TEMPORARY TOWER REQUEST FORM
(Note - this form should be used in conjunction with the checklists located in Chapter 11 of the Interagency Airspace Coordination Guide (www.fs.fed.us/r6/fire/aviation/airspace ).  Please attach this form to the Resource Order and forward both forms to the appropriate FAA Regional Operations Center (ROC), through established ordering channels.

I.  GENERAL INFORMATION:
Incident Name ________________________Management/Fiscal Code _____________________
Resource Order Number ________________Request Number _______ Date_________________

II.  POINTS OF CONTACT
				Name/Agency					Telephone 
Ordering Unit __________________________________		________________________
Air Ops/Air Support _____________________________		________________________
Local or Expanded Dispatch _______________________		________________________
Geographic Area Coordination Ctr__________________		________________________
National Interagency Coordination Ctr_______________		________________________
FAA POC at ROC     ____________________________		________________________  
Name / Phone Number of Airport Owner / Operator_____________________________________
Has the Airport Owner been notified?	YES		NO
Requested Operational Hours:	____________________________
Estimated Length of Duration	:	____________________________

III.  SUPPORT INFORMATION
Closest City/Town _____________________	State _________________
Where is the proposed location of the temporary tower (Select one or explain):
	Airport Name & FAA Code__________________________Helibase_________________
	Incident Command Post ____________________________	Other____________________

Is a facility available on site for use as a tower (Select one or explain)?
	FBO Site/Room rental/etc__________________Rental Trailer ______________________ 
	Facility to be built on site___________________Other ____________________________
Conditions to expect for overnight at site:  Camp ________________ Hotel__________________ 

Is a vehicle (Gov’t or rental) available for tower personnel?    YES		NO
Please attach detailed driving directions to the reporting site 
 Note Road closures, hazardous conditions, easiest route of travel, etc

IV.  EQUIPMENT SURVEY - Refer to Chapter 11 checklist / Interagency Airspace Coordination Guide What equipment do you currently have (radios, etc) for use by tower personnel?

What equipment do you need?  (radios, etc)

Have you completed an inventory of equipment?