DLPF Form 016 - PPL(H) Skill Test

PPL (H) Skill test
DLPF Form 016
Data de Aprovação Approval Date
08/04/2013
INAC – Departamento de Licenciamento de Pessoal e Formação
Rua C - Edifício Santa Cruz - Aeroporto da Portela
1749-034 Lisboa – PORTUGAL
OBSERVAÇÕES REMARKS:
1) As secções A, B e C são de preenchimento obrigatório Section A, B and C are mandatory
2) 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
3) Todas as datas devem ser preenchidas no formato dd/mm/yyyy All dates must be completed in the format dd/mm/yyyy
4) Todos os tempos de voo devem ser preenchidos no formato hh:mm All flight times are to be filled in the format hh:mm
5) Examinador em supervisão, referir em “C3” e preencher “DLPF Form 003” Examiner under supervision mention in “C3” and fill the form “DLPF Form 003”
A ‐ Dados do candidato Applicant Information
Apelido
Last name..……………………..….…………………………..……..
B ‐ ATO
Primeiro (s) nome (s)
First name(s) ...…………………..…………………………………………………………..
Prova de voo inicial
Initial Skill test De LAPL(H)
Repetição de prova de voo com aprovação parcial, efetuado na data dd/mm/yyyy
Repetition of partial passed skill test, from date …..……………………………………
Repetição de prova de voo, efetuada na data dd/mm/yyyy
Repetition of failed skill test, from date …..……………………………………
1 Se aplicável If applicable
Nº de licença 1
Licence number ………….……………………………………
A preencher pela ATO To be completed by the ATO
From LAPL(H)
Outra categoria, exceto balões
Another category except balloon
A organização de formação confirma que o candidato cumpriu o programa teórico e treino de voo aprovado de forma satisfatória. Em anexo
envia‐se certificado/outro documento comprovativo.
The ATO confirms that the applicant has been trained according to the approved syllabus to a satisfactory level. Certificate/another document in attachment.
Desde dd/mm/yyyy
From ……………………………..
Até dd/mm/yyyy
Until …………………………..
Nome da organização
Organization …………………………………………………………
Nome do diretor de instrução
Head of training name ………………………………………………………………………………………………………
C1 ‐ Detalhes da verificação Details of check
Data
Modelo de helicóptero
Matrícula
Date
dd/mm/yyyy
…………………..…………….
Helicopter model
……………………………………….………
Registration
……………………………………….……………
Local de partida
Departure site
Local de destino
Destination site
Arranque rotor
Rotor START
Paragem rotor
Rotor STOP
hh:mm
hh:mm
hh:mm
hh:mm
……………………………………
….………………………….…………… ….……..…………………… ……………………………
C2 ‐ Detalhes da verificação Check details
Apto
Pass
Não apto 2
Fail
C3 ‐ Observações Remarks
Parcialmente apto 2
Partial pass
Assinatura do candidato
Número de Certificado
Certificate number ………………………………………
Assinatura
Signature .……………………………………………………………………………………..……………
A preencher pelo examinador To be completed by the examiner
Tempo de voo
Flight time
hh:mm
……………………………
Qualificação tipo
Type rating
……………………………………….………
Aterragens
Landings
hh:mm
…………………………………
Applicant´s Signature ………………………………………………………………………………………………..……..
2
Mencionar razão para os itens reprovados Mention reasons for failed items
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Confirmo que a instrução e experiência do candidato cumprem com os requisitos aplicáveis da Part‐FCL.
I confirm that instruction and 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 …………………………………………………………………………………………………………………………………
Local e data
Location and date …………………………………………………………………………………………………………………
Número de Certificado de Examinador
Examiner´s Certificate number . …………………………………………………………………..
Assinatura do Examinador
Examiner´s Signature .………………………………………………………………………………………………
Pag. 1/4

PPL (H) Skill test
PPL (H) Requirements Fill by ATO
Applicant minimum age
Certificate of qualifications
Document of identification
Portuguese EASA Medical Certificate
Theoretical examination PPL (H)
English Language Test for Aviation (RELTA)
Logbook filled and signed
DLPF Form 016
17 years
Original
Copy
Class 2
Passed
Level 4
Logbook
Crediting “Remarks” Requirements Fill by ATO
Data de Aprovação Approval Date
08/04/2013
INAC – Departamento de Licenciamento de Pessoal e Formação
Rua C - Edifício Santa Cruz - Aeroporto da Portela
1749-034 Lisboa – PORTUGAL
Age: ……………………………………….…….
Valid until: …………………………….……..
Date: ………………. Rate: …………..…….
Level: …….. Valid until: …………..…….
Total hours: ………………………….………
1) License another category of aircraft Max 10 % License: …….………. Valid: …….….…….
Credit given: .…….………………….……..
Examiner
Check
□
□
□
□
□
□
□
Examiner
Check
□
□
A ‐ Flight experience
Instrument ground time (FNPT e FFS)
Requirements Fill by ATO
Examiner
Check
INAC
only
1) Dual flight instruction Min 25 H Hours: ………………………………….……… □ ⃝
2) Solo flight time
a) Solo cross‐country flight
i) Solo flight
(1) Full stop landings at 2
aerodromes different
from the aerodrome of
departure
3) Flight experience on type used for
skill test
Min 10 H
Min 5 H
185 Km
Hours: …………………………………….……
Hours: …………………………………….……
Date: …………………………………….……..
DEP 1 …………….……… DEST 1 ……………….…… KM ……….……
DEP 2 ………….………… DEST 2 ………….………… KM ……….……
□
□
□
□
□
INAC
only
⃝
⃝
⃝
⃝
⃝
⃝
⃝
INAC
only
⃝
⃝
Min 35 H Hours: ………………………………….……… □ ⃝
Remarks:
Applicants holding a pilot licence for another category of aircraft, with the exception of balloons, shall be credited with 10 % of their total flight time as PIC on such
aircraft up to a maximum of 6 hours. The amount of credit given shall in any case not include the requirements in “Solo flight time”.
B ‐ Flight experience ‐ Holder LAPL (H) Requirements Fill by ATO
Examiner
Check
INAC
only
1) Dual flight instruction Min 5 H Hours: ……………………………………….… □ ⃝
2) Solo flight time
a) Solo cross‐country flight 185 Km
Date: …………………………………………... □
⃝
i) Full stop landings at 2 DEP 1 ………………….… DEST 1 …….……………… KM ……….…… □
⃝
aerodromes different from
the aerodrome of departure
DEP 2 ………….………… DEST 2 ………….………… KM …….……… □
⃝
⃝
⃝
⃝
⃝
⃝
Pag. 2/4

