Application & report form

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Communications DETEC

Federal Office of Civil Aviation FOCA Safety – Division Flight Personnel 3003 Bern

Application & report form

Applicant

last name: first name: date of birth:

place of birth: place of origin: nationality:

post code: city: street:

phone/mobile phone/fax office:

e-mail: signature of applicant:

Employed as pilot by (AOC holder):

Invoice to be sent to:

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applicant

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company internal



company

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initial TR/CR/TMG skill test NO INITIAL IR ON THIS FORM

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Repetition from date:

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revalidation TR/CR

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revalidation IR

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ME/IR revalidation w/o TR/CR revalidation

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renewal of expired TR/CR

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renewal of expired IR

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STI(A) prof check acc Part-FCL.940.STI Only in case of initial rating or renewal of expired rating:

Instructor

last name: first name:

licence number: signature of flight instructor:

The ATO confirms that the candidate has been trained according to the approved syllabus and assures the level of proficiency required

ATO

name: registration number:

name of chief flight instructor: licence number:

location & date: signature of chief flight instructor:

1 Details of flight

date: type of aircraft: registration: CR: TR:

departure/destination block-off: block-on: block time: # of landings:

2 Result of skill test/proficiency check

*delete as necessary Applicant's signature TR / CR

IR

3 Remarks

Revalidation 0(&575only:

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examiner flight (FCL740.A(a))(2)(ii)) date: (examiner's signature)

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10 route sectors

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combined LPC/OPC (FCL.740.A(a)(3))

Examiner:

last name: first name:

licence No: examiner authorisation: valid until:

location and date: signature of flight examiner:

Applicant's licence number:

pass* fail*

fail* partial pass*

CR/TR/IR SP (A)

except complex HPA

partial pass* pass*

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General flight instruction report

Summary of conditions (for skill tests initial ratings only):

For initial Single Pilot CR / TR skill test

a) Pilot licence  PPL  CPL  ATPL date of issue:

b)  1 or  2 /  IR valid until:

c) Theoretical examination for type rating (within 6 months prior to the skill test) d)

A aircraft FS flight simulator FTD flight training device OTD other training device

Additionally for initial Single Pilot MULTI ENGINE CR / TR skill test

e) Flight experience as PIC(A) (MNM 70 HR)

f) Dual flight instruction normal conditions (MNM 02:30 HR)

g) Dual flight instruction abnormal conditions (engine failure procedures / asymmetric flight) (MNM 03:30 HR)

Additionally for High Performance Aircraft CR / TR

h) Flight experience (MNM 200 HR) hours:

i) ATPL(A) theory or passed:

high performance aeroplanes (HPA) course Part VFR passed:

Part IFR passed:

For holders of a LAPL(S) or Sailplane License only:

Requirements to obtain a TMG extension

j) Flight instruction on a TMG (MNM 6 HR)

including Dual flight instruction (MNM 4 HR) hours:

including 1 solo cross-country flight Leg 1 DEP DEST KM

Leg 2 DEP DEST KM

Total (MNM 150 KM or 80 NM great circle distance) KM

For holders of an IR SEP

Requirements to obtain IR MEP

k) Flight instruction in IR in MEP (MNM 05:00 HR) hours:

of which in FFS or FNPTII (MAX 03:00 HR) hours:

Hinweis:

Remarque:

A copy of the relevant logbook pages (flight experience & STD pages) showing the confirmed completion of the flight instruction must be attached to this form. Please make sure to note your licence number together with your signature at the bottom of the pages.

hours: Flight instruction for class / type rating according an approved

syllabus completed:

hours: hours: EASA Medical class

hours: date:

Innert 10 Tagen nach Zustellung des Ergebnisses des Skilltests/Proficiencychecks kann beim Bundesamt für Zivilluftfahrt, 3003 Bern, schriftlich die Ausstellung einer beschwerdefähigen Verfügung über das Prüfungsresultat verlangt werden.

hours: hours: hours:

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Applicant's licence number: Use of checklist, airmanship, A/C limitations must be respected in all sections

*

The starred (*) items shall be flown solely by reference to instruments or the rating will be restricted to VFR only MMandatory item

