Form 61-1512
Instrument Proficiency Check - Aeroplane
Refer to: CASR 61.M
FLIGHT TEST REPORT
ARN
 Satisfactory
Item
No
MOS
Ref
1
2
(i)
2.1(a)
3
4
2.1(b)
2.1(c)
5
6
7
8
2.1(d)
2.1(e)
2.1(f)
2.1(g)
9
2.1(h)
10
11
12
13
14
15
2.1(i)
2.1(j)
2.1(k)
2.1(l)
2.1(m)
2.1(n)
16
17
18
19
20
NTS1.1
NTS1.2
NTS1.3
NTS1.4
NTS1.5
21
22
23
NTS2.1
NTS2.2
NTS2.3
24
IFF.1
25
IFF.2
Description
X Unsatisfactory
Result
GROUND COMPONENT
Underpinning Knowledge of 16 to 49
Privileges and limitations of the instrument
rating and the instrument endorsement(s)
held by the applicant, including recency
and proficiency check requirements;
IFR flight and duty limitations;
Interpreting operational meteorological
information;
Take-off minima;
Holding and alternate requirements;
IFR procedures –all airspace classifications;
Departure and Approach instrument
procedures;
Operations below LSALT/MSA for day and
night operations;
GNSS including PBN standards
Circling approaches
ERSA normal and emergency procedures
IFR planning
Adverse weather operations
Equipment requirements
FLIGHT COMPONENT
Maintain effective lookout
Maintain situational awareness
Assess situations and make decisions
Set priorities and manage tasks
Maintain effective communications and
interpersonal relationships
Recognise and manage threats
Recognise and manage errors
Recognise and manage undesired aircraft
state
Determine and monitor the serviceability
of flight instruments and instrument
power sources
Perform manoeuvres using full instrument
panel
S
A
N Not Tested
Item
MOS Ref
No
26
IFF.3
27
IFL.1
28
29
IFL.2
IFL.3
30
31
32
CIR.1
CIR.2
CIR.3 *
33
CIR.4 *
34
CIR.5
35
CIR.6
36
37
CIR.7
CIR.8
38
CIR.9 *
39
CIR.10
40
41
42
43
44
45
46
47
48
49
IAP2.1
IAP2.2
IAP2.3 *
IAP2.4
IAP2.5
IAP3.1 *
IAP3.2 *
IAP3.3 *
IAP3.4 *
IAP3.5 *
Description
Result
Recover from upset situations and
unusual attitudes
Recognise failure of attitude indicator
and/or stabilised heading indicator
perform manoeuvres – limited panel
Recover from upset situations and
unusual attitudes – limited panel
Plan a flight under the IFR
Perform an instrument departure
Conduct a published/cleared instrument
departure (all engines)
Conduct an instrument departure (one
engine inoperative)
Navigate aircraft under the IFR using
ground based and /or satellite based
navigational systems
Perform a descent and arrival under the
IFR
Perform a published holding procedure
Perform an instrument approach 2D or
3D
Perform an instrument approach one
engine inoperative (multi-engine aircraft
only)-simulated IMC
Perform visual approach operations
(includes visual circling where
applicable)
Prepares for approach
Conducts initial approach
Conducts a holding pattern
Conducts an approach
Conducts a missed approach
Prepares for approach
Conducts initial approach
Conducts a holding pattern
Conducts an approach
Conducts a missed approach
S
* Refer to MOS Schedule 6 – clause 3 (modifications)
Date
VH -
PASS
FAIL
Applicant Name
Applicant Signature
Applicant ARN
Test Number
Aeroplane Type
Examiner Name
ARN
Examiner Signature
Ground Time
Flight Time
Simulator Type
Examiner Name
ARN
Examiner Signature
Ground Time
Simulator Time
APPROACHES TESTED
NDB
VOR
ILS
LLZ
DGA
GNSS/RNAV
OTHER
Examiner comments:
Form 61-1512 (amended)
09/2014
Instrument Proficiency Check - Aeroplane
Page 1 of 2
A
Form 61-1512
Instrument Proficiency Check - Aeroplane
Refer to: CASR 61.M
FLIGHT TEST REPORT
ARN
 Satisfactory
Form 61-1512 (amended)
09/2014
X Unsatisfactory
N Not Tested
Instrument Proficiency Check - Aeroplane
Page 2 of 2