Download doc - · Web viewRNP 10 RNAV 5 RNAV 2 RNAV 1 RNP 4 RNP 2 Basic RNP 1 Advanced RNP RNP APCH RNP AR Ops RF Legs Baro VNAV LPV FANS 1/A ADS-B Out CASA CAO 82.5 EASA AMC 20-24 RTCA DO-260A

Operational Approvals Application

Instructions and advice for completing this Application Form

Note: The CAA Standard Rate hourly charge applies.

Refer to Advisory Circular AC91-Ops1 for the instructions to complete this application.

The charges associated with the operational approvals will be invoiced to the applicant.

Applications must be submitted to CAA not less than 28 days prior to the date required.

To reduce time and costs, this form is intended to be revised for additional applications after the initial approvals for an aircraft type.

Brief DetailsMake: Model:

Single aircraft Multiple aircraft (Complete Appendix A)

Application Type: New Application

Change being made:

Revision HistoryRevision No: Date:

CAA Work Request No: (To be completed by the CAA)

Part A – Details of ApplicantName of Operator:

Client ID No. (if known)

Address for Service: Civil Aviation Act, s8, requires applicants to provide an address for service (ie, a physical address) and to promptly notify the Director of any changes.

Tel: Fax: Email:

Postal Address: (If different from Address for Service.)

Tel: Fax: Email:

Person or organisation who can be contacted for further information concerning this application:Name:

Designation:

Address:

Tel: Mob: Email:

Page 1 of 15 CAA 24091/07Rev 3 : May 2013


Approvals Sought: (Check those required)

RVSM ILS Cat II ILS Cat III

EDTO:

120 min 180 min 210 min 240 min

Navigation

RNP 10 RNAV 5 RNAV 2 RNAV 1

RNP 4 RNP 2 Basic RNP 1 Advanced RNP

RNP APCH RNP AR Ops

RF Legs Baro VNAV LPV

FANS 1/A

ADS-B Out

CASA CAO 82.5 EASA AMC 20-24

RTCA DO-260A RTCA DO-260B

ADS-C

TBD



Part B – Aircraft and Equipment DetailsMake: Model:

Serial No: Line No: Variable No:

Registration Mark: CAA Aircraft ID: Mode S Code (hex): C8XXXX

Aircraft History:

New Used

Previous Registration:

Previous Operator:

State / Country:

For multiple aircraft of the same make and model complete the continuation sheet in Appendix A.



Aircraft Documentation(Insert document number, revision / date and reference information)

Flight Manual:Air No: Manufacturer No: Rev:

RVSM ApprovalsAFM Reference

SIL / SB

Navigation ApprovalsAFM / Approval Doc References

AFM / Approval Doc References

AFM / Approval Doc References

ADS-B ApprovalsApprovals held Nil

AFM Reference

Relevant Approval Doc

ADS-C Approvals

Aircraft ELA

Aircraft Software Configuration List

Maintenance Planning Document

Aircraft Maintenance Manual

IPC

Wiring Diagram Manual

Structural Repair Manual

Configuration Deviation List

MMEL

Operator MEL / DDPG



Aircraft Equipment DetailsCommunications Systems(Insert Make, Model & P/N)

Qty installed

VHF Model 0

HF Model 0

SATCOM Model

SATCOM Data 0

SATCOM Voice 0

Is SCV integrated to audio, CVR and FDR systems? No

Is an Exemption against §91.519 held for this aircraft? No Exemption No:

Navigation SystemsQty installed

Inertial Reference System

Model 0

Part No

Air Data Computers Model

Model 0

Part No

GNSS

Model 0

Part No

DME

Model 0

Part No

Flight Management Computer

Model 0

Part No

Software Version

Flight Control Computer

Model 0

Part No

Software Version

Mode Control Panel

Model

Part No



Pitot Static Probes

Model / Part No 0

Angle of Attack Vanes

Model / Part No 0

Surveillance Systems

Transponder 1

Model Mode S 0

Part No

Software Version

ELS EHS Extended Squitter

Transponder 2

Model Mode S 0

Part No

Software Version

ELS EHS Extended Squitter



Part C – Continued Airworthiness

Maintenance Organisation

Contact Details:

Name:

Phone: Mobile: Email:

Maintenance facilities to be used:

Procedures for managing maintenance providers:

Part 43 specified maintenance completed:

Part 43 App B Radio Station Inspection

Part 43 App D Altimeter Systems Tests & Inspections

Part 43 App E ATC Transponder Tests & Inspections

Comments:

Maintenance Practices(Insert document number, revision / date and reference information)

Maintenance schedule

Configuration management

Modifications / Repairs

Maintenance Practices

Use of BITE

Static System Maintenance

Skin Waviness Checks

Non-Compliant AircraftNotification Procedure (maintenance)

Notification Procedure (operations)

Notification Procedure (CAA)

Corrective Action Procedures

Maintenance TrainingTest Equipment

Documentation

RVSM Test EquipmentAccuracy (0.01% or 4:1)

Calibration Schedule

Audit Programme

Maintenance Practices

Comments:



Part D – Operational Training and Competency

Contact Details:

Name:

Phone: Mobile: Email:

Training programme submitted:

RVSM

PBN: RNAV & RNP

FANS 1/A

ADS-B

ADS-C

Operator Practices and Procedures - RVSMFlight Planning

Pre-Flight

Procedures prior to RVSM airspace entry

In-Flight Procedures

ATC Phraseology

NAT Airspace Procedures

Verification / Monitoring Programme

Operator Practices and Procedures – PBN: RNAV & RNPFlight Planning

Pre-Flight

Procedures prior to RNP airspace entry


ATC Phraseology

Special Airspace Procedures

Training

Operator Practices and Procedures – RNP / FANS 1/AFlight Planning

Pre-Flight

Procedures prior to RNP airspace entry


ATC Phraseology


Training



Operator Practices and Procedures – ADS-B / ADS-CFlight Planning

Pre-Flight

Procedures prior to ADS-B airspace entry


ATC Phraseology


Training

Crew training completed:

Comments:



Part E – Applicants Declaration

I am signing this form as:

A Senior Person in a Part 119 Certificated operator.

Owner / operator of an aircraft engaged in Part 91 operations only.

Agent or representative of an OWNER / OPERATOR of an aircraft engaged in Part 91 operations only.

Giving false or misleading information is an offence under the regulations.

1. I declare that the information provided in this application form is true and correct.

2. I understand that the information provided in this application will allow CAANZ to calculate an estimate for service for processing this application.

3. I understand and agree that the cost estimate may change, and processing the application may be delayed if:

the application does not accurately and completely identify my/our requirements; or

the details in this application are subsequently changed; or

adequate supporting documentation has not been provided.

4. I understand and agree that for CAANZ to proceed with this application, I must:

accept the cost estimate,

forward the prescribed payment; and

forward all supporting documentation to CAANZ.

5. If I am signing this application as an agent, I declare that I have obtained the necessary Power of Attorney authorising me to sign on behalf of the applicants.

Name: Date:

There is no signature required on this form; the presence of the name of the individual in this field is deemed to be a signature.

Part F – Submitting Your Application

Have you attached all required documentation as indicated throughout the application? All supplemental information should be in an electronic format.

After reviewing your application, CAANZ will advise you if any additional information is required.



Part G – CAA Assessment 1. Airworthiness:

a. RVSM:

i. The aircraft meets the airworthiness requirements specified in AC 91-4 approval for RVSM operations.

ii. Aircraft has dual independent communications:VHF HF HF + SCV

iii. Aircraft meets the requirements for: Being assessed.

iv. Aircraft inspection required: No

v. Inspection sheet raised:

b. The aircraft meets the airworthiness requirements specified in AC 91-XX for the following navigation operations:

i. RNP 10 (RNAV 10)

ii. RNAV 5 (BRNAV)

iii. RNAV 2

iv. RNAV 1 (PRNAV)

v. RNP 4

vi. RNP 2

vii. Basic RNP 1

viii. RNP 0.3

ix. RNP APCH

x. RNP AR Operations

xi. Baro VNAV

xii. LPV

xiii. RF legs

xiv. FANS 1/A

xv. Inertial only navigation time for RNP 10: x.x hours

xvi. Inertial only navigation time for RNAV 5: x.x hours

Conditions / limitations / comments:

c. The aircraft meets the airworthiness requirements specified in AC 91-XX for ADS-B operations in airspace with the following requirements:

i. CASA CAO 82.5

ii. EASA AMC 20-24

iii. RTCA DO-260A

iv. RTCA DO-260B




d. The aircraft meets the airworthiness requirements specified in AC 91-XX for ADS-C operations in airspace with the following requirements:

i. TBD


2. Continued Airworthiness:

a. The aircraft operator is already approved for the conduct of the operations requested for the same aircraft make and model; and

b. There are no significant differences from previously approved aircraft;

or

c. The aircraft operator has the capability of maintaining the aircraft in compliance with its type design and AC 91-4 for the conduct of RVSM operations;

d. The aircraft operator has the capability of maintaining the aircraft in compliance with its type design and AC 91-XX for the conduct of the navigation operations listed in 1. b above.

e. The aircraft operator has the capability of maintaining the aircraft in compliance with its type design and AC 91-XX for the conduct of operations requiring ADS-B listed in 1. c above.

f. The aircraft operator has the capability of maintaining the aircraft in compliance with its type design and AC 91-XX for the conduct of the ADS-C operations listed in 1. d above.

3. Flight Operations:

a. The aircraft operator is already approved for the conduct of the operations requested for the same aircraft make and model; and

b. There are no significant differences from previously approved aircraft;

or

c. The aircraft operator has been assessed as having the required training and operational competency for the conduct of RVSM operations in accordance with CAR §91 and AC 91-4 in domestic and oceanic airspace.

d. The aircraft operator has been assessed as having the required training and operational competency for the conduct of the navigation operations listed in 1. b above in accordance with CAR §91 and AC 91-XX.

e. The aircraft operator has been assessed as having the required training and operational competency for the conduct of operations in airspace requiring ADS-B as listed in 1. c above in accordance with CAR §91 and AC 91-XX.

f. The aircraft operator has been assessed as having the required training and operational competency for the conduct of operations in airspace requiring ADS-C as listed in 1. D above in accordance with CAR §91 and AC 91-XX.



Part G – CAA Approval

Approval Recommendation

Airworthiness In assessment

Name: Date:

Continued Airworthiness In assessment

Name: Date:

Flight Operations In assessment

Name: Date:

Manager Flight Operations Approval

The operations identified in Part G Section 1 are In assessment subject to the conditions and limitations specified below:

Conditions and Limitations

Manager Flight Operations Approval

Name: Date:

Approval Completion1. RVSM inspection report received and satisfactory

(if required). Not required

2. Letter(s) of Authorisation issued.

3. Ops Specs revised and approved.

4. For RVSM, PARMO Form F2 submitted.

5. For RVSM, CAA Registration database updated.

6. ACU Operational Approvals database updated.



Appendix A: Additional AircraftAircraft 2Make: Model:



Aircraft History:

New Used


Previous Operator:

State / Country:

Approval Completion

1. RVSM inspection report received and satisfactory (if required). Not required






Aircraft 3Make: Model:



Aircraft History:

New Used


Previous Operator:

State / Country:

Approval Completion












Aircraft History:

New Used


Previous Operator:

State / Country:

Approval Completion










Aircraft History:

New Used


Previous Operator:

State / Country:

Approval Completion1. RVSM inspection report received and satisfactory

(if required). Not required





