SKILL TEST IR(H) HELICOPTER SE ME Application and report form A. Udfyldes af ansøgeren/to be filled out by the applicant:
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1 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: G llr vj:/strt: Postnr. o y/postl o n ity: -mil: Tl./Tlphon: Dto or unrskrit/dt o sintur: Unrskrit/Sintur: B: Uyls skoln/to ill out y ATO: Nm o ATO: (Us stmp): Spiition o liht tim Totl: IFR Fliht Tim Cross-Country:PIC Instrumnt Fliht Instrution Instrumnt Groun tim: Niht:Quliition optin t? Critin o liht tim (tth oumnttion) I hry rtiy tht th pplint hs pss th rquir trinin n tht th pplint ulils th rquirmnt or th issu o Instrumnt Rtin (Hlioptr) Dt o sintur o H o Trinin Sintur o H o Trinin C: To ill out y th Exminr: Dt o tst: Lin Enorsmnt: Typ o irrt: Nm o Exminr or stmp: Stmp o Exminr, Authoristion no. o Exminr or stmp: I hry vriy tht th pplint hs pss th rquir trinin n tht th pplint ulills th rquirmnt or th issu o Instrumnt Rtin (Hlioptr) Dt o sintur o Exminr Sintur o Exminr Stion 1: Pss Finl rsult: Fil Stion 2: Pss Fil Stion 3: Rsult o th tst Stion 4: Stion 5: Pss Fil Pss Fil Pss Fil Tmporry lin issu (opy nlos): Stion 6: Not Applil Pss Fil Pss Prtil Pss Fil Ys No Vli until: IR(H) Dmr 2014 P 1 o 5 Trikstyrlsn, Evr Thomsns Vj 14, 2300 Kh. S., Tl.: , -mil: ino@trikstyrlsn.k
2 For til instrutions s Commision Rultion 1178/2011 Appnix 7 Us o hklist, irmnship, nti-iin/-iin prours, t., pply in ll stions Nm o Applint: SECTION 1 DEPARTURE Pss Fil h i Us o liht mnul (or quivlnt) spilly irrt prormn lultion, mss n ln Us o Air Tri Srvis oumnt; wthr oumnt Prprtion o ATC liht pln; IFR liht pln/lo Pr-liht insption Wthr Minim Txiin/Air txy in omplin with ATC or instrutions o instrutor Pr-tk o riin; prours n hks Trnsition to instrumnt liht Instrumnt prtur prours SECTION 2 GENERAL HANDLING Pss Fil Control o th hlioptr y rrn solly to instrumnts, inluin: Climin n snin turns with sustin rt on turn Rovris rom unusul ttitus, inluin sustin 30 nk turns n stp snin turns SECTION 3 EN-ROUTE IFR PROCEDURES Pss Fil h Trkin, inluin intrption;.. NDB; VOR; RNAV Us o rio is Lvl liht, ontrol o hin, ltitu n irsp, powr sttin Altimtr sttin Timin n rvision o ETAs Monitorin o liht prorss, liht lo, ul us, systms mnmnt I prottion prours, simult i nssry n pplil ATC liison n omplin; R/T prours IR(H) Dmr 2014 P 2 o 5
3 For til instrutions s Commision Rultion 1178/2011 Appnix 7 Us o hklist, irmnship, nti-iin/-iin prours, t., pply in ll stions Nm o Applint: SECTION 4 PRECISION APPROACH PROCEDURE Pss Fil Sttin n hkin o nvitionl is, intiition o ilitis Arrivl prours, ltimtr hks Approh n lnin riin, inluin snt/pproh/lnin hks * Holin prour Complin with pulish pproh prour Approh timin Altitu, sp, hin ontrol, (stilis pproh) h* Go-roun tion I* Miss pproh prour/lnin j ATC liison omplin; R/T prours * to prorm in Stion 4 or Stion 5 SECTION 5 NON-PRECISION APPROACH PROCEDURE Pss Fil Sttin n hkin o nvitionl is, intiition o ilitis Arrivl prours, ltimtr hks Approh n lnin riin, inluin snt/pproh/lnin hks * Holin prour Complin with pulish pproh prour Approh timin Altitu, sp, hin ontrol, (stilis pproh) h* Go-roun tion i* Miss pproh prour/lnin j ATC liison omplin, R/T prours * to prorm in Stion 4 or Stion 5 SECTION 6 ABNORMAL AND EMERGENCY PROCEDURES (This stion my omin with stions1 throuh 5) Enin ilur tr tk-o n on/urin pproh (Multi-nin hlioptr only) (At s ltitu or in Fliht Simultor or FNPT II/III, FTD 2.3) Filur o stility umnttion vis/hyruli systm (i pplil) Limit pnl Autorottion n rovry to pr-st ltitu Prision pproh mnully without liht irtor* Prision pproh mnully with liht irtor* *(Only on itm to tst) Pss Fil IR(H) Dmr 2014 P 3 o 5
4 For til instrutions s Commision Rultion 1178/2011 Appnix 7 Us o hklist, irmnship, nti-iin/-iin prours, t., pply in ll stions Nm o Applint: Dtils o th liht Airrt ristrtion On lok On roun Dprtur rorom O lok Airorn Dstintion rorom Totl lok tim Totl irorn tim No. o lnins: Rmrks/Ovrll ssssmnt/rsons or ilur (i pplil): Nm o instrutor prsnt t th Skill Tst: Sintur o Exminr Sintur o Applint: IR(H) Dmr 2014 P 4 o 5
5 For til instrutions s Commision Rultion 1178/2011 Appnix 7 Us o hklist, irmnship, nti-iin/-iin prours, t., pply in ll stions Nm o Applint: In orn with ARA.GEN.315(), () () Unrtn krætr hrm, t j v nsøninstispunktt Not: 1. ikk vr ikk i sils t prsonlit rtiikt, rtin, tillls llr ttsttion m smm nvnlssområ o i smm ktori ustt i n nn mlmsstt; 2. ikk hr nsøt om t prsonlit rtiikt, rtin, tillls llr ttsttion m smm nvnlssområ o i smm ktori i n nn mlmsstt; o 3. lri hr ht t prsonlit rtiikt, rtin, tillls llr ttst m smm nvnlssområ o i smm ktori ustt i n nn mlmsstt, som r tilklt llr suspnrt i nn mlmsstt. Ukorrkt oplysninr vrørn ovnstån, kn vær iskvliirn or ustls rtiikt, rtin, tillls m.v. Unrsin hry onirm tht I t th tim o pplition Not: 1. ws not holin ny prsonnl lin, rtiit, rtin, uthoristion or ttsttion with th sm sop n in th sm tory issu in nothr Mmr Stt; 2. hs not ppli or ny prsonnl lin, rtiit, rtin, uthoristion or ttsttion with th sm sop n in th sm tory in nothr Mmr Stt; n 3. hs nvr hl ny prsonnl lin, rtiit, rtin, uthoristion or ttsttion with th sm sop n in th sm tory issu in nothr Mmr Stt whih ws rvok or suspn in ny othr Mmr Stt. Inorrt inormtion rrin th ov n isquliyin or otinin rtiit, rtin, uthoriztion, t. Dto:/Dt: Unrskrit:/Sintur: IR(H) Dmr 2014 P 5 o 5
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