FS1388 HPR APRIL 2018
EQUIPMENT SERVICE REQUEST WILDFIRE MANAGEMENT BRANCH
Section A COMPLETED BY Ministry Representative FAX TO: CORPORATE
WILDFIRE SERVICES AT 250-565-6634 OR EMAIL TO
[email protected]
Hire Date: Task Force Licensee:
Requested by: Employee Number: Zone: Ministry Representative
Full Legal Company Name:
Contact Name:
Phone Number: Alt. Phone Number: Fax #:
Excavator Forestry Excavator Feller Buncher Crawler Lowbed
Skidder Water Tender Pick-up Truck ATV
Section B COMPLETED BY Hired Company FAX TO: CORPORATE WILDFIRE
SERVICES AT 250-565-6634 OR EMAIL TO [email protected]
Mailing Address: City, Province, Postal Code:
Email: WorkSafe BC Number:
Equipment
Make & Model: Year: Size/Capacity:
Excavator Attachments: Bucket/Clam Shell/Grapple Size: Crawler
Attachments:
Skidder Types: Chains: S ize: Tank Capacity: Pump Size: Water
Tender Attachments: Tank Capacity:
Pump size: Extra Hose:
Vehicle: 4x2 4x4 GVW: Pilot Vehicle: Yes No
Section C COMPLETED BY Corporate Wildfire Services AND fax/email
to company and zone office for their records Equipment Rate
Calculation File Number: 10005-40/EQ19PGE Page # Rates
LO Rate
AF Rate
Lim Dim New AF Rate
POH Standby
Calculations Completed By : OS Standby
Employee Number: Daily Bare Tank Rental Rate (Standby is paid at
½ this rate)
Modification Number: Daily Bare Rental Pump Rate (Standby is
paid at ½ this rate)
Hire Date: Task Force Licensee: Requested by: Employee: Zone:
Full Legal Company Name: Contact Name: Phone: Alt Phone: Fax:
Excavator: OffForestry Excavator: OffFeller Buncher: OffCrawler:
OffLowbed: OffSkidder: OffWater Tender: OffPickup Truck: OffATV:
OffMailing Address: CityProv: Email: WCB: Year: SizeCapacity: 4x2:
OffYes_4: Off4x4: OffNo_4: OffEquipment Rate Calculation File
Number 107020EQRow1: RatesLO Rate: Equipment Rate Calculation File
Number 107020EQRow2: RatesAF Rate: Equipment Rate Calculation File
Number 107020EQRow3: Equipment Rate Calculation File Number
107020EQRow4: RatesEmployee Number Daily Bare Tank Rental Rate
Standby is paid at ½ this rate: RatesModification Number Daily Bare
Rental Pump Rate Standby is paid at ½ this rate: Calculations
Completed By: EMP #: MOD #: Pg: File #: Water Tender 1: [ ]GVW: [
]Excavator Size: Chain Sizes: []Extra Hose: [ ]OS SB: New AF Rate -
48.50 / 2 + 48.50 = Crawler 1: [ ]Make & Model: Excavator 1: [
]Excavator 2: [ ]Skidder Type: [ ]Pump Size: [ ]Tank Capacity: [
]Crawler 2: [ ]OS: RatesLim DIm: POH: AF Rate / 2 =RatesNew AF
Rate: POH SB:
