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INAC – Departamento de Licenciamento de Pessoal e Formação Rua C - Edifício Santa Cruz - Aeroporto da Portela 1749-034 Lisboa – PORTUGAL

CPL (A) Skill test

DLPF Form 013 Revision date

04/04/2014 /4

1) Preencher preferencialmente por via eletrónica, caso contrário deve utilizar letras MAIÚSCULAS com tinta azul ou preta Preferably complete electronically, otherwise use CAPITAL letters with blue or black ink 2) Examinador em supervisão, referir em “C3” e preencher “DLPF Form 003” Examiner under supervision mention in “C3” and fill the form “DLPF Form 003”

Nome do candidato: Applicant´s name ....….……………………………………………………………………………………………………………………………………………………………..

Nº de licença:

Licence number …………………………………..……………………………

Nome da ATO: Name of ATO ……………………..…………………………………………...……………………..….………………………

Número de Certificado ATO: Certificate number of ATO ….…………………………………..……………………..….………………………

Exame de voo inicial Initial Skill Test

ATP curso integrado ATP integrated course

CPL/IR curso integrado CPL/IR integrated course

CPL curso integrado CPL integrated course

CPL curso modular CPL modular course

Repetição de exame de voo com aprovação parcial Repetition of partial passed skill test

Repetição de exame de voo Repetition of failed skill test efetuado na data: from date

dd/mm/yyyy

………………………………..

A - Declaração da ATO ATO declaration Em anexo envia-se certificado/outro documento comprovativo.

Certificate/another document in attachment. A preencher pelo Diretor de Instrução

To be completed by the Head of Training

A organização de formação confirma que o candidato cumpriu o programa teórico e treino de voo aprovado de forma satisfatória. I confirm that the experience of the applicant comply with the applicable requirements of Part-FCL

Nome do DI: HT´s name …………………………………….…………………………………………………………………………………..

Assinatura do DI: HT´s Signature ………….……………………………………………………………………………………..……………

B - National Procedures Declaration Only for NON-INAC EXAMINERS

To be completed by the examiner

“I hereby declare that I, (complete name) ………………………………..………………………………………………………….…………………………………………………………………………………………………………………………..

have reviewed and applied the relevant national procedures and requirements of the applicants Competent Authority contained in version

…….…..….………………………………………..… of the Examiner Differences Document.” Examiner´s signature: .………………..………………………………….…………………………………………………

C1 - Detalhes da verificação Check details A preencher pelo examinador


Data Date

Modelo de avião Aircraft model

Matrícula Registration

Classe/Tipo Class/Type

Tempo total Total time

dd/mm/yyyy ………………………………..

………………………………..

…………………………………………………

……………………….……………..

hh:mm ………………………………..

Aeródromo de partida Departure

Aeródromo de destino Destination

Calços retirados

Block-OFF Calços colocados

Block-ON Descolagens

Take-offs Aterragens

Landings

……………………………..……….……………..

…………………………………..…………….. hh:mm

……………………………….. hh:mm

………………………………..

………………………………..

……………………………….

C2 - Resultado da verificação Check result * Mencionar razão para os itens reprovados, referir em “C3”

* Mention reasons for failed items in “C3” A preencher pelo examinador


Apto Pass

Não apto * Fail **

Parcialmente apto * Partial pass **

Assinatura do candidato:

Applicant´s signature ……………………………………………………..………………

C3 - Observações Remarks A preencher pelo examinador


.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………

.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………

.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………

.……………………………………………………………………………………………………………………………………………………………………………………………………………………………………

C4 - Declaração do Examinador Examiner Declaration A preencher pelo examinador


Confirmo que a experiência do candidato cumpre com os requisitos aplicáveis da Part-FCL. I confirm that the experience of the applicant comply with the applicable requirements of Part-FCL

Confirmo que as manobras e exercícios requeridos foram completados. I confirm that the required manoeuvres and exercises have been completed

Nome: Name …………………………………………………………………………………………………………………………………

Número de certificado de examinador: Examiner´s certificate number ………………………………………………………….………

