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

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1 Fdrl Dprtmnt o th Environmnt, Trnsport, Enry nd Communitions DETEC Fdrl Oi o Civil Avition FOCA Sty Division Fliht Prsonnl 3003 Brn IR (H) Skill tst Applition nd rport orm Applint's Applint lst nm: irst nm: dt o irth: pl o irth: pl o oriin: ntionlity: privt ddrss: postod: ity: strt: phon/x hom: phon/x oi: -mil: sintur o pplint: initil skill tst rnwl o xpird rtin rptition o ild / prtil pssd skill tst, rom dt: Instrutor lst nm: irst nm: sintur o liht instrutor: Th ATO omirms hvin trind th ndidt in ordn with th pprovd syllus nd tstd him to rdy to pss th skill tst/proiiny hk. ATO nm: ristrtion numr: nm o hi liht instrutor: lotion & dt: sintur o hi liht instrutor: 1 Dtils o liht dt: typ o hlioptr: ristrtion: TR: dprtur/dstintion lok-o: lok-on: lok tim: # o lndins: 2 Rsult o skill tst *dlt s nssry Applint's sintur pssd* ild* prtil pssd* 3 Rmrks Exminr: lst nm: irst nm: xminr uthoristion: lotion nd dt: sintur o liht xminr: FOCA will issu nw lin tr ristrtion o skill tst dt in th linsin systm. Th xpiry dt o th typ rtin on th nw lin miht vry rom th xminrs hnd writtn lin ntry ut shll onsidrd s th rlvnt xpiry dt. FOCA/EASA Form EASA Prt FCL Appndix 7 P 1 o 6

skill tst, rom dt: Instrutor lst nm: irst nm: sintur o liht instrutor: Th ATO omirms hvin trind th ndidt in ordn with th pprovd syllus nd tstd him to rdy to pss th skill tst/proiiny hk.

2 Instrution / xprin rport Gnrl liht xprin rport A opy o th rlvnt loook ps (liht xprin & STD ps) showin th onirmd ompltion o th liht instrution must tthd to this orm. Pls mk sur to mrk your lin numr tothr with your sintur t th ottom o th ps. Dtils o onditions nd lyin xprin or IR(SPH) skill tst ) Lin PPL(H) or CPL(H) or ATPL/VFR (H) vlid until: ) EASA Mdil lss 1 or 2 / with IR vlid until: ) Thortil xmintion IR(H) pssd d) IR rdiotlphony prtil tst pssd dt: dt: ) Niht quliition ompltd ntry in lin: or onirmd with orm dt: ) Fliht xprin (MNM 50 HR PIC): (Exptions. EASA Prt FCL.610 IR ()) I instrution is don on SE (H) ) IFR dul liht instrution: (MNM 50 HR) o whih instrution tim on n IFR-rtiitd hlioptr o whih instrution tim FNPT I (H/A) or in n ropln pprovd or this ours or instrution tim in hlioptr FTD2/3, FNPT II/III or FS I instrution is don on ME (H) (MNM 10 HR) (MAX 20 HR) (MAX 35 HR) ) IFR dul liht instrution: (MNM 55 HR) o whih instrution tim FNPT I (H/A) or in n ropln pprovd or this ours o whih instrution tim in hlioptr FTD2/3, FNPT II/III or FS o whih instrution tim on n IFR-rtiitd multi-nin hlioptr (MAX 20 HR) (MAX 40 HR) (MNM 10 HR) FOCA/EASA Form EASA Prt FCL Appndix 7 P 2 o 6

Dtils o onditions nd lyin xprin or IR(SPH) skill tst ) Lin PPL(H) or CPL(H) or ATPL/VFR (H) vlid until: ) EASA Mdil lss 1 or 2 / with IR vlid until: ) Thortil xmintion IR(H) pssd d) IR rdiotlphony

3 Condut o th skill tst An pplint or n IR shll hv rivd instrution on th sm typ o irrt in th tst An pplint shll pss ll th rlvnt stions o th skill tst. I ny itm in stion is ild, tht stion is ild. Filur in mor thn on stion will rquir th pplint to tk th ntir tst in. An pplint ilin only on stions shll only rpt th ild stion. Filur in ny stion o th rtst, inludin thos stions tht n pssd on prvious ttmpt, will rquir th ppliqunt to tk th ntir tst in. All rlvnt stionss o th skill tst shll ompltd within 6 months. Filur to hiv à pss in ll rlvnt stions o th tst in two ttmps will rquir urthr trinin Furthr trinin my rquird ollowin ild skill tst. Thr is no limit to th numr o skill tsts tht my ttmptd. Th tst is intndd to simult prtil liht. Th rout to lown shll hosn y th xminr. An ssntil lmnt is th ility o th pplint to pln nd ondut th liht rom routin riin mtril. Th pplint shll undrtk th liht plnnin nd shll nsur tht ll quipmnt nd doumnttion or th xution o th liht r on ord. Th durtion o th liht shll t lst on hour. Should th pplint hoos to trmint skill tst or rsons onsidrd indqut y th xminr, th pplint shll rtk th ntir skill tst. I th tst is trmintd or rsons onsidrd dqut y th xminr, only thos stions not ompltd shll tstd in urthr liht. At th disrtion o th xminr, ny mnouvr or produr o th tst my rptd on y th pplint. Th xminr my stop th tst t ny st i it is onsidrd tht th pplint's dmonstrtion o lyin skills rquirs omplt r-tst. An pplint shll ly th hlioptr rom position whr th pilot-in-ommnd untions n prormd nd rry out th tst s i thr is no othr rw mmr. Th xminr will tk no prt in th oprtion o th hlioptr xpt whn intrvntion is nssry in th intrsts o sty or to void unptl dly to othr tri. Rsponsiility or th liht shll didd in ordn with ntionl rultions. Dision hihts/ltitud, minimum dsnt hihts/ltituds nd missd pproh point shll dtrmind y th pplint nd rd y th xminr. An pplint or IR(H) shll indit to th xminr th hks nd dutis rrid out, inludin th idntiition o rdio ilitis. Chks shll ompltd in ordn with th uthorisd hk list or th hlioptr whih th tst is in tkn. Durin pr-liht prprtion or th tst th pplint is rquird to dtrmin powr sttins nd spds. Prormn dt or tk-o, pproh nd lndin shll lultd y th pplint in omplin with th oprtions mnul or liht mnul or th hlioptr usd. Hinwis: Innrt 10 Tn nh Zustllun ds Ernisss vom Skill Tst/Proiiny Chk knn im Bundsmt ür Zivilluthrt, 3003 Brn, shritlih di Ausstllun inr shwrdähin Vrüun ür ds Prüunsrsultt vrlnt wrdn. Rmrqu: Il st possil, dns ls dix jours suivnt l ommunition du résultt du Skill Tst/Proiiny Chk d'otnir, sur réquêt érit uprès d l'oi édérl d l'vition ivil, 3003 Brn, un déision susptil d rours portnt sur l résultt dudit xmn. Avviso: Entro dii iorni dll'invio di rsultti dllo Skill Tst/Proiiny Chk può ssr rihist pr isritto ll'uiio drl dll'vizion ivil, 3003 Brn, un dision impunil sull'sito dll'sm. Rmrk: Within 10 dys tr ript o this skill tst/proiiny hk rsult, n ppl l dision out th tst / hk rsults my dmndd y writin in on o th oiil lnus (Grmn/Frnh/Itlin), to th Fdrl Oi o Civil Avition, 3003 Brn. FOCA/EASA Form EASA Prt FCL Appndix 7 P 3 o 6

Filur in ny stion o th rtst, inludin thos stions tht n pssd on prvious ttmpt, will rquir th ppliqunt to tk th ntir tst in. All rlvnt stionss o th skill tst shll ompltd within 6 months.

4 Us o hklist, irmnship, nti-iin/d-iin produrs,t., pply in ll stions Stion 1 Us o liht mnul (or quivlnt) spilly / prormn lultion, mss & ln 1 ttmpt 2 ttmpt Dprtur Us o Air Tri Srvis doumnt, wthr doumnt Prprtion o ATC liht pln, IFR liht pln / lo d Pr-liht insption Wthr minim Txiin/Air txi in omplin with ATC or instrutions o instrutor Pr-tk o riin, produrs nd hks h Trnsition to instrumnt liht i Instrumnt dprtur produrs Stion 2 1 ttmpt 2 ttmpt Gnrl hndlin Control o th hlioptr y rrn solly to instrumnts, inludin: lvl liht t vrious spds, trim Climin nd dsndin turns with sustind rt on turn Rovris rom unusul ttituds, inludin sustind 30 nk turns nd stp dsndin turns FOCA/EASA Form EASA Prt FCL Appndix 7 P 4 o 6

liht pln / lo d Pr-liht insption Wthr minim Txiin/Air txi in omplin with ATC or instrutions o instrutor Pr-tk o riin, produrs nd hks h Trnsition to instrumnt liht i Instrumnt

5 Us o hklist, irmnship, nti-iin/d-iin produrs,t., pply in ll stions Stion 3 1 ttmpt 2 ttmpt En-Rout IFR produrs Trkin, inludin intrption,.. NDB, VOR, RNAV Us o rdio ids Lvl liht, ontrol o hdin, ltitud nd irspd, powr sttin d Altimtr sttins Timin nd rvision o ETAs Monitorin o liht prorss, liht lo, ul us, systms mnmnt I prottion produrs, simultd i nssry nd i pplil h ATC liison - omplin - R/T produrs Stion 4 1 ttmpt 2 ttmpt Airport prision pproh Aph Sttin nd hkin o nvitionl ids, idntiition o ilitis Arrivl produrs, ltimtr hks Approh nd lndin riin, inludin dsnt / pproh / lndin hks d* Holdin produr Complin with pulishd pproh produr Approh timin Altitud, spd, hdin ontrol (stilisd pproh) h* Go-round tion i* Missd pproh produr / lndin j ATC liison - omplin - R/T produrs * To prormd in ithr Stion 4 or Stion 5 FOCA/EASA Form EASA Prt FCL Appndix 7 P 5 o 6

simultd i nssry nd i pplil h ATC liison - omplin - R/T produrs Stion 4 1 ttmpt 2 ttmpt Airport prision pproh Aph Sttin nd hkin o nvitionl ids, idntiition o ilitis Arrivl produrs, ltimtr hks Approh nd

6 Us o hklist, irmnship, A/C limittions must rsptd in ll stions Stion 5 1 ttmpt 2 ttmpt Airport Non-prision pproh Aph Sttin nd hkin o nvitionl ids, idntiition o ilitis Arrivl produrs, ltimtr hks Approh nd lndin riin, inludin dsnt / pproh / lndin hks d* Holdin produr Complin with pulishd pproh produr Approh timin Altitud, spd, hdin ontrol (stilisd pproh) h* Go-round tion i* Missd pproh produr* / lndin j ATC liison - omplin - R/T produrs * To prormd in ithr Stion 4 or Stion 5 Stion 6 (i pplil) Anorml nd mrny produrs This stion my omind with stions 1 throuh 5. Th tst shll hv rrds to ontrol o th hlioptr, idntiition o th ild nin, immdit tions (touh drills), ollow up tions nd hks, nd lyin ury, in th ollowin situtions: 1 ttmpt 2 ttmpt Simultd nin ilur tr tk-o nd on/durin pproh* (t s ltitud unlss rrid out in FS or FNPT II/III, FTD 2,3) * ME (H) only Filur o stility umnttion dvis / hydruli systm (i pplil) Limitd pnl d Autorottion nd rovry to pr-st ltitud Prision pproh mnully without liht dirtor* Prision pproh mnully without liht dirtor* Prision pproh mnully with liht dirtor* *only on itm to tstd FOCA/EASA Form EASA Prt FCL Appndix 7 P 6 o 6

lndin j ATC liison - omplin - R/T produrs * To prormd in ithr Stion 4 or Stion 5 Stion 6 (i pplil) Anorml nd mrny produrs This stion my omind with stions 1 throuh 5.

SKILL TEST IR(H) HELICOPTER SE ME Application and report form A. Udfyldes af ansøgeren/to be filled out by the applicant:

SKILL TEST IR(H) HELICOPTER SE ME Applition n rport orm A. Uyls nsørn/to ill out y th pplint: CPR-nr./Dt o Birth: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: