IR AEROPLANE APPLICATION AND REPORT FORM FOR THE INSTRUMENT RATING SKILL TEST ON AEROPLANE ACCORDING TO PART FCL SUBPART G AND APPENDIX 7 TO COMMISSION REGULATION (EU) NO 1178/2011 OF 3 NOVEMBER 2011 A. IR Sgle enge IR Multi enge B. completed by the examer Date of test Flight time total C. completed by the applicant Date of birth (yyyy-mm-dd) Last name State of licence issue First and middle names Street or box Country Telephone Postal code and city E-mail address Place Date Signature of applicant FLIGHT TIME Total Cross-country Night Flight Instrument Instrument ground time D. completed by ATO TRAINING COMPLETED AND APPLICANT APPROVED Name of ATO Date Name block letters Flight time durg course Instrument time durg course Signature Head of Trag Total time FTD/FFS E. completed by the examer RESULT OF THE TEST Fal result: Temporary ratg issued ed Partial pass Temporary ratg not issued ed Place and date: Stamp Signature of examer: Examer s certificate number: L 1645-9 Send to: Transportstyrelsen, Certifikat, SE-601 73 Norrköpg, Sweden. Internet: www.transportstyrelsen.se
F. TO BE COMPLETED BY THE EXAMINER Before Test/check Written test passed Valid PPL/CPL/ATPL/MPL licence Valid Medical Class 1/2 Night Qualification Basic strument flight module previously completed (certificate attatched) Personal identification card Cross country 50 h PIC ME 55h strument time I hereby declare that I have read the formation accordg to FCL.1015 c, and checked all prerequisites for this test Valid language proficiency Valid R/T certificate class Swedish English (examer) * ) = May be performed a Flight Simulator or FNPT II +) = May be performed either Section 4 or Section 5 G. SECTION 1 PRE-FLIGHT OPERATIONS AND DEPARTURE Use of checklist, airmanship, anti/de-icg procedures, etc., apply all sections. 1.a 1.b Use of flight manual (or equivalent) especially a/c performance calculation, mass and balance Use of Air Traffic Services document, weather document 1.c Preparation of ATC flight plan, IFR flight plan/log 1.d Pre-flight spection 1.e Weather Mima 1.f Taxig 1.g Pre-take off briefg. Take off 1.h Transition to strument flight 1.i Instrument departure procedures, altimeter settg 1.j ATC liaison - compliance, R/T procedures Examers itials when SECTION 2 GENERAL HANDLING 2.a Control of the aeroplane by reference solely to struments, cludg: level flight at various speeds, trim 2.b Climbg and descendg turns with sustaed Rate 1 turn Examers itials when
SECTION 2 GENERAL HANDLING (CONT D) 2.c Recoveries from unusual attitudes, cludg sustaed 45 bank turns and steep descendg Turns 2.d* 2.e Recovery from approach to stall level flight, climbg/descendg turns and landg configuration Limited panel, stabilised climb or descent at Rate 1 turn onto given headgs, recovery from unusual attitudes Examers itials when SECTION 3 En route IFR procedures 3.a Trackg, cludg terception, e.g. NDB, VOR, RNAV 3.b 3.c 3.d Use of radio aids Level flight, control of headg, altitude and airspeed, power settg, trim technique Altimeter settgs 3.e Timg and revision of ETAs (En-route hold if required) 3.f Monitorg of flight progress, flight log, fuel usage, systems management 3.g Ice protection procedures, simulated if necessary 3.h ATC liaison and compliance, R/T procedures Examers itials when SECTION 4 PRECISION APPROACH PROCEDURES 4.a Settg and checkg of navigational aids, identification of facilities 4.b 4.c 4.d+ Arrival procedures, altimeter checks Approach and landg briefg, cludg descent/approach/ landg checks Holdg procedure 4.e Compliance with published approach procedure 4.f Approach timg 4.g Altitude, speed headg control, (stabilised approach) 4.h+ Go-around action 4.i+ Missed approach procedure / landg 4.j ATC liaison compliance, R/T procedures Examers itials when
SECTION 5 NON-PRECISION APPROACH PROCEDURES 5.a Settg and checkg of navigational aids, identification of facilities 5.b Arrival procedures, altimeter settgs 5.c Approach and landg briefg, cludg descent/approach/landg checks 5.d+ Holdg procedure 5.e Compliance with published approach procedure 5.f Approach timg 5.g Altitude, speed, headg control, (stabilised approach) 5.h Go-around action 5.i Missed approach procedure/landg 5.j ATC liaison compliance, R/T procedures Examers itials when SECTION 6 (if applicable) Simulated asymmetric flight 6.a Simulated enge failure after take-off or on go-around 6.b Asymmetric approach and procedural go-around 6.c Asymmetric approach and landg, missed approach procedure 6.d ATC liaison: compliance, R/T procedures Examers itials when
DETAILS OF THE FLIGHT H. Registration of a/c Block on On ground Departure aerodrome Block off Take off Destation aerodrome Total block Total Aircraft type PIC I. REMARKS Item no Comments J. Additional formation regardg the test Debriefg/Taken parts of comments above Date Signature of applicant
Instructions for completg form L 1645 Instrument ratg Aeroplane, A. Please tick appropriate boxes. B. Please enter the complete formation. Flight time total is the applicants total flight time on the relevant category of aircraft. C. Personal formation of the applicant D. This section is to be completed by the Head of Trag of the ATO. E. The result of the test. Please note that only examers certified by a the authority Sweden, Norway and Denmark can issue a Temporary Ratg. F. This section is a checklist of prerequisites for the examer to check before the test/check.. Please note that the examer must sign and thus affirm that he has checked all prerequisites before the test. G. Test/check protocol. * ) = May be performed a Flight Simulator or FNPT II +) = May be performed either Section 4 or Section 5 H Details of the flight. I. Comments regardg tested items please dicate the item commented. The applicant signs that he/she has taken part of the result of the test. J. Additional formation regardg the conditions durg test...