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document_type=form entity=format:application/pdf entity=language:ar language=en taxonomy_l1=transport taxonomy_l2=aviation taxonomy_l3=gacars validity=valid validity_confidence=0.6
GACA
الهييه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
EXAMINER/EVALUATOR AUTHORIZATION COMPETENCY EVALUATION/CHECK
1. APPLICANT INFORMATION
<table><tr><td colspan="2">Applicant Name(First, Middle, Last)</td><td>Nationality</td><td></td></tr><tr><td>Pilot&#x27;s License Details</td><td>☐ PPC ☐ PPC/IR ☐ CPC☐ CPC/IR ☐ ATPL</td><td>License Number</td><td></td></tr><tr><td>Instructor Rating Certificate Number</td><td>☐ CFI ☐ CFII</td><td>Class Rating</td><td>☐ ASEL ☐ AMEL☐ ASES ☐ AMES☐ RH ☐ RG</td></tr><tr><td>Instructor Certificate Number</td><td></td><td>Expiry Date (dd/mm/yy)</td><td></td></tr><tr><td>Organization Name</td><td></td><td>Location</td><td></td></tr></table>
2. EVALUATION/TEST DETAILS
<table><tr><td>Test Attempt Number</td><td>□ 1st</td><td>□ 2nd</td><td>Duration</td><td></td></tr><tr><td>Location</td><td></td><td></td><td>Date (dd/mm/yy)</td><td></td></tr></table>
3. TESTING/ CHECKING AUTHORIZATION
<table><tr><td>Certificate Level</td><td>□ ACR-141 □ ACR-FIRC □ SPE □ PEC □ CE□ CIRE □ ATPE □ SFIE □ FIE □ FIEl□ FIRE □ TYPE □ PPE</td></tr><tr><td>Aircraft Category/Class Privileges</td><td>□ ASEL □ AMEL □ ASES□ RH □ RG □ AMES</td></tr><tr><td>Objective of Testing/ Checking Assessment</td><td>□ Initial Authorization □ Surveillance-Observation □ Authorization Renewal</td></tr></table>
4. DEFINITIONS
<table><tr><td>a</td><td>Inspector</td><td>The Air Safety Inspector of GACA conducting the Examiner applicant competence assessment or observing the said assessment/evaluation if it is conducted by designated qualified Examiner.</td></tr><tr><td>b</td><td>Examiner applicant</td><td>The person seeking certification as an Examiner;</td></tr><tr><td>c</td><td>Candidate</td><td>The person being tested or checked by the Examiner applicant. This person may be a pilot for whom the test or check would be required, or the inspector of the competent authority who is conducting the examiner certification acceptance test.</td></tr><tr><td>d</td><td>Designated Examiner</td><td>Qualified Designated Evaluator/Examiner approved by GACA.</td></tr></table>
<table><tr><td colspan="2">5. CONDUCT OF THE ASSESSMENT/EVALUATION</td><td>YES</td><td>NO</td></tr><tr><td>a</td><td>An inspector of GACA or a Qualified Designated examiner (Senior Examiner) will observe all examiner applicants conducting a test on a ‘candidate’ in an aircraft for which examiner certificate/authorization is sought. Items from the related training course and test or check schedule will be selected by the inspector for examination of the ‘candidate’ by the examiner applicant;</td><td>□</td><td>□</td></tr><tr><td>b</td><td>Having agreed with the inspector the content of the test, the examiner applicant will be expected to manage the entire test. This will include briefing, the conduct of the flight, assessment and debriefing of the ‘candidate’. The inspector will discuss the assessment with the examiner applicant before the ‘candidate’ is debriefed and informed of the result.</td><td>□</td><td>□</td></tr><tr><td>c</td><td>Confirmation of Examine applicant eligibility, Completing Examiner qualifications and training requirements, Training records, etc.</td><td>□</td><td>□</td></tr><tr><td>d</td><td>Confirmation of Examiner applicant Documents such as License, medical, logbook, (if applicable), as necessary;</td><td>□</td><td>□</td></tr></table>
GACA-AVSES-OPS-F104
Rev: 3, Date: 22 Jun 25
Page 1 of 4

GACA
ال necesita تطلب للطيران المدني
General Authority of Civil Aviation
[Non-Text]
EXAMINER/EVALUATOR AUTHORIZATION COMPETENCY EVALUATION/CHECK
