AIRCRAFT CHECKOUT FORM (V1.

5)
WVFC Member Information

Approved: ___________ Chief CFI

Name: Jose Herrero Bajo

Member #

Pilot Certificate Level: None

Ratings:

-1

Certificate #

Medical Class: None

Last Medical Date*:
Last BFR Date*:
IFR Expiration date**:
* Note: Medical Certificate, Flight Review, IPC dates are entered in CASSi only if copies are attached.
Total Hours:

Last Year:

Tailwheel:

Complex:

Last 90 Days:

PIC***:

HP:

Time in Model:

Multi:

** If you are IFR current, please indicate when your currency expires

Night:

*** Note: non-dual flights / total time to date

The above named pilot may fly the following aircraft marked with a check
(Show time in each aircraft along with a checkmark to indicate the aircraft you would like privileges in)
__________ C-150
__________ PA28-161
__________ SR20
__________ C-152
__________ PA28-181
__________ SR22
__________ C-162
__________ PA28R-200
__________ T-SR22
__________ C-172
__________ DA40
__________ T-SR22G1
__________ C-172SP
__________ DA42
__________ 7ECA
__________ C-172SP-G1
__________ BE-76
__________ 7GCAA
__________ C-172RG
__________ 8KCAB
__________ C-182
__________ S2C
__________ C-182T-G1
N# (s): _____________________________ Date Range Conducted: _________________ Total # of

__________
__________
__________
__________

AST300
ES200
Frasca
Other

Landings ____________

Checkout Flight(s) Hours: _____ Checkout Ground Hours: _____ Airports Used: ______________________________________

Checkouts with an asterisk (*) require completion of an Aircraft Ground Review Form and a Member Regulations Quiz
which are to be reviewed by the CFI and attached to this form. New member checkouts require pilot certificate, medical
certificate, and Flight Review endorsement be attached as well.
______ Initial Make/Model Checkout*

______ Student Solo *

For any of the following checkouts, if a logbook endorsement is required by FARs, a copy must be attached to this form:
_____ Tailwheel

_____ High Performance

_____ Aerobatics
_____Grass Runway

_____ Complex

_____ Right Seat Ops

(CFI student only)
_____ WVFC CFI Privileges

_____ High Altitude Ops

(Turbo Charged & Pressurized A/C)
_____ Mountain

_____ *VFR ONLY Review all appropriate items from other side to Private Pilot PTS standards.
* If checking VFR only, then pilot certifies that they will not operate aircraft under IFR.
_____ VFR AND IFR Review all appropriate items from other side to Private Pilot PTS standards plus proficiency to IPC standards.
Simulated/Actual Instrument Time ___________
Number of Approaches __________
I certify all information provided is correct and accurate, please SIGN and PRINT your name below.
Member:

Jose-Angel Herrero Bajo

Digitally signed by Jose-Angel Herrero Bajo

DN: cn=Jose-Angel Herrero Bajo, o, ou, email=jaherrero@gmail.com, c=US
Date: 2015.01.17 09:56:20 -08'00'

Date:

I certify that the checkout procedures meet all applicable FARs, WVFC Member Regs, Bylaws and Operating Rules.
CFI:

WVFC #

-1

Date:

WWW.WVFC.ORG
Palo Alto Airport (650) 856-2030
San Carlos Airport (650) 595-5912

11/05/2012

1901 Embarcadero Rd #100 Palo Alto, CA 94303

655 Skyway Dr #101 San Carlos, CA 94070

 All items listed below, as appropriate to the checkout and aircraft make and model flown, are to be reviewed or conducted
under the direction of a WVFC CFI.
Essential to flight safety are precise aircraft control and sound judgment in decision-making. Accordingly, member
performance in these areas will receive careful evaluation throughout all operations.

Instructor and Member Note:

Please check all items that were covered during this checkout.

PREFLIGHT
Aeronautical Decision Making (See accidents/incident section below)
Airworthiness Requirements
Weight & Balance
Normal Operating Procedures
Emergency Procedures
Walk Around and Inspection
PRETAKEOFF
Aircraft Starting
Run-up Procedures
Radio Usage
FLIGHT PROCEDURES
Takeoff
Instrument Procedures (IFR only)
Leaning Procedure
Autopilot Ops
Takeoff / Departure Stall

Aircraft Ground Review Form

Review Aircraft Systems
Fuel Handling Guidelines
Taxi & Maneuvering

Steep Turn
Level Flight
Avionics
Approach to Landing Stall

Climb / Descent
Navigation Procedures
Slow Flight / MCA
Aerobatics

Gear Extension
Electrical Failure

Engine Fire
Navigation Errors

Traffic Observation
Landing
Soft Field Procedures

Approach
No Flap Landings
Short Field Procedures

SECURING AIRCRAFT
Shutdown
Logbook Entries

Control Lock
Tiedown

Tow Bar Use

Aircraft Cleanup

REGULATIONS
FARs
Aircraft Documents
Reviewed WVFC Key Book Items

Local Procedures
Pilot Documents
WVFC Squawk Procedures

Noise Abatement
WVFC Member Regulations
Aircraft Observations

EMERGENCY PROCEDURES
Engine Failure
Weather Considerations
TRAFFIC PATTERN
Takeoff
Go-Around
Wheel Landings (Tailwheel)
Simulated Engine Failure

ACCIDENTS/INCIDENTS All checkouts require a minimum discussion of one WVFC accident/incident.

Accident Number (e.g.: B42) ____________

Time spent reviewing accident ____________________________________

Accident Number (e.g.: B46) ____________

Time spent reviewing accident ____________________________________

CFI Comments: (To justify abbreviated or expanded checkout or any special circumstances. Please use additional stationary as
needed to conclude all comments)

WWW.WVFC.ORG
Palo Alto Airport (650) 856-2030
San Carlos Airport (650) 595-5912

11/05/2012

1901 Embarcadero Rd #100 Palo Alto, CA 94303

655 Skyway Dr #101 San Carlos, CA 94070