Non-standard Helicopter & HELM Mgmt. Request
(One Manager Assigned to Two Restricted/Limited Helicopters)
Or
(Restricting Use – Standard to Limited)
			
Date of Request:      

Forest:      	Incident Name:       		 

Requesting Official:      	Title:               

Helicopter Manager Name:      	“O”#:      

Helicopter Make and Model:	1)      	N#:      	“A”#:      

2)      	N#:      	“A”#:      

 Manager is qualified and in full agreement to manage 2 helicopters		
	(Trained to 310-1 HCWN standards)				                     yes         no
 A second qualified HELM is on order with active efforts to fill		
											         yes	no
 Both Helicopters are physically side-by-side at the same helibase		
											         yes	no
 A fully qualified HEB1 or HEB2 is assigned to the helibase		
											         yes         no
				 
 If either the manager or aircraft changes from the original approval, a new approval will need to be obtained.
2 If “N” number of second helicopter is unknown, a tentative approval will be given. Once the “N” number is provided and the helicopter meets FS standards, a full approval will be given. 

Requesting Standard Helicopter be operated as Limited category:		
											        Yes	no
Rational:												        	
                                                                                                                   		                           . 
													
      Helicopter Make and Model:  	                                    	N#:        	“A”#:          

Tentative Approval: ____________________________________	   Date:                          .
(If second “N” number unknown)	    Title: ___________________________________________	
Approved:                                                                                         	   Date:                          .
	Title: _______________________________________		
Rescinded:  ___________________________________________	   Date: _____________