Form FS-5700-21 Airplane Data Record

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Overview

FS-5700-21, Part 1 Form
FS-2700-21, Part 2 (FIRE CARD)
FS-2700-21, Part 3
Instructions

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

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

OMB 0596-0015 (Exp. date omitted by approval of OMB)

USDA - Forest Service

1. Contract/Rental Agreement No.

1. Contract/Rental Agreement No: Enter Contract or Rental Agreement Number.

AIRPLANE DATA RECORD

2. Item No.

2. Item No: Some Contracts have multiple awards. If so enter the Item Number from Section B for this award.

3. Designated Base

3. Designated Base: Designated Base as listed Section B of the Contract. If a CWN type Contract, enter the Operators Home Base.

(Reference FSH 5709.16)

4. Region/Area

4. Region/Area: Enter the Region which awarded the Contract. Not the Issuers region.

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

1. Operator

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

1. Operator: Enter the Company's Name, not the name listed on the aircraft's Registration Certificate.

2. Address: Enter the Address as listed on the Contract.

3. Phone No.

4. Make and Model

5. FAA Registration No.

6. Manufacturer's Serial No.

3. Phone No: Don't forget the Area Code.

4. Make and Model: Self Explanatory, i.e. Cessna 206F.

5. FAA Registration No: Self Explanatory. However, if Foreign Registered enter the appropriate Registration Number, i.e. C-FYKH.

7. Gross Weight

8. No. of Passenger Seats

9. Hobbs/Tach Reading

10. Hobbs/Tach Reading at Last 100 Hour Insp.

7. Gross Weight: Gross Weight as listed in the Aircraft Flight Manual. Ensure you check for any STC's and Flight Manual Supplements that might increase (or decrease) the Gross Weight.

8. No. of Passenger Seats: Total number of seats, excluding the pilot(s) seat(s).

10. Hobss/Tach at Last 100 Hr. Inspection: Or Annual Inspection. You may want to enter both if aircraft has both. i.e. 268.3/2857.9.

FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA

11. Authorized Uses (Initial appropriate boxes)

Expires (Fill in the Blank)

December-00

(Line Through Unapproved Uses)

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

a.

Passenger

f.

Backcountry Airstrip

Backcountry Airstrip: Must have an AFF System installed, and an FM Antenna or AUX FM capability.

b.

Cargo

g.

Approved MEL (D95) (MMEL Rev No.

11f. Approved MEL: Verify against the Ops Specs D095. )

c.

Resource Reconnaissance

11c. Resource Reconnaissance: Verify it meets the minimum requirements of the National Avionics Standards. Current standards can be found at: http://www.fs.fed.us/fire/niicd/avionics/index.html

h.

Equipped w/Autopilot (Single Pilot IFR) (A15)

11e. Equipped w/Autopilot (Single Pilot IFR): Verify against Ops Specs A015

d.

Fire Reconnaissance

11c. Fire Reconnaissance: Verify it meets the minimum requirements of the National Avionics Standards. Current standards can be found at: http://www.fs.fed.us/fire/niicd/avionics/index.html

i.

Other

e.

Air Attack

(Type

11d. Air Attack: Per the Contract and the National Avionics standards. Enter type "I, II, III, or IV" Current standards can be found at: http://www.fs.fed.us/fire/niicd/avionics/index.html )

j.

Other

12. Approved By (Signature)

13. Title

14. Region

15. Date

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

SECTION II - Airframe Information (Fill in the Blanks)

SECTION III - Engine, Prop & Governors (Fill in the Blanks)

1.

Aircraft Total Time

1.

Engine Make & Model

2.

Last Complete Inspection Date C/W

2.

TBO:

Hours

Calendar

Years

Annual

Type Inspection: 1. Enter "X" if under an Annual Inspection Program. 2. Leave "Blank" if under a Manufacturer's Program. 3. Enter "-" (DASH) if under a AAIP

Manufacturer

AAIP

(D73)

(D101)

HSI

(Time/Date Since New, O/H & HSI)

3.

Last 100 Hr/Phase (Total Time)

3.

Hours

Left

Right

4.

Last 100 Hr/Phase (Date)

HSI

Left

Right

5.

Weight & Balance (36 Months Multi; 5 Yr Single)

Date

Left

Right

Date of Last Weighing

1/3/1905

12/30/1899

12/30/1899

Empty Weight

Equipment List

4.

Propeller

(Time/Date Since New or O/H)

6.

Flight Manual Rev No.

Date

TBO:

Hours

Calendar

Years

7.

Airworthiness

Registration

Hours

Left

Right

8.

