Fax Number: 011-545-1459 Ikhaya Lokundiza, 16 Treur Close, Waterfall Park, Bekker Street, Midrand, Gauteng Physical address:

Private Bag X73, Halfway House 1685 Website: www.caa.co.za Postal address: DETAILS OF BANK ACCOUNT FOR PAYMENT OF PRESCRIBED FEE Bank: Standard Bank of SA Ltd Branch: Brooklyn, Pretoria Branch Code: 011245 Account Number: 013007971 COMPULSORY CLIENT PAYMENT CODE (to be completed on deposit slip) Service/transaction Over the counter payments EFT, Internet, Wire, Electronic payments Skill test Instrument rating (A)(H)

Section/division: Telephone number:

Licensing Section 011-545-1000

Form Number: CA 61-15.4

INITIAL SKILLS TEST OR REVALIDATION CHECK REPORT FOR AN INSTRUMENT RATING (AEROPLANE & HELICOPTER)
NOTES:
1. 2. 3. 4. 5. 6. 7. See the relevant checklist on the SACAA website (www.caa.co.za) for the applicable requirements for each licence or rating. Insert a tick (P) in the applicable box(es) *. This form must be submitted within 30 days of the completion of the skills test or revalidation check, as applicable. In the case of an initial skills test, this form must be accompanied by the application form CA61-01.0. For this form to be accepted by the SACAA, each page must be completed in full and must be initialed by BOTH the examiner and the candidate. For maintenance of competency of an ATPL (A), the revalidation check must be conducted on a multi-engine aeroplane or approved multi-engine FSTD. For maintenance of competency of a CPL (A), the revalidation check must be conducted on an aeroplane with adjustable flaps and variable pitch propeller or turbo-jet engine or in an approved FSTD with similar systems.
SE ME SE ME

Initial*

Revalidation*

Licence for which maintenance of competency is to be revalidated* PPL CPL ATPL

Details of Candidate Surname Licence Number Test or check details For initial skills test only * Training file complete Aerodrome Aircraft Make & Model FSTD type Duration Outcome * Remarks Briefing Competent Flying VP* RU* Recommended All requirements met Date of test Registration Registration De-briefing Not yet Competent Caroline 12345 First names Phone number Grant Michael

Experience (for the applicable licence) Total PIC Total PIC cross-country (Initial test only) Total PIC cross-country in aircraft (Initial test only) Total Instrument Flying (initial skills test)

119.3

Total PIC during last 6 months Total Co-pilot during last 6 months Grand total

2.0 0.0 278.2

SE aircraft

ME aircraft

FSTD

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Note to Examiners a) b) c) d) e) f) g) h) i) The correct use of appropriate checklists must be applied at all times. A high level of RT must be exhibited at all times The candidate must be assessed as competent in the ground evaluation section prior to the practical skills test or revalidation check being carried out. It is recommended that the ground evaluation be conducted according to the SACAA recommended format (available on the SACAA website). All flight manoeuvres must be conducted in compliance with the POH and certification of the aircraft used for the skills test or the revalidation check. If a mandatory aspect is omitted, the Examiner must write NOT ASSESSED and motivate the decision in the observations sheet. The column (I) tagged with Q means a mandatory aspect for the initial skills test. The column (R) tagged with Q means a mandatory aspect for the revalidation check. 4-point scale When applying the 4-point scale, award the mark that best describes the weakest element(s) applicable to the candidates performance. 4. Excellent standard
Performance remains well within the qualification standards and flight management skills are excellent. Aircraft handling is smooth and precise. Technical skills and knowledge exceed the required level of competency. Behaviour indicates continuous and highly accurate situational awareness. Flight management skills are excellent. Safety of flight is assured. Risk is well managed.

3. Meets SACAA expected standards

Minor deviations occur from the qualification standards and performance remains within prescribed limits. Performance meets the recognised standard yet may include deviations that do not detract from the overall performance. Aircraft handling is positive and within specified limits. Technical skills and knowledge meet the required level of competency. Behaviour indicates that situational awareness is maintained. Flight management skills are effective. Safety of flight is maintained. Risk is acceptably managed.