Oral examination for holders of a LAPL(S) and SPL for the TMG extension only

to be assessed during the skill test pass fail

M M M M M examiner's signature

Section 1

pass fail pass fail Pre-flight including:

Documentation, mass and balance, weather briefing, NOTAM

M Engine starting: Normal Malfunctions M M M Take - off procedure:

Normal with Flight Manual flap settings Crosswind (if conditions available) Climbing:

Vx/Vy

Turns onto headings Level off examiner's signature

Departure

passed failed

30 70 1.4Taxiing

1.5Pre-departure checks: _{Engine run-up (if applicable)} 1.6

1.8ATC liaison - Compliance - R/T procedures

please delete as necessary Operational procedures

please delete as necessary Aircraft general knowledge

1.3 60Navigation 20 1.7 1 attempt 2 attempt 1.1

1.2Pre-start checks, external/internal 80Principles of flight

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Section 2

pass fail pass fail

M

Stalls and recovery: _M

M

examiner's signature

Section 3A

see Appendix 9, B . 5 (c) and (d)

passed failed

clean stall (i)

Airwork (VMC)

3A.4

passed failed

1 attempt 2 attempt 2.3

Straight and level flight at various airspeeds including flight at critically low airspeed with and without flaps. (including approach to VMCA when applicable)

3A.2

Use of radio navigation aids (if applicable)

please delete as necessary

3A.3

3A.5

Approach to stall in descending turn with bank with approach configuration and power

2.1

ATC liaison - Compliance - R/T procedures (iv)

Approach to stall in landing configuration and power 2.2

(iii) (ii)

please delete as necessary Maintenance of altitude, heading and speed

Enroute procedures VFR

2 attempt 1 attempt

Steep turns (360° left and right at 45° bank)

Approach to stall, climbing turn with take-off flap and climb power (single engine aeroplane only)

3A.1

Handling using autopilot and flight director (may be conducted in section 3), if applicable

3A.6

Flight plan, dead reckoning and map reading 2.4

2.5

Flight management (flight log, routine checks including fuel, systems and icing)

ATC liaison - Compliance - R/T procedures Orientation, timing and navigation aids (if applicable)

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Applicant's licence number:

Section 3B

M M M M M Rate 1 turns

Recovery from unusual attitudes M

Section 4

M M M M examiner's signature

passed failed

Instrument flight

Arrival and landings

3B.6*Flight exercises including simulated failure of the compass and _{attitude indicator:}

Failure of localizer or glideslope Holding Procedures

please delete as necessary

Normal landing Flapless landing

Crosswind landing (if suitable conditions)

Go-around from minimum height

ATC liaison - Compliance - R/T procedures 3B.7* 4.2 4.3 4.4 4.6 3B.4* 3B.2*

Night go-around and landing (if applicable) 4.8ATC liaison - Compliance - R/T procedures

please delete as necessary 3B.8

4.5Approach and landing with idle power from up to 2000' above _{the runway (single engine aeroplane only)} 4.1Aerodrome arrival procedure

4.7

Non-precision approach to MDH/A and MAP

ILS to DH/A of 200' (60m) or to procedure minima (autopilot may be used for glideslope intercept)

Departure IFR

Enroute IFR 3B.1*

3B.5* 3B.3*

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Section 5

This section may be combined with Sections 1 to 4

M M M 5.4Simulated emergencies: examiner's signature

Section 6

M M M examiner's signature

passed failed

Simulated asymmetric flight

1 attempt 2 attempt 2 attempt 1 attempt

Abnormal & emergency procedures

please delete as necessary please delete as necessary Engine shutdown and restart (ME skill test only)

ATC liaison - Compliance - R/T procedures

Simulated forced landing without power (single engine aeroplanes only)

Systems malfunctions as appropriate

Simulated engine failure during take-off (at a safe altitude unless carried out in FS or FNPT II)

Asymmetric approach and go-around procedure

Asymmetric approach and full stop landing Rejected take-off [at reasonable speed]

(i) (ii) 6.4 6.3* 6.2* 6.1* 5.3 5.2 5.1

ATC liaison - Compliance - R/T procedures 5.5

5.6

Fire or smoke in flight

Simulated engine failure after take-off (single engine aeroplanes only)