Local e data: Location and date …………………………………………………………………………………………………………………

Assinatura do examinador: Examiner´s signature .……………………………………….……………………………………………………


CPL (A) Skill test


04/04/2014 /4

General Requirements Fill by ATO Examiner

Check INAC only

Applicant minimum age Mathematics or Test at ATO Physics or Test at ATO Document of identification EASA Medical Certificate Theoretical examination ATPL (A) MCC course English Language Test for Aviation Logbook filled and signed

18 years Passed Passed Copy Class 1 Passed Passed ≥ Level 4 Logbook

Age: ……………………………………………… Valid until: ……………………………………. Date: ………………. Rate: …………………. Date: ……………………………………………. Level: …….. Valid until: …………………. Total hours: ………………………………….

□ □

□

⃝ ⃝ ⃝ ⃝ ⃝ ⃝ ⃝ ⃝ ⃝

Crediting Requirements Fill by ATO Examiner

Check INAC only

1) License PPL (A) □ or PPL (H) □ * 2) Basic Instrument Flight Module ** 3) Other: …………………………………………….

50%/40H/45H Max 10 H

Total credit given: ………………………... Total credit given: ………………………... Total credit given: ………………………...

⃝ ⃝ ⃝

CPL Requirements Fill by ATO Examiner

Check INAC only

Flight experience *** ∑ = 1) + 2) + 5)b) + 7) Hours: …………………………………………. □ ⃝ 1) Dual instruction Hours: …………………………………………. □ ⃝ 2) PIC 3) Cross-country flight PIC

a) VFR cross-country flight

540 Km

Hours: …………………………………………. Hours: …………………………………………. Date: ……………………………………………

□ □ □

⃝ ⃝ ⃝

(1) Full stop landings at 2 aerodromes different from the aerodrome of departure

DEP 1 …………….……… DEST 1 ……………….…… KM ……….…… DEP 2 ………….………… DEST 2 ………….………… KM ……….…… DEP 3 ………….………… DEST 3 ………….………… KM ……….……

□ □ □

⃝ ⃝ ⃝

4) Night flight time a) Dual instruction

i) Cross-country navigation ii) 5 solo take-offs iii) 5 solo full stop landings

5) Instrument time**** a) SPIC ***** b) MCC c) Instrument flight instruction

of which:

Min 5 H total Min 3 H Min 1 H 5 take-offs 5 landings ∑ = 5) a) + 5) b) + 5) c)

Hours: …………………………………………. Hours: …………………………………………. Hours: …………………………………………. Nº take-offs: ……………………………….. Nº landings: ………………………………… Hours: …………………………………………. Hours: …………………………………………. Hours: …………………………………………. Hours: ………………………………………….

□ □ □ □ □ □ □ □ □

⃝ ⃝ ⃝ ⃝ ⃝ ⃝ ⃝ ⃝ ⃝

i) FNPT I; or ii) FNPT II, FTD 2 or FFS

(1) FNPT I.

Hours: ………………………………………… or Hours: ………………………………………… Hours: …………………………………………

□ or □ □

⃝ or ⃝ ⃝

6) Aeroplane ****** 7) Total SPIC hours *******

Min 5 H Hours: ………………………………………… Hours: …………………………………………

□ □

⃝ ⃝

* An applicant may be admitted to training either as an ab-initio entrant, or as a holder of a PPL(A) or PPL(H) issued in accordance with Annex 1 to the Chicago

Convention. In the case of a PPL(A) or PPL(H) entrant, 50 % of the hours flown prior to the course shall be credited, up to a maximum of 40 hours flying experience, or 45 hours if an aeroplane night rating has been obtained, of which up to 20 hours may count towards the requirement for dual instruction flight time.

