Instructions For Use of the


Pilot Proficiency Check Form



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12.5 Pilot Proficiency Check Form


Name of applicant

Name of Examiner

License Held - Type and Number

Location of Flight Test

Date of Flight Test

Name of Recommending Instructor

Aircraft Group

Single Engine Airplane

Aircraft Type

Simulator Type

Multi-Engine Airplane

Helicopter




Exercise

Pass

Fail

Remarks

1.

Oral Examination










2.

Pre-Flight













A. Aircraft Inspection













B. Cockpit and System Checks










3.

Taxiing










4.

Powerplant Checks










5.

Normal Take-off










6.

Crosswind Take-off










7.

Powerplant Failure on Take-off










8.

Rejected take-off










9.

Approaches to Stall










10.

Instrument Procedures













A. Departure & Arrival













B. Holding













C. Instrument Approaches













D. Circling Approach










11.

Specific Flight Characteristics










12.

Engine Failures










13.

Normal Landing










14.

Crosswind Landing










15.

landing with Failed Powerplant










16.

Rejected landing










17.

Normal & Abnormal Procedures













A.













B.










18.

Emergency Procedures













A.













B.













Final Assessment
















Examiner’s Signature



Date






Examiner Comments









































12.6 Extension to Maximum Flight Duty Time



(Company Name)
Extension To Maximum Flight Duty Time

Due To Unforeseeable Operational Circumstances



Date


























































PIC













SIC











































Other Crew members




















































Aircraft

Type











Aircraft

Registration












































Planned Reporting in Time







Actual Reporting in Time





































Planned Finish Time







Actual Finish Time





































Planned Duty Time







Actual Duty Time




































Description of Events
























PIC Signature




Date












































































Flight Department Manager Comments

13Company Directives




Include Company directives here.


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1 Extract from Principles and Guidelines for Duty and Rest Scheduling in Corporate and Business Aviation published by the Flight Safety Foundation, February 1997.

2 Extract from Principles and Guidelines for Duty and Rest Scheduling in Corporate and Business Aviation published by the Flight Safety Foundation, February 1997.

3 PANS ATM Doc 4444, 15th Ed., Amendment 2, effective 19 November 2009, contains significant changes to oceanic emergency/contingency procedures.

Male – Female - Child



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