the Contract, not the name on the Registration. This will eliminate confusion with entries found in the Federal Aviaiton Resources Database. 0

2. Address: Use the address as listed on the Contract. 0

3. Phone No.

4. Make and Model

5. FAA Registration No.

6. Manufacturer's Serial No.

7. Hobbs Reading

3. Phone No: Include the Area Code 0

4. Make and Model: Self Explanatory, i.e. Bell 407 0

5. FAA Registration No: Self Explanatory. If Foreign, enter appropriate Registration Number, i.e. C-FYHK. 0

FSDefaultUser: Self-Explanatory 0

7. Hobbs Reading: Hobbs at time of Inspection. 0

8. Max Gross Weight

9. Max Gross Weight

10. No. of Passengers

11. Type Fuel

12. Fuel Flow (Cruise)

(Internal)

0

(External)

9. Max Gross Weight: Maximum Gross Weight from Flight Manual for Jettisonable External Loads. Ensure Flight Manual Supplements checked. 0

10. No. Passengers: Max seats, excluding pilot(s) 0

12. Fuel Flow (Cruise): See Section J of the Contract for the Hourly Fuel Consumption. 0

FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA

13. Authorized Uses (Initial appropriate boxes)

Expires (Fill in the Blank)

December-00

(Line Through Unapproved Uses)

a.

Passenger & Cargo

h.

Fire Suppression - Interagency

o.

Approved Left Seat Ops

b.

Low Level Reconnaissance

i.

Fire Suppression - Local

p.

Approved MEL (MMEL Rev No.

0

13p. Approved MEL: Verify against Operators Ops Spec D095. Enter MMEL Revion Number used to develop MEL. )(D95)

c.

Cargo Only (Restricted Category)

j.

Water/Retardant Bucket

q.

Other

13q - 13u. Other: For other requirements listed in Contract.

d.

External Load (Sling)

k.

Fixed Tank

Tanker No.(

Fixed Tank: Tanker Numbers are assigned to Type 1 helicopters only. If NOT a Type 1 helicopter enter NA )

r

Other

e.

Rappelling

l.

Longline/Remote Hook

s.

Other

f.

Aerial Ignition

m.

Rapid Refuel

CCR

Splash

t.

Other

g.

Manager May Ride (Type 1 Only)

13p. Manager May Ride Point-to-Point: For Type I & II only if approved by Contract. Not Applicable to Restricted Category Helicopters.

n.

Air Attack

Type(

)

u.

Other

14. Approved By (Signature)

15. Title

16. Region

17. Date

12/30/99

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Sheet 3: FS-5700-21a, Part 3(Heli Data)

FS-5700-21a, Part 3 (03/2008)

OMB 0596-0015 (Omission of Exp. date approved by OMB)

USDA - Forest Service

1. Contract/Rental Agreement No.

0

0

HELICOPTER DATA RECORD

2. Item No.

0

0

3. Designated Base

0

0

(Reference FSH 5709.16)

4. Region/Area

0

0

SECTION I - Operator & Aircraft Information (Fill in Blanks)

1. Operator

2. Address (Street, City, State & ZIP Code)

1. Operator: Many Operators have different names than on the Aircraft Registration Certificate. Enter the Operators Company Nameas listed on the Contract, not the name on the Registration. This will eliminate confusion with entries found in the Federal Aviaiton Resources Database. 0

2. Address: Use the address as listed on the Contract. 0

3. Phone No.

4. Make and Model

5. FAA Registration No.

6. Manufacturer's Serial No.

7. Hobbs Reading

3. Phone No: Include the Area Code 0

4. Make and Model: Self Explanatory, i.e. Bell 407 0

5. FAA Registration No: Self Explanatory. If Foreign, enter appropriate Registration Number, i.e. C-FYHK. 0

FSDefaultUser: Self-Explanatory 0

7. Hobbs Reading: Hobbs at time of Inspection. 0

8. Max Gross Weight

9. Max Gross Weight

10. No. of Passengers

11. Type Fuel

12. Fuel Flow (Cruise)

(Internal)

0

0

(External)

9. Max Gross Weight: Maximum Gross Weight from Flight Manual for Jettisonable External Loads. Ensure Flight Manual Supplements checked. 0

10. No. Passengers: Max seats, excluding pilot(s) 0

12. Fuel Flow (Cruise): See Section J of the Contract for the Hourly Fuel Consumption. 0

FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA

13. Authorized Uses (Initial appropriate boxes)

Expires (Fill in the Blank)

December-00

(Line Through Unapproved Uses)

a.

Passenger & Cargo

h.

Fire Suppression - Interagency

o.

Approved Left Seat Ops

b.

Low Level Reconnaissance

i.

Fire Suppression - Local

p.

Approved MEL (MMEL Rev No.

0

13p. Approved MEL: Verify against Operators Ops Spec D095. Enter MMEL Revion Number used to develop MEL. )(D95)

c.

Cargo Only (Restricted Category)

j.

Water/Retardant Bucket

q.

Other

13q - 13u. Other: For other requirements listed in Contract.

d.

External Load (Sling)

k.

Fixed Tank

Tanker No.(

Fixed Tank: Tanker Numbers are assigned to Type 1 helicopters only. If NOT a Type 1 helicopter enter NA )

r

Other

e.

Rappelling

l.

Longline/Remote Hook

s.

Other

f.

Aerial Ignition

m.

Rapid Refuel

CCR

Splash

t.

Other

g.

Manager May Ride (Type 1 Only)

13p. Manager May Ride Point-to-Point: For Type I & II only if approved by Contract. Not Applicable to Restricted Category Helicopters.

n.

Air Attack

Type(

)

u.

Other

14. Approved By (Signature)

15. Title

16. Region

17. Date

12/30/99

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Sheet 4: FS-5700-21a, Part 4 (Heli Calc)

FS-5700-21a, Part 4 (03/2008)

MB 0596-0015 (Omission of Exp. date approved by OMB)

INTERAGENCY HELICOPTER LOAD CALCULATON Electronic Version (03/2008)

MODEL

Enter the helicopter make, model and variant designator. 0

N#

Enter the full FAA tail number. 0

PILOT(S)

Enter first and last name of the Pilot-In-Command (PIC) and any Co-Pilots.

DATE

Enter the date that this Load Calculation is completed.

MISSION

Describe the mission or project being conducted. Ex: "Irish Springs Sling Project"; "Rattlesnake Fire"; "Initial Attack"

TIME

Enter the time of Load Calculation completion, in Military Time.

1

DEPARTURE

Enter the name or designator of the Departure location.

PA

Enter the Pressure Altitude (PA) at departure point (read altimeter when set to 29.92).

OAT

Enter Outside Air Temperature (OAT) at the Departure point, in degrees Celsius.

2

DESTINATION

Enter the name or designator of the Destination location. If unknown, enter "unknown" or "various"

PA

Enter the Pressure Altitude (PA) at the destination location. If PA is unknown, use MSL elevation from a map. If the destination location is unknown, use the highest expected landing elevation for that day.

OAT

Enter Outside Air Temperature (OAT) at the destination location. If unknown, use Standard Lapse Rate of 2oC/1000' to estimate destination OAT. If the destination location is unknown (initial attack), use the highest OAT expected that day for the highest expected landing altitude.

Check the box on either the Departure line or the Destination line, whichever has the most restrictive conditions, to indicate which PA and OAT will be used to compute gross weight on line7b. (the destination conditions are usually more restrictive)

3

HELICOPTER EQUIPPED WEIGHT

Equipped Weight equals the Empty Weight (found in the aircraft weight and balance data) plus the weight of lubricants and other equipment required by contract (i.e. survival kit) 0

4

FLIGHT CREW WEIGHT

Enter the weight of the Pilot and any co-pilots plus the weight of their personal flight gear.

5

FUEL WEIGHT

Enter the total number of US gallons of fuel currently onboard the aircraft. 0

gals X

Enter the weight per gallon, in pounds, for type of fuel on board. (Use 7 lbs/gallon for Jet Fuel) 7

lbs/gal

THIS FIELD IS LOCKED. Automatically multiplies gallons of fuel X lbs/ gallon. 0

6

OPERATING WEIGHT (3 + 4 + 5)

THIS FIELD IS LOCKED. Automatically adds the values entered in lines 3, 4 and 5 to derive Helicopter Operating Weight. 0

Non-Jettisonable

Jettisonable

HIGE

HOGE

HOGE- J

7a

PERFORMANCE REFERENCE (List chart/supplement from Flight Manual)

From the Performance section of the basic Flight Manaual or appropriate FM supplement, identify the page number and/or chart used to derive Computed Gross Weight for HIGE operations. This may be a basic IGE chart, an "external cargo" IGE chart or, in some instances, an OGE performance chart.

From the Performance Section of the basic Flight Manual or appropriate FM supplement, identify the page number and/or chart used to derive Computed Gross Weight for non-jettisonable HOGE operations. This must be a OGE performance chart.

From the Performance Section of the basic Flight Manual or appropriate FM Supplement, identify the page number and/or chart used to derive Computed Gross Weight for HOGE-Jettisonable operations where the pilot has total jettison control. This must be an OGE chart.

7b

COMPUTED GROSS WEIGHT (From Flight Manual Performance Section)

Enter Computed Gross Weight as derived from the performance chart indicated on Line 7a using the Pressure Altitude (PA) and Outside Air Temperature (OAT) at either the Departure or Destination, whichever is more restrictive.

Enter the Computed Gross Weight as derived from the performance chart listed on Line 7a using the PA and OAT at either the Departure or Destination location, whichever is more restrictive.

Enter the Computed Gross Weight as derived from the performance chart listed in Line 7a using the PA and OAT at either the Departure or Destination, whichever is more restrictive.

8

WEIGHT REDUCTION (Required for all Non-Jettisonable loads)

The Government Weight Reduction is required for all non-jettisonable loads, both HIGE and HOGE. Weight reduction values, for make & model, can be found in the current helicopter procurement document (contract).

The Government Weight Reduction is required for all non-jettisonable loads, both HIGE and HOGE. Weight reduction values, for make & model, can be found in the current helicopter procurement document (contract).

The Government Weight Reduction is optional (mutual agreement between Pilot and Helicopter Manager) when carrying jettisonable loads (HOGE-J) where the pilot has total jettison control. If the decision is made to not use the Weight Reduction, enter 0.

9

ADJUSTED WEIGHT (7b minus 8)

THIS FIELD IS LOCKED. Automatically subtracts the Weight Reduction (Line 8) from the Computed Gross Weight (Line 7b). #VALUE!

THIS FIELD IS LOCKED. Automatically subtracts the Weight Reduction (Line 8) from the Computed Gross Weight (Line 7b). #VALUE!

THIS FIELD IS LOCKED. Automatically subtracts the Weight Reduction (Line 8) from the Computed Gross Weight (Line 7b). #VALUE!

10

GROSS WEIGHT LIMITATION (From Flight Manual Limitations Section)

Enter the applicable Gross Weight Limitation from the Limitations Section of the basic Flight Manual or appropriate supplement. This may be a Maximum Gross Weight Limit for Take-Off and Landing (skid limit) or a Weight-Altitude-Temperature (WAT) Limit.

Enter the appropriate Gross Weight Limitation from the Limitations Section of the basic Flight Manual or appropriate supplement. This may be a Maximum Gross Weight Limit forTake-Off & Landing (skid limit) or a Weight-Altitude-Temperature (WAT) Limit. 0

Enter the appropriate Gross Weight Limitation from the Limitations Section of the basic Flight Manual or appropriate supplement. This is usually a Maximum Gross Wt Limit for External Loads (jettisonable) found in the External Load/Cargo Hook supplement. With some models, there is no difference between the Gross Weight Limit for External Load and the basic aircraft Gross Weight Limit.

11

SELECTED WEIGHT (Lowest of 9 or 10)

THIS FIELD IS LOCKED. Automatically selects the lowest weight of either Line 9 or Line 10. The Limitation entered on Line 10 must never be exceeded. #VALUE!

THIS FIELD IS LOCKED. Automatically selects the lowest weight of either Line 9 or Line 10. The limitation entered on Line 10 must never be exceeded. #VALUE!

THIS FIELD IS LOCKED. Automatically selects the lowest weight of either Line 9 or Line 10. The limitation entered on Line 10 must never be exceeded. #VALUE!

