/ SIN CLASIFICAR / Dirección
FORMULARIO PARA LA PRUEBA DE PERICIA / VERIFICACIÓN DE COMPETENCIA PARA LA EMISIÓN, RENOVACIÓN O REVALIDACIÓN DE LA HABILITACIÓN DE VUELO POR INSTRUMENTOS EN RUTA (EIR) / SKILL TEST/PROFICIENCY CHECK FOR THE ISSUE, REVALIDATION, OR RENEWAL OF AN EN ROUTE INSTRUMENT RATING (EIR) / DSA
Unidad
DLPA
Nombre Aspirante: / Nº Lic.: / Aeronave: /
EN ROUTE INSTRUMENT RATING (EIR)
Applicant Surname(s): / Aircraft / SE-SP o
SE-MP o / ME-SP o
ME-MP o
Applicant Name: / Operation / SP o MP o
Type of licence held:
Licence number: / Checklist / o Training record
o Skill test
o Proficiency check
State of licence issue:
Please keep in mind that if the medical report data that supports your aero-medical certificate will not act in Aviation Medicine Unit of AESA your application may be rejected.
I certify that do not have more than one license per category of aircraft issued under Part-FCL and all my Part-FCL licenses are issued by the same State.
Applicant’s signature
2 / FSTD
FSTD (aircraft type) / Three or more axes:
Yes o No o / Ready for service and used:
FSTD manufacturer. / Motion or system / Visual aids: Yes o No o
FSTD operator: / FSTD ID code:
Total training time at the controls: / Instrument approaches to aerodromes at decision altitude of:
Total training time in FSTD:
Place and date
………………./………………./……………………… / Instructor/examiner licence type and number:
TRI o CRI o Other o
Instructor’s Signature: / Name (capitals)
3 / Flight training: aircraft
Type of aircraft: / Registration: / Flight control time:
Take offs: / Landings: / Training aerodromes or sites (take-offs, approaches and landings):
Take-off time: / Landing time:
Place and date:
………………./………………./………………… / Instructor/examiner type and number of licence held:
FI  FE  IRI  IRE  CRI  CRE  TRI  TRE 
Instructor’s/Examiner’s Signature: / Name (capital)
RTF: SPANISH o ENGLISH o
4 / Skill test o Proficiency check o
Skill test or proficiency check details:
Aerodrome or site: / Total flight time:
Take off time: / Landing time:
Pass o / Fail o / Fail reasons: (see point 5)
Place and date:
………………./………………./…………………… / Aircraft or FSTD registration mark:
I received information from the applicant regarding their experience and training and certify that meets the EASA Part-FCL requirements.
o (Tick as appropriate) To examiners who have been certified by another competent authority.
I hereby declare that I have reviewed and applied the relevant national procedures and requirements of the applicant’s competent authority contained in current version of the Examiner Differences Document.
Examiner’s certificate number
(if applicable): / Type and number of licence:
Examiner’s Signature. / Name (capitals)
5. TEST, CHECKS AND ASSESSMENTS OF COMPETENCE – NOTICE OF FAILURE (To be completed by examiner)
Has been duly notified that failed in the following:
FAILS
Section: / Subsection: / Justification:
In accordance with Part FCL, shall be determined and delivered the required refresher/remedial training prior to the applicant reattempting the skill test, proficiency check or assessment of competence. The applicant must provide evidence of this training to the examiner who conducts the next test, check or assessment of competence.
Minimum training recommended by the Examiner:
......
I understand that I have failed the items notified above.
I understand that I may not exercise the privileges of my ...... following the failure of this test, check or assessment of competence until the successful completion of training and a further test, check or assessment of competence
Received (Applicants Name): …………….. …………………………………………………………………
Signature...... Date: ...... /...... /......
Copies of the report shall be submitted to (1) The Applicant (2) The Applicant’s Competent Authority (3) The Examiner (4) The Examiner’s Competent Authority
SECTION 1 —PRE-FLIGHT OPERATIONS AND DEPARTURE / A / N A
Use of checklist, airmanship, anti/de-icing procedures, etc., apply in all sections.
a / Use of flight manual (or equivalent) especially a/c performance calculation, mass and balance.
b / Use of ATC document, weather document
c / Preparation of ATC flight plan, IFR flight plan/log
d / Pre-flight inspection
e / Weather Minima
f / Taxiing
g / Pre-take-off briefing. Take-off
h / ATC liaison: compliance, R/T procedures
SECTION 2 —GENERAL HANDLING / A / N A
a / Control of the aeroplane by reference solely to instruments, including: level flight at various speeds, trim
b / Climbing and descending turns with sustained Rate 1 turn
c / Recoveries from unusual attitudes, including sustained 45° bank turns and steep descending turns
d / Recovery from approach to stall in level flight, climbing/descending turns and in landing configuration
e / Limited panel, stabilised climb or descent at Rate 1 turn onto given headings, recovery from unusual attitudes
SECTION 3 -- EN ROUTE IFR PROCEDURES / A / N A
a / Transition to instrument flight
b / Tracking, including interception, e.g. NDB, VOR, RNAV
c / Use of radio aids
d / Level flight, control of heading, altitude and airspeed, power setting, trim technique
e / Altimeter settings
f / Timing and revision of ETAs (En route hold — if required)
g / Monitoring of flight progress, flight log, fuel usage, systems management
h / Simulated emergency situation(s)
i / Ice protection procedures, simulated if necessary
j / Simulated diversion to alternate aerodrome
k / Transition to visual flight
l / ATC liaison and compliance, R/T procedures
SECTION 4 / A / N A
Intentionally left blank
SECTION 5 / A / N A
a / Setting and checking of navigational aids, identification of facilities
b / Arrival procedures, altimeter settings
c / Approach and landing briefing, including descent/approach/landing checks
d / Visual landing
e / ATC liaison: compliance, R/T procedures
SECTION 6 -- (multi-engine aeroplanes only) FLIGHT WITH ONE ENGINE INOPERATIVE / A / N A
a / Simulated engine failure during en route phase of flight
b / ATC liaison: compliance, R/T procedures
© AESA 2013
Queda terminantemente prohibida la reproducción total o parcial de este documento, así como su uso indebido y/o su exhibición o comunicación a terceros. / Código del Documento: / Fecha Edición: / Ed. /Rev.: / Página:
F-DLA-EIR-16-Eng / 01/09/2014 / 1.0 / 3/4