2. Below SACAA expected standards

Occasionally, major deviations from the qualification standards occur, which may include momentary excursions beyond prescribed limits but these are recognized and corrected in a timely manner. Performance includes deviations that detract from the overall performance, but are recognized and corrected within an acceptable time frame. Aircraft handling is performed with limited proficiency and/or includes momentary deviations from specified limits. Technical skills and knowledge reveal limited technical proficiency and/or depth of knowledge. Behaviour indicates lapses in situational awareness that are identified and corrected. Flight management skills are effective but slightly below standard. Safety of flight is not compromised. Risk is poorly managed.

1. Not yet competent

Unacceptable deviations from the qualification standards occur, which may include excursions beyond prescribed limits that are not recognized or corrected in a timely manner. Performance includes deviations that adversely affect the overall performance, are repeated, have excessive amplitude, or for which recognition and correction are excessively slow or nonexistent, or the aim of the task was not achieved. Aircraft handling is rough or includes uncorrected or excessive deviations from specified limits. Technical skills and knowledge reveal unacceptable levels of technical proficiency and/or depth of knowledge. Behaviour indicates lapses in situational awareness that are not identified or corrected. Flight management skills are ineffective. Safety of flight is compromised. Risk is unacceptably managed.

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Should the candidate achieve a 2 in any aspect, he or she must be re-assessed in that ASPECT and the Examiner must indicate the new grading (1,3 or 4). k) This form becomes invalid if an aspect graded with a 2 is not re-assessed and re-graded. l) Should the candidate achieve a 1 in fewer than 5 aspects, he or she must undergo further training in compliance with Regulation SACAR 61.01.5 (9)(a)(b) and (c) and must be re-assessed in those aspects using the same form. m) Should the candidate achieve a 1 in 5 or more aspects, the entire test or check must be repeated using a new form. n) The Examiner must write comments in the observation sheet whenever an aspect is marked as 1. o) During a revalidation check, in the case of a grading of 2, the Examiner may teach in a particular aspect and then immediately re-assess such aspect. p) Should the candidate achieve a 1 in fewer than 5 aspects in an initial skills test, this form must remain in the possession of the ATO until a re-assessment is conducted. q) Should the candidate achieve a 1 in fewer than 5 aspects in a revalidation check, this form must remain in the possession of the Examiner until a re-assessment is conducted. r) Should the candidate achieve a 1 in 5 or more aspects, the Examiner must send this form to the CAA licensing section. s) Should any aspect in section 9 (Airmanship) be assessed as not yet competent (NYC), the entire test or check must be repeated.

j)

Tolerances Altitude / height All engines operating With simulated engine failure Limited instrument panel Starting go-around at DA/H MDA/H Circling minima Tracking All except precision approach Precision approach LLZ Precision approach GS DME arc 5 scale deflection scale deflection 1nm 100 ft 100 ft 200 ft + 50 ft / - 0 ft + 50 ft / - 0 ft + 100 ft / - 0 ft Heading All engines operating With simulated engine failure Limited instrument panel Speed Take-off / VR Climb and approach VAT / VREF Cruise Limited instrument panel With simulated engine failure VYSE / V2 + 5 kt / - 0 kt 5 kt + 5 kt / - 0 kt 5 kt 10 kt + 10 kt / - 5 kt 5 kt 5 10 15

Note: Allowance for turbulence at the discretion of the Examiner

Section 1: Ground evaluation

I Q 2 Q
1 3 4

R Q Q Q Q

Aspects CAR/CATS, AIP, SUPPLEMENTS, AIC, NOTAMS and Completion of flight plan Correct interpretation of weather reports and forecasts Flight performance and planning / all weather operations (SID,STAR, APP and en-route charts) Technical knowledge of aircraft (POH, AFM as applicable) En-route navigation preparation and preparation of IFR navigation log 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4

Q 5 Q

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Section 2: Pre-flight Operations

