Comprehensive Pre-Flight Clearance & Safety Authorization Form for Experimental Aircraft and Unmanned Systems Flight Test Operations

Aircraft Registration or Experimental Identification Number

Aircraft Manufacturer and Model Designation

Experimental Flight Test Certificate or Special Airworthiness Number

Aircraft Operational Category

Describe Other Experimental Configuration:

Maximum Takeoff Weight (MTOW) in kilograms

Wingspan or Maximum Rotor Diameter in meters

Overall Length in meters

Primary Propulsion Type

Describe Other Propulsion System:

Power Source Details and Endurance Specifications

Primary Construction Materials (select all that apply)

Is this the inaugural flight of this specific aircraft?

Provide detailed inaugural flight test objectives and specific safety protocols for maiden flight:

Total accumulated flight hours on this aircraft configuration:

Test Crew Roster and Certification Details

Chief Test Pilot Total Flight Hours (all aircraft)

Chief Test Pilot Flight Hours on This Aircraft Type

I confirm that valid flight test insurance coverage is active for this operation

Insurance Provider Name and Policy Number

Liability Coverage Amount (in USD equivalent)

Has this aircraft or crew been involved in any previous flight test incidents or accidents?

Provide incident details, investigation outcomes, and corrective actions implemented:

Primary Flight Test Objective and Success Criteria

Secondary Test Objectives (if any)

Detailed Description of Test Maneuvers and Flight Profile

Test Category Classification

Describe Specialized Test Category:

Proposed Primary Test Date

Planned Test Start Time (UTC)

Estimated Test Duration in Minutes

Planned Test End Time (UTC)

Alternative Backup Dates and Times (in priority order)

Is there flexibility in the test time window?

Specify Flexible Time Ranges and Constraints:

Minimum Operating Altitude Above Ground Level (AGL) in feet

Maximum Operating Altitude Above Ground Level (AGL) in feet

Typical Cruise/Operating Altitude AGL in feet

Maximum Rate of Climb/Descent in feet per minute

Will the test require operation above standard altitude restrictions or in controlled airspace?

Provide detailed justification, specific altitude requirements, and additional safety measures for high-altitude operations:

Primary Flight Profile Type

Describe Other Flight Profile:

Restricted Area Name or Designator

Airspace Classification Type

Horizontal Boundary Definition Method

Circular Area Definition

Polygon Vertex Coordinates (list in clockwise order, closed polygon)

Complete Coordinate Set with Vertical Limits

Vertical Lower Limit (minimum altitude) in feet AGL

Vertical Upper Limit (maximum altitude) in feet AGL

Will the aircraft exit the defined restricted airspace at any point during the test?

Provide exit coordinates, time of exit, destination airspace, and coordination measures:

Coordination Measures with Adjacent Airspace Users or ATC Facilities

Overall Mission Risk Level Assessment

Risk Assessment Methodology Used (e.g. MIL-STD-882, FAA Order 8110.4)

Date of Last Formal Risk Review

Rate each hazard category for Probability and Severity

Propulsion System Failure Contingency and Emergency Landing Procedure

Flight Control System Failure or Degradation Response

Communication Link Failure (Lost C2 Link) Procedure

Navigation System Failure or GPS Denial Contingency

Structural Failure or Anomaly Response Plan

Complete Electrical Power Loss Emergency Procedure

Pre-Selected Emergency Landing Sites

In-Flight Emergency Procedure Trigger Conditions and Decision Matrix

Is a Flight Termination System (FTS) installed and available for this test?

Describe FTS type, activation method, command authority, and safety exclusion zones:

Explain alternative aircraft containment method and rationale for no FTS:

Complete Lost Link Procedure for Unmanned Systems

Minimum Safe Altitude for Controlled Recovery in feet AGL

Weather Deterioration Contingency and Abort Criteria

Intruder Aircraft or Unauthorized Airspace Penetration Procedure

I confirm that a comprehensive pre-flight inspection checklist has been completed and verified

Redundant Systems Available Onboard (select all that apply)

Safety and Recovery Equipment Onboard

Will a chase aircraft be deployed for visual observation?

Chase Aircraft Registration and Type:

Will ground observers be deployed for visual line-of-sight monitoring?

Number of Ground Observer Stations:

NOTAM or equivalent airspace notification has been or will be coordinated

GCS Physical Address or Location Description

Primary Telemetry and Command & Control Frequency

Backup or Redundant C2 Frequency

Maximum Reliable Telemetry Range in kilometers

Is the telemetry data link encrypted?

Parameters Continuously Monitored in Real-Time

Ground Station Personnel and Shift Schedule

Will real-time telemetry data be relayed to external authorities or regulators?

Specify recipient agency, contact person, data format, and update frequency:

Have local emergency services been formally notified of the test operation?

Notification Date and Reference Number:

Explain plan for emergency services notification and coordination:

Primary Fire and Rescue Service Contact Number

Medical Emergency and Ambulance Service Contact

Search and Rescue Coordination Center Contact

Estimated Emergency Response Time in minutes

Is a dedicated emergency hotline established for this operation?

Emergency Hotline Number:

On-Site Emergency Equipment and Personnel

Primary Communication Method with Emergency Services

Describe Other Communication Method:

Backup Communication Method

I confirm that communication equipment check with emergency services has been completed successfully

Inter-Agency Communication Plan and Frequency Management

Escalation Procedure for Emergency or Abnormal Situations

All required technical documentation, drawings, and specifications are attached and verified

Complete technical data package and flight test cards have been reviewed and approved

Formal risk assessment has been completed, reviewed, and approved by safety board

Valid insurance certificate and liability coverage documentation is current and on file

Official restricted airspace approval or coordination has been obtained from appropriate authority

Current and forecast weather conditions have been reviewed and meet minimum requirements

All test crew members have met rest requirements and are medically fit for flight

Pre-flight safety briefing schedule is confirmed with all participants

Chief Test Pilot concurs that the flight can be conducted safely within the defined parameters

Chief Test Pilot Approval Comments and Conditions:

Reason for Chief Test Pilot Non-Concurrence and Required Actions:

Airworthiness Safety Board Final Approval Status

Specify All Conditions and Limitations for Conditional Approval:

Detail Rejection Rationale and Required Resubmission Actions:

Specify Additional Information Required for Board Review:

Final Organizational Risk Acceptance Decision

Chief Test Pilot Digital Signature

Chief Test Pilot Printed Name

Chief Test Pilot License or Certification Number

Chief Test Pilot Signature Date

Airworthiness Safety Board Chair or Designated Authority Digital Signature

Board Chair Printed Name and Credentials

Board Approval Date

Authorization Valid From (date and time UTC)

Authorization Valid Until (date and time UTC)

Special Conditions, Limitations, or Additional Authorization Notes