PPL (H) Skill test
DLPF Form 016
Data de Aprovação Approval Date
08/04/2013
INAC – Departamento de Licenciamento de Pessoal e Formação
Rua C - Edifício Santa Cruz - Aeroporto da Portela
1749-034 Lisboa – PORTUGAL
Nome do candidato
Name of Applicant ……………………………….....................................……………………..………
SECTION 1 — PRE‐FLIGHT/POST‐FLIGHT CHECKS AND PROCEDURES
Use of checklist, airmanship, control of helicopter by external visual reference, anti‐icing procedures, etc. apply in all sections
Helicopter knowledge (e.g. technical log, fuel, mass and balance, performance), flight planning, documentation,
a
NOTAMS, weather
b Pre‐flight inspection/action, location of parts and purpose
c Cockpit inspection, starting procedure
d Communication and navigation equipment checks, selecting and setting frequencies
e Pre‐take‐off procedure, R/T procedure, ATC liaison‐compliance
f Parking, shutdown and post‐flight procedure
Data
Date …………………………….………
Pass Fail
SECTION 2 — HOVER MANOEUVRES, ADVANCED HANDLING AND CONFINED AREAS Pass Fail
a Take‐off and landing (lift‐off and touchdown)
b Taxi, hover taxi
c Stationary hover with head/cross/tail wind
d Stationary hover turns, 360° left and right (spot turns)
e Forward, sideways and backwards hover manoeuvring
f Simulated engine failure from the hover
g Quick stops into and downwind
h Sloping ground/unprepared sites landings and take‐offs
i Take‐offs (various profiles)
j Crosswind, downwind take‐off (if practicable)
k Take‐off at maximum take‐off mass (actual or simulated)
l Approaches (various profiles)
m Limited power take‐off and landing
n Autorotations (FE to select two items from — Basic, range, low speed, and 360° turns)
o Autorotative landing
p Practice forced landing with power recovery
q Power checks, reconnaissance technique, approach and departure technique
SECTION 3 — NAVIGATION — EN‐ROUTE PROCEDURES Pass Fail
a Navigation and orientation at various altitudes/heights, map reading
b Altitude/height, speed, heading control, observation of airspace, altimeter setting
Monitoring of flight progress, flight log, fuel usage, endurance, ETA, assessment of track error and re‐ establishment of
c
correct track, instrument monitoring
d Observation of weather conditions, diversion planning
e Use of navigation aids (where available)
f ATC liaison and observance of regulations, etc.
SECTION 4 — FLIGHT PROCEDURES AND MANOEUVRES Pass Fail
a Level flight, control of heading, altitude/height and speed
b Climbing and descending turns to specified headings
c Level turns with up to 30 ° bank, 180 ° to 360 ° left and right
d Level turns 180 ° left and right by sole reference to instruments
Examiner´s Signature: _______________________________
Pag. 3/4

PPL (H) Skill test
DLPF Form 016
Data de Aprovação Approval Date
08/04/2013
INAC – Departamento de Licenciamento de Pessoal e Formação
Rua C - Edifício Santa Cruz - Aeroporto da Portela
1749-034 Lisboa – PORTUGAL
Nome do candidato
Name of Applicant ……………………………….....................................……………………..………
SECTION 5 — ABNORMAL AND EMERGENCY PROCEDURES (SIMULATED WHERE APPROPRIATE)
Note 1: Where the test is conducted on a multi‐engine helicopter a simulated engine failure drill, including a
single‐engine approach and landing, shall be included in the test.
Note 2: The FE shall select four items from the following:
a Engine malfunctions, including governor failure, carburettor or engine icing and oil system, as appropriate
b Fuel system malfunction
c Electrical system malfunction
d Hydraulic system malfunction, including approach and landing without hydraulics, as applicable
e Main rotor and/or anti‐torque system malfunction (FFS or discussion only)
f Fire drills, including smoke control and removal, as applicable
g
Other abnormal and emergency procedures as outlined in an appropriate flight manual and with reference to Appendix
9 C to Part‐FCL, sections 3 and 4, including for ME helicopters:
a) Simulated engine failure at take‐off:
1) Rejected take‐off at or before TDP or safe forced landing at or before DPATO;
2) Shortly after TDP or DPATO.
b) Landing with simulated engine failure:
1) Landing or go‐around following engine failure before LDP or DPBL;
2) Following engine failure after LDP or safe forced landing after DPBL.
Data
Date …………………………….………
Pass Fail
Examiner´s Signature: _______________________________
Pag. 4/4