<table><tr><td colspan="2">6. BRIEFING THE CANDIDATEThe ‘Candidate’ Should Be Given Time And Facilities To Prepare For The Test Flight.The Briefing Should Cover The Following:</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a</td><td>Dose Examiner (applicant) have a plan of action?</td><td>□</td><td>□</td></tr><tr><td>b</td><td>The objective of the flight;</td><td>□</td><td>□</td></tr><tr><td>c</td><td>Freedom for the ‘candidate’ to ask questions;</td><td>□</td><td>□</td></tr><tr><td>d</td><td>Operating procedures to be followed (e.g. operators manual);</td><td>□</td><td>□</td></tr><tr><td>e</td><td>Weather assessment;</td><td>□</td><td>□</td></tr><tr><td>f</td><td>Operating capacity of ‘candidate’ and examiner;</td><td>□</td><td>□</td></tr><tr><td>g</td><td>Aims to be identified by ‘candidate’;</td><td>□</td><td>□</td></tr><tr><td>h</td><td>Contents of exercise to be performed;</td><td>□</td><td>□</td></tr><tr><td>i</td><td>Agreed speed and handling parameters (e.g. V-speeds, bank angle, approach minima);</td><td>□</td><td>□</td></tr><tr><td>j</td><td>Respective roles of ‘candidate’ and examiner (e.g. during emergency);</td><td>□</td><td>□</td></tr><tr><td>k</td><td>Administrative procedures (e.g. submission of flight plan) in flight;</td><td>□</td><td>□</td></tr><tr><td>l</td><td>Standards;</td><td>□</td><td>□</td></tr><tr><td>m</td><td>Outcomes;</td><td>□</td><td>□</td></tr><tr><td>n</td><td>Special Emphasis Items (if applicable):</td><td>□</td><td>□</td></tr><tr><td>1)</td><td>Positive aircraft control</td><td>□</td><td>□</td></tr><tr><td>2)</td><td>Collision avoidance</td><td>□</td><td>□</td></tr><tr><td>3)</td><td>Wake turbulence</td><td>□</td><td>□</td></tr><tr><td>4)</td><td>LAHSO</td><td>□</td><td>□</td></tr><tr><td>5)</td><td>CFIT</td><td>□</td><td>□</td></tr><tr><td>6)</td><td>CRM</td><td>□</td><td>□</td></tr><tr><td>7)</td><td>Aeronautical decision making</td><td>□</td><td>□</td></tr><tr><td>8)</td><td>Runway incursion awareness</td><td>□</td><td>□</td></tr></table>
<table><tr><td colspan="2">7. THE EXAMINER (APPLICANT)Should Maintain The Necessary Level Of Communication With The ‘Candidate’.The Following Check Details Should Be Followed By The Examiner Applicant</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a</td><td>Involvement of an examiner in a multi-pilot operating environment;</td><td>□</td><td>□</td></tr><tr><td>b</td><td>The need to give the ‘candidate’ precise instructions;</td><td>□</td><td>□</td></tr><tr><td>c</td><td>Responsibility for safe conduct of the flight;</td><td>□</td><td>□</td></tr><tr><td>d</td><td>Intervention by examiner, when necessary;</td><td>□</td><td>□</td></tr><tr><td>e</td><td>Use of screens;</td><td>□</td><td>□</td></tr><tr><td>f</td><td>Liaison with ATC and the need for concise, easily understood intentions;</td><td>□</td><td>□</td></tr><tr><td>g</td><td>Prompting the ‘candidate’ regarding the required sequence of events (e.g., following a go-around);</td><td>□</td><td>□</td></tr><tr><td>h</td><td>Keeping brief, factual and unobtrusive notes;</td><td>□</td><td>□</td></tr><tr><td>i</td><td>Proper use of checklists</td><td>□</td><td>□</td></tr></table>
<table><tr><td colspan="2">8. ASSESSMENT</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a</td><td>The Examiner applicant should refer to the flight test tolerances given in the relevant test/check reference (PTS/ACS or other GACA approved manual (Flight Examiner Manual);</td><td>□</td><td>□</td></tr><tr><td>b</td><td>Attention should be paid to the following points:</td><td>□</td><td>□</td></tr></table>
GACA-AVSES-OPS-F104
Rev: 3, Date: 22 Jun 25
Page 2 of 4

GACA
المنيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
EXAMINER/EVALUATOR AUTHORIZATION COMPETENCY EVALUATION/CHECK
<table><tr><td>(1)</td><td>Questions from the ‘candidate’;</td><td>□</td><td>□</td></tr><tr><td>(2)</td><td>Give results of the test and any sections failed;</td><td>□</td><td>□</td></tr><tr><td>(3)</td><td>Give reasons for failure</td><td>□</td><td>□</td></tr></table>
<table><tr><td colspan="2">9. DEBRIEFING</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a</td><td>The Examiner applicant should demonstrate to the inspector the ability to conduct a fair, unbiased, debriefing of the ‘candidate’ based on identifiable factual items. A balance between friendliness and firmness should be evident.</td><td>□</td><td>□</td></tr><tr><td>b</td><td>The following points should be discussed, but not limited to, with the ‘candidate’:</td><td>□</td><td>□</td></tr><tr><td>(1)</td><td>Advise the candidate how to avoid or correct mistakes;</td><td>□</td><td>□</td></tr><tr><td>(2)</td><td>Mention any other points of criticism noted;</td><td>□</td><td>□</td></tr><tr><td>(3)</td><td>Give any advice considered helpful;</td><td>□</td><td>□</td></tr><tr><td>c</td><td>Accuracy;</td><td>□</td><td>□</td></tr><tr><td>d</td><td>Appropriateness;</td><td>□</td><td>□</td></tr><tr><td>e</td><td>Clear/Concise;</td><td>□</td><td>□</td></tr><tr><td>f</td><td>Informative</td><td>□</td><td>□</td></tr></table>
<table><tr><td colspan="2">10. DEMONSTRATION OF THEORETICAL KNOWLEDGE</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a</td><td>The examiner applicant should demonstrate to the inspector a satisfactory knowledge of the regulatory requirements associated with the function of an examiner.</td><td>□</td><td>□</td></tr><tr><td>b</td><td>The examiner applicant should demonstrate to the inspector satisfactory General and Technical knowledge which are required and related to the checks/tests such as aircraft systems, normal and abnormal procedures, limitations, performance, etc.</td><td>□</td><td>□</td></tr></table>
<table><tr><td colspan="2">11. EXAMINER (APPLICANT) SKILLS</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a</td><td>Question Structure;</td><td></td><td></td></tr><tr><td>b</td><td>Use of Facilities;</td><td></td><td></td></tr><tr><td>c</td><td>Identification of Training vs Checking;</td><td></td><td></td></tr><tr><td>d</td><td>Completion of required events;</td><td></td><td></td></tr><tr><td>e</td><td>Workload management;</td><td></td><td></td></tr><tr><td>f</td><td>Identification of deviations from appropriate standards;</td><td></td><td></td></tr><tr><td>g</td><td>Checking documentation completion;</td><td></td><td></td></tr><tr><td>h</td><td>Proper ATC Phraseology</td><td></td><td></td></tr></table>
<table><tr><td colspan="2">12. RECORDING OR DOCUMENTATION</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a</td><td>The examiner applicant should demonstrate to the inspector the ability to complete the relevant records correctly. These records should be at least:</td><td>□</td><td>□</td></tr><tr><td>(1)</td><td>The relevant test or check report form;</td><td>□</td><td>□</td></tr><tr><td>(2)</td><td>The relevant test or check application form;</td><td>□</td><td>□</td></tr><tr><td>(3)</td><td>Airman Certificate ;</td><td>□</td><td>□</td></tr><tr><td>(4)</td><td>Notification of failure form; Notice of Dis-Approval;</td><td>□</td><td>□</td></tr><tr><td>(5)</td><td>Copy of his Airman Certificate, medical, logbook, if applicable</td><td>□</td><td>□</td></tr></table>
<table><tr><td colspan="2">13. EXAMINER (APPLICANT) SKILL TEST (ON AIRCRAFT AND/OR FLIGHT SIMULATOR)</td><td>SAT</td><td>UNSAT</td></tr><tr><td>a.</td><td>* For the Assessments of the Flying Skills and Maneuvers, refer to the applicable Airman Proficiency Check Form.</td><td>□</td><td>□</td></tr><tr><td colspan="4">* The applicable Airman Proficiency Check Form must be utilized during the practical assessment and attached with this checklist.</td></tr></table>
GACA-AVSES-OPS-F104
Rev: 3, Date: 22 Jun 25
Page 3 of 4

GACA
المنيه العامه للطيران المدني
General Authority of Civil Aviation
[Non-Text]
EXAMINER/EVALUATOR AUTHORIZATION COMPETENCY EVALUATION/CHECK
FOR EXAMINER/EVALUATOR USE ONLY
14. EVALUATION/ASSESSMENT RESULT
<table><tr><td colspan="2">□ Satisfactory</td><td colspan="2">□ Unsatisfactory</td></tr><tr><td colspan="4">15. REMARKS</td></tr><tr><td>1.</td><td colspan="3"></td></tr><tr><td>2.</td><td colspan="3"></td></tr><tr><td>3.</td><td colspan="3"></td></tr><tr><td>4.</td><td colspan="3"></td></tr><tr><td>5.</td><td colspan="3"></td></tr><tr><td>6.</td><td colspan="3"></td></tr><tr><td>7.</td><td colspan="3"></td></tr><tr><td>8.</td><td colspan="3"></td></tr><tr><td>9.</td><td colspan="3"></td></tr><tr><td>10.</td><td colspan="3"></td></tr><tr><td>11.</td><td colspan="3"></td></tr><tr><td>12.</td><td colspan="3"></td></tr><tr><td>13.</td><td colspan="3"></td></tr><tr><td>14.</td><td colspan="3"></td></tr><tr><td>15.</td><td colspan="3"></td></tr></table>
<table><tr><td colspan="2">Designated Evaluator/Examiner Name</td><td>Title</td><td>Signature</td><td>Date</td></tr><tr><td colspan="2"></td><td></td><td></td><td></td></tr><tr><td colspan="5">If the Evaluation/Assessment was observed by GACA</td></tr><tr><td colspan="2">Aviation Safety Inspector Name</td><td>Title</td><td>Signature</td><td>Date</td></tr><tr><td colspan="2"></td><td></td><td></td><td></td></tr></table>
GACA-AVSES-OPS-F104
Rev: 3, Date: 22 Jun 25
Page 4 of 4