PART ONE               

  This form is to be used by the instructor when a pilot is undergoing a checkout.  In addition, the pilot is to have in his possession an Owner’s Manual for the aircraft and separate copies of all checklists..

  AIRCRAFT : N_______________ 

           Make: ________ Model ________________

   ENGINE:  Make_________________   HP  _____

                     Type of Carburation ________________

                     Oil Type _________   Grade  ______

   FUEL CAPACITY (useable) _________gal.

   V-SPEEDS:
       Vne -  Never Exceed Speed               _______
       Vfe  - Max. Flap Extended                 _______
       Vlo  - Max Land Gear
                     Operating  Speed                  _______
       Va   -  Design Maneuvering               _______
       Vs   -  Stall Speed-No Flaps              _______
       Vso -  Stall Speed - Flaps
                     Landing Configuration         _______
       Vx   -  Best Angle of Climb               _______
       Vy  -   Best rate of Climb                   _______

   WEIGHT & BALANCE:
   Execute a weight & balance problem using all stations.
      

   POWER SETTINGS:
   The range of this aircraft at 6,000 ft. MSL at 75% power (no reserve) is _______(Assume Std conditions and no wind)

   TAKE-OFF GROUND RUN :
     (FEET) @  6,000 ft.
     Hard Surface __________  Turf _____________
     Hard Surface over 50 ft. obstacle __________

   LANDING:
     Ground Roll  __________ ft. @  6,000 ft.

     Ground Roll over 50 ft. obstacle _______ ft @ 6,000 ft.

PART TWO

  This part of the checkout is intended to supplement the information normally found in the Owner’s Manual of this particular aircraft. With this knowledge, hopefully, the pilot will be able to execute his flight more efficiently and safely by being aware of all of the idiosyncrasies associated with this particular aircraft.

        1.   INTERIOR
             Seat adjustment; lighting; heat and ventilation.
 2.   PANEL
              Equipment, switches, fuses and breakers
 3.   FUEL MANAGEMENT 
              Selector Valve, checks for water.
 4.   OIL MANAGEMENT
 5.   BRAKES (foot and park)
 6.   ENGINE OPERATION
              Cold/Hot start; flooding; shutdown
 7.   PLACARDS
 8.   GROUND HANDLING
 9.   STALL CHARACTERISTICS
10. CROSSWIND HANDLING
11. SPIN RECOVERY (DISCUSS)
12. EMERGENCY PROCEDURES
13. HANGARING
14. TIE-DOWN
15. REVIEW CHECK LISTS
16. REVIEW CLUB RULES ON THIS AIRCRAFT

  Total Time:    _________________ 

  Total Time in Type: _____________

  Date of Completed Checkout:  ___________________

  Total Time for Checkout:  _______________ Hours

  Pilot Name:  ________________________________

  Pilot Signature: ___________________ Acct# ______

  Instructor Signature:  __________________________

ITEMS

WEIGHT (lbs)

ARM (inches)

MOMENT (inch lbs)

Subtotal:

TOTAL: