Check Assessment Form

• Candidate Name

• ARN

• Staff Number

• Examiner

• Select date

  Date

• Fleet Type

  300

  400

• Check Type

  Select cyclic endorsement follow up check annual route check sim command check training CPT check check to line CMD sim progress

  • cyclic
  • endorsement
  • follow up check
  • annual route check
  • sim command check
  • training CPT check
  • check to line
  • CMD sim progress

Pre flight

• Grade

  1

  2

  3

  4

  5

• Repeat

• Reason Code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Taxi

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

RTO

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Take Off

• Take Off

Take off

• Crosswind

• Time of day

  day

  night

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason Code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Departure Procedures

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

EFATO

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Climb

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Cruise

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Decent

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Approach

Approach

• Type of approach

  Select Visual ILS LLZ VOR NDB DME RNAV/GNNS

  • Visual
  • ILS
  • LLZ
  • VOR
  • NDB
  • DME
  • RNAV/GNNS

• Type of approach

  2D

  3D

• Time of day

  day

  night

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason Code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Go Around

• Engines

  2 Engine

  Single Engine

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Landing

Landing

• Crosswind

• Engine

  2 Engine

  Single Engine

• Time of day

  day

  night

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason Code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Support Duties

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

System Knowledge

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

MEL

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Procedure / SOP Knowledge

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

Abnormal / emergencies

• Abnormal / Emergency

Abnormal

• Type of emergency

• Grade

  1

  2

  3

  4

  5

• Repeats

• Reason Code

  Select Situational Awareness Decision Making AC Maintained Tolerance Knowledge Management Communication

  • Situational Awareness
  • Decision Making
  • AC Maintained Tolerance
  • Knowledge
  • Management
  • Communication

• Situational awareness

  1

  2

  3

  4

  5

• Decision making

  1

  2

  3

  4

  5

• Aircraft Maintained within Limits

  1

  2

  3

  4

  5

• Knowledge

  1

  2

  3

  4

  5

• Management

  1

  2

  3

  4

  5

• Communication

  1

  2

  3

  4

  5

• Comments

• Overall assessment

  proficient

  not proficient

  interim sim

• Candidate

  Sign

• Examiner

  Sign