Flight Risk Assessment Tool
Email *
Name
CFI
Total Weight *
1 point
Balance (Center of Gravity) *
1 point
Fuel Required
1 point
Airfield Familiarity
3 points
Select One
Very Familiar (home airfield)
Familiar
Unfamiliar (Have not Taken Off, Landed, and Taxied at all airports in the sortie planned in the last)
Clear selection
Time of Day
2 points
Select One
Day
Night
Clear selection
Departure and Arrival Weather
106 points
Select One
VFR
Special VFR
IMC (>800' Ceilings and 2sm Vis)
Low IMC
Clear selection
Surface winds
135 points
Select One
Light < 10kts
Moderate 10-20 kts
High >20 kts
Extreme >30 kts
Clear selection
Calculated Takeoff Distance *
1 point
Takeoff Distance
145 points
Select one
Takeoff Ground Roll <50% of runway
Takeoff Ground Roll 50-80% of runway
Takeoff Ground Roll >80% of runway
Clear selection
Calculated Landing Distance
1 point
Landing Distance
145 points
Select One
Landing Distance <50% of runway
Landing Distance 50-80% of runway
Landing Distance >80% of runway
Clear selection
Runway Conditions
300 points
Select One
Dry
Grass
Wet
Snow
Ice
Clear selection
Enroute Conditions (Thunderstorm/Icing/Turbulence)
210 points
Select One
None / None / Calm
Isolated / within 2000' / Light
Scattered(30-50%) / within 1000' / Moderate (tango)
Numerous (60%+) / within 500' /
T Storms in area <10NM / Icing Conditions / Extreme Turbulence Forecast
Clear selection
Mountain Flying Winds Aloft
190 points
Select One
Non Mountainous
Light <11 kts
Moderate (>15 to < 26kts)
High (>25 to <31kts)
Extreme (>30 kts)
Clear selection
Pilot Experience
71 points
Select One
>500 Hours PIC
300-500 Hours PIC
<300 Hours PIC
<40 Hours PIC
Clear selection
Mission
90 points
Select One
Very Familiar (Flown mission profile in the last 60 days)
Familiar (Flown mission in the last 120 days)
Moderately Familiar(Flown mission in the last 180 days)
Unfamiliar (Never flown this mission or >180 days)
Clear selection
PIC Currency
70 points
Select One
Very Current (<30 days)
Current (31-90 days)
Non-current (181 days or more)
Clear selection
Mission Complexity
70 points
Select One
Routine (Flown mission profile in the last 60 days)
Moderate (Some new elements)
Elevated (Mostly new elements)
Clear selection
Over Water Flight
1195 points
Select One
Over Land with emergency landing available
Over Land with emergency landing NOT available
Over water Glide Distance of shore
Beyond Gliding Distance (Life jackets and Rescue Support)
Beyond Gliding Distance (Life jackets and No Rescue Support)
Beyond Gliding Distance (beyond 50NM of shore)
Clear selection
Flight Crew
625 points
Select One
Solo Flight
Passengers
Safety Pilot
Flight Instructor
Clear selection
IMSAFE Evaluated
Illness.  Medication. Stress. Alcohol. Fatigue. Emotion (Hazardous Attitudes).
1100 points
Select One
No issues
minor consideration for one of six items
Significant consideration for one or more items
Clear selection
Aircraft
120 points
Select One
No issues
Minor Operational issue(radio not working)
Significant consideration for one or more items
Clear selection
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Flight Test Prep. Report Abuse