LST / LPC / IR Check Form

LST / LPC / IR Check Form
The following symbols mean:

P = Pilot Flying (PF) and Pilot Monitoring (PM)

M = Where the letter “M” appears in the LST/LPC/IR check column this will indicate the Mandatory exercises.

The starred items (*) shall be flown in simulated IMC for renewal of an Instrument Rating.

Note: TRE/TRI shall refer to KCASR 1 Part-FCL as applicable for more details.
Applicant Details

Please complete the Trainee details
Name*
CaptainFirst Officer
Staff Number*
License Number
License Validity

DayMonthYear
Date
ATPLCPL
Examiner Details

Please complete the Examiner details.
Staff Number*
Examiner Name*
License Number
Authority Number:
Authority Validity
Session Details

Please enter the SIM session details
Date of Check*

DayMonthYear
Date
FFS Used JZR 32-
SIM Location
SIM Duration

Hour Minutes

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

Rows	PASS	FAIL
Attempt 1
Attempt 2

ATTEMPT 1
Competencies

.

KNO*

Rows	SELECT
GRADE

KNO GRADE

PRO*

Rows	SELECT
GRADE

PRO GRADE

COM*

Rows	SELECT
GRADE

COM GRADE

FPA*

Rows	SELECT
GRADE

FPA GRADE

FPM*

Rows	SELECT
GRADE

FPM GRADE

LTW*

Rows	SELECT
GRADE

LTW GRADE

PSD*

Rows	SELECT
GRADE

PSD GRADE

SAW*

Rows	SELECT
GRADE

SAW GRADE

WLM*

Rows	SELECT
GRADE

WLM GRADE
CHECK RESULT
PASSPARTIAL PASSFAIL

FAILED ITEMS (IF APPLICABLE)

Rows	1	2	3	4	5	6
ITEMS

Trainee Name*
Trainee Signature*

Clear
Examiner Name*
Examiner Signature*

Clear
E. EXAMINER RECOMMENDATIONS
Observations/ Comments :

ATTEMPT 2

(This part is applicable only if ATTEMPT 1 is "PARTIAL PASS")

KNO

Rows	SELECT
GRADE

KNO GRADE

PRO

Rows	SELECT
GRADE

PRO GRADE

COM

Rows	SELECT
GRADE

COM GRADE

FPA

Rows	SELECT
GRADE

FPA GRADE

FPM

Rows	SELECT
GRADE

FPM GRADE

LTW

Rows	SELECT
GRADE

LTW GRADE

PSD

Rows	SELECT
GRADE

PSD GRADE

SAW

Rows	SELECT
GRADE

SAW GRADE

WLM

Rows	SELECT
GRADE

WLM GRADE
Date of Check

DayMonthYear
ATTEMPT 2

Rows PASS FAIL

RESULT

FAILED ITEMS (IF APPLICABLE)

Rows	1	2	3	4	5	6
ITEMS

Trainee Name
Trainee Signature

Clear
Examiner Name
Examiner Signature

Clear
F.EXAMINER'S RECOMMENDATION Observations/ Comments
ATO Head of Training Remarks
ATO Head of Training Signature

Clear
Should be Empty:

LST / LPC / IR Check Form

Applicant Details

Examiner Details

Session Details

Manoeuvre / Procedures

SECTION 1

SECTION 2

2.5 Take-off with simulated engine failure: M

SECTION 3

3.4 Normal and Abnormal Operations of Systems

3.6 Abnormal and Emergency Procedures

3.8 Instrument Flight Procedures

SECTION 4

SECTION 5

SECTION 6

Performance Based Navigation (PBN)

Right Hand Seat

Competencies

CHECK RESULT

E. EXAMINER RECOMMENDATIONS

ATTEMPT 2