I
1 2 3 4 5

R Q Q Q Q Q

Aspects Adherence to manufacturer or company pre-flight procedures Pre-start, start and after start procedures Flight instruments and navigation aids set and checked (as applicable) Taxi and aerodrome procedures (as applicable) Take-off briefing including departure clearance and threat & error management 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4

Q Q Q Q Q

Section 3: Departure Procedures

I
1 2 3

Q Q

Aspects Q Take-off procedures and technique Adherence to Instrument departure procedures including altimeter setting Q procedures (as applicable) Low Visibility Take-off

1 1 1

2 2 2

3 3 3

4 4 4

Section 4: Flight Manoeuvres and Procedures

I Q 2 Q
1 3 4

Q 5 Q

R Aspects Q Steep turns (45 of bank) Q Slow flight handling Stall or approach to the stall in various configurations Q (at least 2 different configurations for initial skills test) Recovery from unusual attitudes Q Operations with limited flight instruments

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

Section 5: Descent and Arrival Procedures

I
1 2 3

Q Q Q

Aspects Setting and identification/checking of navigational aids, altimeter setting Q procedures, etc. Q Approach preparation, checks and procedures (briefing / cockpit setup etc.) Q Holding / EAT, Arrival procedures (STAR, DME Arc, radar vectors, etc.)

1 1 1

2 2 2

3 3 3

4 4 4

Section 6: Approach and Landing Procedures

For initial skills test: select at least one precision approach and one non-precision procedural approach For revalidation check: select at least one procedural approach ILS I R Q Q Q Q Q Q Q Q Aspects Compliance with published approach procedure and flight-path accuracy Stabilized approach and adherence to minima Go-around and missed approach procedure Transition to visual flight and landing CAT II CAT III VOR NDB GNSS RNAV VOR/DME Aspects Compliance with published approach procedure and flight-path accuracy Stabilized approach and adherence to minima Go-around and missed approach procedure Transition to visual flight and landing Circle to land (To be discussed if not feasible)

1 2 3 4 5 6

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

LLZ I R Q 8 Q 9 Q 10 Q 11 Q
7

Q Q Q Q

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

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Section 7A: Multi-Engine aircraft

Complete at least 2 aspects Aspects: Simulated engine failure / fire Simulated one engine inoperative approach Simulated one engine inoperative landing Specify others:

1 2 3

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

4 5 6

Section 7B: Single-Engine aeroplane (VMC)

Complete at least 2 aspects Aspects Simulated EFATO Simulated forced landing Simulated precautionary landing Specify others:

1 2 3

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

4 5 6

Section 7C: Helicopter (VMC)

Complete at least 2 aspects Aspects Autorotation Confined area landing Specify others:

1 2

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

3 4 5

Section 8: Abnormal operations and procedures

Simulate or discuss at least 3 aspects Aspects: Communication failure Navigation facility failure Cockpit smoke/fire (ground/flight) Low visibility RTO Specify others:

1 2 3 4

1 1 1 1 1 1 1

2 2 2 2 2 2 2

3 3 3 3 3 3 3

4 4 4 4 4 4 4

5 6 7

Section 9: Airmanship
Aspects 1 Situational awareness 2 Aeronautical decision making (threat and error management) 3 Safety consciousness 4 Flying accuracy and smoothness 5 RT procedures, ATC liaison / compliance 6 Compliance with regulations C NYC

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Aspects

Observations

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Details of Examiner Surname Licence Number First names Phone number

I certify that all sections and aspects were carried out and assessed by me as indicated above:

SIGNATURE OF EXAMINER

NAME IN BLOCK LETTERS

DATE

Details of Examiner who carried out a re-assessment (if different from above) Surname Licence Number First names Phone number

I certify that I re-assessed all the aspects as specified in the observation sheet:

SIGNATURE OF EXAMINER

NAME IN BLOCK LETTERS

DATE

I certify that this form has not been altered or tampered with in any way whatsoever and all information on it is correct: Grant Michael Caroline SIGNATURE OF CANDIDATE NAME IN BLOCK LETTERS DATE

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