SINGLE-PILOT AEROPLANE (Non-HPCA)
SKILL TEST
PROFICIENCY CHECK
Licence Endorsement:
PIC
CO-PILOT
VFR
IFR
Application and report form
A. Udfyldes af ansøgeren/To be filled out by the applicant:
CPR-nr./Date of Birth:
Certifikat nr./Licence no.: (If any)
Fornavne/First name(s):
Udstedende Stat/State of Licence
Issue:
Efternavn/Last name:
Gade eller vej:/Street:
Postnr. og by/Postal code and city:
e-mail:
Dato for underskrift/Date of signature:
Tlf./Telephone:
Underskrift/Signature:
B: Udfyldes af skolen/To be filled out by ATO:
Name of ATO: (Use stamp):
Total:
Specification of flight time Only Skill Test for the issue of Class/type rating and Instrument Rating
PIC:
Instrument time::
Flight time during training:
Total:
Specification of flight time Proficiency check
Total on class/type:
Route sectors latest validity period:
Total:
Instrument:
ME:
If issue or renewal: Flight time
during training:
I hereby certify that the applicant has passed the required training and that the applicant fulfils all the requirements for the test or check to be
taken
Date of signature of Head of Training
Name and Signature of Head of Training
C: To be filled out by the Examiner:
Date of test:
Licence Endorsement:
Name of Examiner or stamp:
Type of aircraft:
Stamp of Examiner,
Authorisation no. of Examiner or stamp:
I hereby certify that the applicant has passed the required training and that the applicant fulfils all the requirements for the test or check to be
taken
Date of signature of Examiner
Signature of Examiner
Result of the test
Section 1:
Passed
Section 2:
Failed
Passed
Section 3:
Failed
Passed
Final result:
Passed
Section 4:
Failed
Passed
Section 5:
Failed
Passed
Failed
Section 6:
Not Applicable
Passed
Failed
Temporary licence issued (copy enclosed):
Partial Pass
Failed
Yes
No Valid until:
Proficiency check only: I have entered the following details in the applicants licence:
Rating
Date of check
Valid until
Rating
Date of check
Valid until
SP(A) Non-HPCA december 2014
Page 1 of 5
Trafikstyrelsen, Edvard Thomsens Vej 14, 2300 Kbh. S., Tlf.: +45 72218800, e-mail: [email protected]
For detailed instructions see Commision Regulation 1178/2011 Appendix 9
Use of the aeroplane checklists, airmanship, control of aeroplane by external visual reference, anti-icing/de-icing procedures and
principles of threat and error management apply in all sections
1.1
Pre-flight, incl. Documentation, Mass and Balance, Weather briefing, NOTAM
1.2
Pre-start checks. External/internal
1.3
Engine starting: Normal and malfunctions
1.4
Taxiing
1.5
Pre-departure checks. Engine run-up
1.6
Take-off procedures (crosswind if available)
P
1.7
Climbing: Vx/Vy, Turns onto headings, Level off
P
1.8
ATC liaison - Compliance, R/T procedure
P
Failed
Passed
Mandatory
M
P
M
P
M
P
M
2.2
Steep turns (360° left and right, 45° bank)
P
M
P
M
P
M
Failed
P
Failed
Straight and level flight at various airspeed
Passed
2.1
Passed
A
Mandatory
M
Instructor initials when training completed
FS
FTD
SECTION 2 Airwork (VMC)
A
Instructor initials when training completed
FS
SECTION 1 Departure
FTD
Name of Applicant:
Stalls and recovery
i:
Clean stall
2.3
iii: Approach to stall landing configuration and
power
2.4
iv: Approach to stall, climbing turn take-off flap
and climb power
(single engine aeroplane only)
Handling using autopilot and flight director (may
be conducted in section 3)
2.5
ATC liaison - Compliance, R/T procedure
3A.1
Flight plan, dead reckoning and map reading
3A.2
Maintenance of altitude, heading and speed
3A.3
Orientation, timing and revision of ETAs
3A.4
Use of radio navigation aids
3A.5
Flight management(flight log, routine checks
including fuel, systems and icing)
3A.6
ATC liaison - Compliance, R/T procedure
SP(A) Non-HPCA december 2014
A
Instructor initials when training completed
FS
(See App. 3 to JAR-FCL 1.240 note 3 and 4)
FTD
SECTION 3A En route procedures VFR
Mandatory
ii: Approach to stall descending turn approach
configuration and power
Page 2 of 5
For detailed instructions see Commision Regulation 1178/2011 Appendix 9
Use of the aeroplane checklists, airmanship, control of aeroplane by external visual reference, anti-icing/de-icing procedures and
principles of threat and error management apply in all sections
3B.1∗
Departure IFR
P
M
3B.2∗
En route IFR
P
M
3B.3∗
Holding procedures
P
M
3B.4∗
ILS to DH/DA of 200 FT or to procedure minima
(Autopilot may be used to glideslope intercept)
P
M
3B.5∗
Non-precision approach to MDH/A and MAP
P
M
Failed
Passed
A
FS
FTD
SECTION 3B Instrument flight
Instructor initials when training completed
Mandatory
Name of Applicant:
Flight exercises including simulated failure of
compass and attitude indicator
3B.6∗
Rate 1 turns
P
M
Recoveries from unusual attitudes
Passed
Failed
Passed
Failed
SECTION 4 Arrival and landings
Instructor initials when training completed
Mandatory
ATC liaison - Compliance, R/T procedure
A
3B.8∗
P
FS
Failure of localiser or glideslope
FTD
3B.7∗
Aerodrome arrival procedure
4.1
P
M
4.2
Normal landing
P
M
4.3
Flapless landing
P
M
4.4
Crosswind landing (if suitable conditions)
P
4.5
Approach and landing with idle power from up to
2000 FT (single engine aeroplane only)
P
4.6
Go-around from minimum height
P
4.7
Night go-around and landing (if applicable)
4.8
ATC liaison - Compliance, R/T procedure
5.1
5.2
5.3
5.4
Rejected take-off at a reasonable speed
Simulated engine failure after take-off
(single engine aeroplanes only)
Simulated forced landing without power
(single engine aeroplanes only)
Simulated emergencies
i: Fire or smoke in flight
ii: Systems malfunctions as appropriate
5.5
Engine shutdown and restart (ME Skill test only)
5.6
ATC liaison - Compliance, R/T procedure
SP(A) Non-HPCA december 2014
Mandatory
P
A
Instructor initials when training completed
FS
FTD
SECTION 5 Abnormal and emergency procedures.
(This section may be combined with sections 1 through 4)
M
P
M
P
M
P
M
P
P
Page 3 of 5
For detailed instructions see Commision Regulation 1178/2011 Appendix 9
Use of the aeroplane checklists, airmanship, control of aeroplane by external visual reference, anti-icing/de-icing procedures and
principles of threat and error management apply in all sections
6.1∗
Simulated engine failure during take-off
(At as safe altitude unless carried out in FS or
FNPT II)
P
6.2∗
Asymmetric approach and go-around
P
M
6.3∗
Asymmetric approach and full stop landing
P
M
6.4
ATC liaison - Compliance, R/T procedure
X
Failed
Passed
ing completed
A
FS
Instructor initials when trainFTD
SECTION 6 Simulated asymmetric flight
(This section may be combined with sections 1 through 5)
Mandatory
Name of Applicant:
M
Details of the flight
Destination aerodrome
On block
On ground
Departure aerodrome
Off block
Airborne
Aircraft registration
Total block time
Total airborne time
No. of landings:
Remarks/Overall assessment/Reasons for failure (if applicable):
Name of instructor present at the Skill Test:
Signature of Examiner:
SP(A) Non-HPCA december 2014
Signature of Applicant:
Page 4 of 5
For detailed instructions see Commision Regulation 1178/2011 Appendix 9
Use of the aeroplane checklists, airmanship, control of aeroplane by external visual reference, anti-icing/de-icing procedures and
principles of threat and error management apply in all sections
Name of Applicant:
In accordance with ARA.GEN.315(a), (b) – (c)
Undertegnede bekræfter hermed, at jeg ved ansøgningstidspunktet
1. ikke var ikke i besiddelse af et personligt certifikat, rating, tilladelse eller
attestation med samme anvendelsesområde og i samme kategori udstedt i en anden medlemsstat;
2. ikke har ansøgt om et personligt certifikat, rating, tilladelse eller
attestation med samme anvendelsesområde og i samme kategori i en anden medlemsstat; og
3. aldrig har haft et personligt certifikat, rating, tilladelse eller attest
med samme anvendelsesområde og i samme kategori udstedt i en anden medlemsstat, som er
tilbagekaldt eller suspenderet i anden medlemsstat.
Note:
Ukorrekte oplysninger vedrørende ovenstående, kan være diskvalificerende for udstedelse af certifikat,
rating, tilladelse m.v.
Undersigned hereby confirm that I at the time of application
1. was not holding any personnel licence, certificate, rating, authorisation or
attestation with the same scope and in the same category issued in another
Member State;
2. has not applied for any personnel licence, certificate, rating, authorisation or
attestation with the same scope and in the same category in another Member
State; and
3. has never held any personnel licence, certificate, rating, authorisation or attestation
with the same scope and in the same category issued in another Member State
which was revoked or suspended in any other Member State.
4.
Note:
Incorrect information regarding the above can be disqualifying for obtaining a certificate, rating, authorization, etc.
Dato:/Date:
Underskrift:/Signature:
SP(A) Non-HPCA december 2014
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