** An applicant holding a course completion certificate for the Basic Instrument Flight Module shall be credited with up to 10 hours towards the required instrument

instruction time. Hours done in a BITD shall not be credited;

*** Total hours during the course flight training (aeroplane and simulator). Flight experience is the sum of the hours of “1)Dual instruction”, “2) PIC”, “5)b) MCC” and

“7) Total SPIC hours”;

**** Total hours of instrument time during the course. Instrument time is the sum of hours of “5) a) SPIC”, “5) b) MCC” and “5) c) Instrument flight instruction”; ***** The instrument flight time as SPIC shall only be counted as PIC flight time up to a maximum of 20 hours. When transporting this SPIC hours to the PIC hours,

attention to not duplicate them for the total sum of “Flight experience”;

****** Aeroplane certificated for the carriage of at least 4 persons that has a variable pitch propeller and retractable landing gear.

******* Total sum of SPIC hours (VFR and IFR) made during the course.

Local e data

Location and date …………………………………………………………………………………………………………………… Assinatura do examinador: Examiner´s signature .……………………………………….………………………………………………


CPL (A) Skill test


04/04/2014 /4

Nome do candidato: Applicant´s name ……………………………………………………….….………………………………………………………………………………………..

SECTION 1 — PRE-FLIGHT OPERATIONS AND DEPARTURE Pass Fail

a Pre-flight, including: Flight planning, Documentation, Mass and balance determination, Weather brief, NOTAMS

b Aeroplane inspection and servicing c Taxiing and take-off d Performance considerations and trim e Aerodrome and traffic pattern operations f Departure procedure, altimeter setting, collision avoidance (lookout) g ATC liaison — compliance, R/T procedures

SECTION 2 — GENERAL AIRWORK Pass Fail

a Control of the aeroplane by external visual reference, including straight and level, climb, descent, lookout b Flight at critically low airspeeds including recognition of and recovery from incipient and full stalls c Turns, including turns in landing configuration. Steep turns 45° d Flight at critically high airspeeds, including recognition of and recovery from spiral dives

e

Flight by reference solely to instruments, including: i) Level flight, cruise configuration, control of heading, altitude and airspeed ii) Climbing and descending turns with 10°-30° bank iii) Recoveries from unusual attitudes iv) Limited panel instruments

f ATC liaison — compliance, R/T procedures

SECTION 3 — EN-ROUTE PROCEDURES Pass Fail

a Control of aeroplane by external visual reference, including cruise configuration Range/Endurance considerations b Orientation, map reading c Altitude, speed, heading control, lookout d Altimeter setting. ATC liaison — compliance, R/T procedures e Monitoring of flight progress, flight log, fuel usage, assessment of track error and re-establishment of correct tracking f Observation of weather conditions, assessment of trends, diversion planning

g Tracking, positioning (NDB or VOR), identification of facilities (instrument flight). Implementation of diversion plan to alternate aerodrome (visual flight)

SECTION 4 — APPROACH AND LANDING PROCEDURES Pass Fail

a Arrival procedures, altimeter setting, checks, lookout b ATC liaison — compliance, R/T procedures c Go-around action from low height d Normal landing e Short field landing f Approach and landing with idle power (single-engine only) g Landing without use of flaps h Post-flight actions

SECTION 5 — ABNORMAL AND EMERGENCY PROCEDURES (This section may be combined with sections 1 through 4)

Pass Fail

a Simulated engine failure after take-off (at a safe altitude), fire drill b Equipment malfunctions c Forced landing (simulated) d ATC liaison — compliance, R/T procedures e Oral questions

Local e data



CPL (A) Skill test


04/04/2014 /4

Nome do candidato: Applicant´s name ……………………………………………………….….………………………………………………………………………………………..

SECTION 6 — SIMULATED ASYMMETRIC FLIGHT RELEVANT CLASS OR TYPE ITEMS (This section may be combined with sections 1 through 5)

Pass Fail

a Simulated engine failure during take-off (at a safe altitude unless carried out in an FFS) b Asymmetric approach and go-around c Asymmetric approach and full stop landing d Engine shutdown and restart e ATC liaison — compliance, R/T procedures, Airmanship

f

As determined by the FE — any relevant items of the class or type rating skill test to include, if applicable: i) aeroplane systems including handling of autopilot ii) operation of pressurisation system iii) use of de-icing and anti-icing system

g Oral questions Local e data


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