Airframe Logbooks (91.417)

Date

Left

Right

12/30/1899

12/30/1899

9.

Engine Logbooks

5. Prop Governor

(Time/Date Since New or O/H)

10

Propeller Logbooks

TBO:

Hours

Calendar

Years

11.

FAA Form 337

Hours

Left

Right

12.

AD's & Listing

Date

Left

Right

13.

Time Change List (As required)

SECTION IV - Operating Certificates (Fill in the Blanks)

14.

Service Bulletins (As Required)

1.

14 CFR 135 Certificate No.

15.

Aging Aircraft (D485)(As Required)

2.

14 CFR 137 Certificate No.

12/30/1899

12/30/1899

SECTION V - Equipment (X appropriate boxes)

Satisfactory

Satisfactory

Yes

No

Yes

No

1.

Hobbs Installation

1. Hobbs Installation: Required for most Contracts.

5.

Flight Instruments

2.

Free Air Temperature Gauge

6.

Engine Instruments

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.

7.

Skis/Wheels

4.

Shoulder Harness (Front)

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, but must be inspected and the inertia reels operationally checked.

8.

Floats

(Size:

)

FS-5700-21 (1/08)

N Number

0

Make & Model

0

Inspection Date

30-Dec-99

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

Satisfactory

Satisfactory

Yes

No

Yes

No

9.

First Aid Kit

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

20.

High Visibility Markings

10.

Survival Kit

6. Survival Kit: Usually required for All Special Mission Aircraft. Minimum requirements can be found in Section J of the Contract.

21.

HAZMAT Handbook(w/Current Exemption Letter)

11.

Fire Extinguisher

7. Fire Extinguisher: Verify charge, security of mounting and Annual/Hydro (6 year) dates.

22.

Procurement Document in Aircraft

12.

Light - Navigation/Landing

23.

Ops Specs/Ops Manual in aircraft

13.

Stobes and/or Beacon (Anti-Collision)

24.

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.

14.

De-ice/Anti-ice Equipment

1

15.

Cabin Heater

2

16.

Pulselites

3

Incorporated into Preflight checklist

17.

Navigation Charts/Approach Plates

25.

Additional Items

18.

Shooting Door/Window

26.

19.

Shoulder Harness w/Inertia Reel (Rear)

27.

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

Satisfactory

Satisfactory

Pass

Fail

Pass

Fail

1. ELT - Battery Due Date

(

)

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2. ELT 91.207 Complied With

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

27. Audio Controls (No.

)

3. ELT TSO#

91a

126

ELT TSO #: Either TSO 91a, or after January 31, 2009, TSO 126a

28. Transmitter Selectors

4. #1 VHF-AM Comm. Transceiver

720

760

29. Receiver Selectors

5. #2 VHF-AM Comm. Transceiver

720

760

30. Microphone/Drop Cords

6. #1 VHF-FM Comm. Transceiver

(Type

)

31. Trasnceiver PTT

7. #2 VHF-FM Comm. Transceiver

(Type

)

32. ICS Hot Mic/VOX

8. #3 VHF-FM Comm. Transceiver

(Type

)

33. ICS PTT

9. Aux FM Provisions

9. Aux FM Provision:: Verify 10-pin connector operation and VHF-FM antenna installed.

34. Check Pilot ICS

10. GPS or LORAN (Panel Mounted / Handheld)

10. GPS or LORAN: Identify whether Portable or Panel Mounted. Air Attack Type I & II must be panel mounted. Identify whether VFR or IFR Approved.

Panel

Hand

35. Rear Seat PTT

(Mark IFR / VFR as applicable)

IFR

VFR

36. ICS 2,3,4 or

Inph Positions

11. GPS Database (Expiration Date

11. GPS Database: Enter Expiration of Database. Under no circumstances may it be more than 1 year old. )

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12. Transponder (Per 91.413) (Due Date

)

37. Avionics Placarding

13. Altimeter/Static (Per 91.411)(Due Date

)

38. General Condition

14. #1 VOR/LOC (IFR 30 Day Due

)

39. Avionics Records

15. #2 VOR/LOC (IFR 30 Day Due

)

40. Accessory Power (3 Pin)

40. Accessory Power (3 Pin): Verify correct power and polarity.

16. Glideslope

41. Supplementary Radio Kit Capability

41. Supplementary Radio Kit Capability: (Air Attack Kit) Antenna(s) and space for kit.

17. Marker Beacon

42. FM Antenna (For Backcountry Airstrips)

18. DME or TACAN

43. Other

19. ADF or IFR GPS Substitute

44. Other

20. Magnetic Compass Placard

45. Other

21. Cockpit Voice Recorder

21. Cockpit Voice Recorder: As required by Contract. Verify Battery Due Date, Beacon (ping) Check, etc., current.

46. Other

22. Flight Data Recorder

22. Flight Data Recorder: As required by Contract. Verify Battery Due Date, Beacon (ping) Check, etc., current.

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23. TAWS/GPWS

23. TAWS/GPWS: As required by Contract. For Turbine Powered Aircraft Class A Class B Part 121 All N/A Part 135 10 or more Pax seats 6-9 Pax seats

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24. TCAS/TCAD

24. TCAS/TCAD: As required by Contract.

47. Avionics Inspection Completed By:

-----

-----

25. Autopilot w/Flight Director

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26.

Automated Flight Following System

26. Automated Flight Following System: As required by Contract.

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AFF Website Check

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Notes/Discrepancies:

SECTION VII - (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-2700-21, Part 2 (FIRE CARD)

FS-2700-21, Part 2 (Rev. 03/2008)

OMB 0596-0015 (Exp. date omitted by approval of OMB)

USDA - Forest Service

1. Contract/Rental Agreement No.

0

INTERAGENCY FIRE

2. Item No.

0

3. Designated Base

0

AIRPLANE DATA RECORD

4. Region/Area

0

(Reference FSH 5709.16)

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

1. Operator

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

0

0

3. Phone No.

4. Make and Model

5. FAA Registration No.

6. Manufacturer's Serial No.

3. Phone No: Don't forget the Area Code. 0

0

0

0

7. Gross Weight

8. No. of Passenger Seats

9. Hobbs/Tach Reading

10. Hobbs/Tach Reading at Last 100 Hour Insp.

7. Gross Weight: Gross Weight as listed in the Aircraft Flight Manual. Ensure you check for any STC's and Flight Manual Supplements that might increase (or decrease) the Gross Weight. 0

0

0

0

FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA

11. Authorized Uses (Initial appropriate boxes)

Expires (Fill in the Blank)

December-00

(Line Through Unapproved Uses)

a.

0

Passenger

f.

0

Backcountry Airstrip

b.

0

Cargo

g.

0

Approved MEL (D95) (MMEL Rev No.

0

)

c.

0

Resource Reconnaissance

h.

0

Equipped w/Autopilot (Single Pilot IFR)

(A15)

d.

0

Fire Reconnaissance

i.

0

Other

e.

0

Air Attack

(Type

)

j.

0

Other

12. Approved By (Signature)

13. Title

14. Region

15. Date

0

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Sheet 3: FS-2700-21, Part 3

FS-2700-21, Part 3 (Rev. 03/2008)

OMB 0596-0015 (Exp. date omitted by approval of OMB)

USDA - Forest Service

1. Contract/Rental Agreement No.

0

AIRPLANE DATA RECORD

2. Item No.

0

3. Designated Base

0

4. Region/Area

0

(Reference FSH 5709.16)

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

1. Operator

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

3. Phone No.

4. Make and Model

5. FAA Registration No.

6. Manufacturer's Serial No.

0

0

5. FAA Registration No: Self Explanatory. However, if Foreign Registered enter the appropriate Registration Number, i.e. C-FYKH. 0

0

7. Gross Weight

8. No. of Passenger Seats

9. Hobbs/Tach Reading

10. Hobbs/Tach Reading at Last 100 Hour Insp.

0

0

0

0

FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA

11. Authorized Uses (Initial appropriate boxes)

Expires (Fill in the Blank)

December-00

(Line Through Unapproved Uses)

a.

0

Passenger

f.

0

Backcountry Airstrip

b.

0

Cargo

g.

0

Approved MEL (D95) (MMEL Rev No.

0

)

c.

0

Resource Reconnaissance

h.

0

Equipped w/Autopilot (Single Pilot IFR)

(A15)

d.

0

Fire Reconnaissance

i.

0

Other

e.

0

Air Attack

(Type

)

j.

0

Other

12. Approved By (Signature)

13. Title

14. Region

15. Date

0

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Sheet 4: Instructions

INSTRUCTIONS FOR FS 5700-21 AIRPLANE DATA RECORD

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 FS-5700-21, Part 1, the information will be automatically transferred to the FS-5700-21, Parts 2 and 3.

B. Printing: Click on the tab along the lower edge of the worksheet to gain access to the individual sheets FS-5700-21, Part 1; FS-5700-21, Part 2; FS-5700-21, Part 3.

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: “.5”.

2. SPECIAL USES – If a Special Use is Authorized, clicking on the item on the “5700-21 Front Page”, 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 5700-21 Card.

Instructions for Notes: 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 “Airplanes” 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 4 hours 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.