12

OPERATING WEIGHT (From Line 6)

THIS FIELD IS LOCKED. Automatically enters the Operating Weight from Line 6. 0

THIS FIELD IS LOCKED. Automatically enters the Operating Weight from Line 6. 0

THIS FIELD IS LOCKED. Automatically enters the Operating Weight from Line 6. 0

13

ALLOWABLE PAYLOAD (11 minus 12)

THIS FIELD IS LOCKED. Automatically computes the Allowable HIGE Payload by subtracting the Operating Weight (Line 12) from the Selected Weight (Line 11). #VALUE!

THIS FIELD IS LOCKED. Automatically computes the Allowable HOGE Non-Jettisonable Payload by subtracting the Operating Weight (Line 12) from the Selected Weight (Line11). #VALUE!

THIS FIELD IS LOCKED. Automatically computes the Allowable HOGE Jettisonable Payload by subtracting the Operating Weight (Line 12) from the Selected Weight (Line 11). #VALUE!

14

PASSENGERS/CARGO

Enter the weights of passengers and/or cargo that are named or described on the lines to the left.

Provide the names of passengers and/or descriptions of cargo on these lines. HazMat type and location may also be noted here. NOTE: A separate manifest may be used to list all passengers and/or cargo, and to compute the Actual Payload.

15

ACTUAL PAYLOAD (Total of all weights listed in Item 14) Line 15 must not exceed Line 13 for the intended mission (HIGE, HOGE or HOGE-J)

THIS FIELD IS LOCKED. Automatically computes the Actual Payload by adding all the passenger and/or cargo weights entered above. Actual Payload must not exceed the Allowable Payload for the intended mission profile, i.e. HIGE, HOGE or HOGE-J. 0

PILOT SIGNATURE

THIS FIELD IS LOCKED. When using the electronic Load Calculation, the completed form shall be printed out and must be signed by the Pilot and the Helicopter Manager.

HazMat Onboard

MANAGER SIGNATURE

THIS FIELD IS LOCKED. When using the electronic Load Calculation, the completed form shall be printed out and must be signed by the Helicopter Manager and the Pilot.

Place an "X" after Yes or No to indicate whether HazMat is being transported or not; alerts the pilot to such. Yes No

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Sheet 5: Instructions

Instructions - FS 5700-21a (Helicopter Data Record), FS-5700-21b (Helicopter Fire Card), and FS-5700-21c (Helicopter Data Card)

1. A. This form may be filled in on the computer, or blank forms may be printed and filled in by hand. Computer: When the information is entered on the 5700-21a - Part 1, the information will be automatically transferred to the FS-5700-21a - Part 2, Fire Card.
B. Printing: Click on the tab along the lower edge of the worksheet to gain access to the individual sheets. The forms should print one page for each form. If this does not happen do the following: (1) Click on “File”, “Page Setup”, Margins”, Check that all margins are set to: “.25”.

2. SPECIAL USES – If a Special Use is Authorized, clicking on the item on FS-5700-21a - Part 1, a check mark will appear in the provided space. You will have to Initial the Authorized Uses on the card, and line through the items not authorized. Any Additional Uses will also automatically be filled in on the FS-5700-21a - Part 2, Fire Card.

FSDefaultUser: A Box like this will appear if you place the cursor over a RED TRIANGLE on the forms, which will provide pertinent information regarding the information petaining to an item on the forms.
A RED TRIANGLE indicates a drop down box which provides information on what information is required, or what should be looked for, as in the example in the upper right corner of this block.

3. To Insert your information in blocks 13. Title, and 14. Region, Click on “Tools”, “Protection”, “Unprotect Sheet”. Remember to Re-Protect the sheet and Card(s) afterward.

SUGGESTION: Before or After completing a form, save it to a separate file i.e. N12345.xls. I recommend you make a folder for “Helicopters” and then sub-folders for the individual operators, and save the different “N” numbers in the operators file.

Please forward all comments, questions, noted discrepancies, and suggestions to:

Gil Elmy
Work: 801-622-9170
Cell: 801-540-8473
e-mail: gelmy@fs.fed.us

BURDEN AND NONDISCRIMINATION STATEMENTS

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0015. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer.