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

1. Aircraft & Test Crew Metadata - Identification and Technical Specifications

Provide complete identification and technical specifications for the experimental aircraft or unmanned system. All fields marked mandatory must be completed to process your clearance request.


Aircraft Registration or Experimental Identification Number

Aircraft Manufacturer and Model Designation

Experimental Flight Test Certificate or Special Airworthiness Number

Aircraft Operational Category


Maximum Takeoff Weight (MTOW) in kilograms

Wingspan or Maximum Rotor Diameter in meters

Overall Length in meters

Primary Propulsion Type


Power Source Details and Endurance Specifications

Primary Construction Materials (select all that apply)

Is this the inaugural flight of this specific aircraft?


2. Test Crew Qualifications and Contact Information

Detail the qualifications and contact information for all key personnel involved in the flight test operation. This information is critical for emergency response and authority coordination.


Test Crew Roster and Certification Details

Crew Role

Full Name

License or Certification Number

Primary Contact Number

Emergency Contact Name and Number

Chief Test Pilot
John Doe
ATP-123456
+1-555-0100
Jane Doe +1-555-0101
Flight Test Engineer
Alice Smith
FTE-789012
+1-555-0102
Bob Smith +1-555-0103
Safety Observer
Robert Johnson
SO-345678
+1-555-0104
Mary Johnson +1-555-0105
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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?


3. Flight Plan, Altitude & Restricted Airspace Coordinates - Mission Overview

Define the complete flight test plan including objectives, temporal parameters, and precise airspace boundaries. Accuracy in this section is critical for airspace management and collision avoidance.


Primary Flight Test Objective and Success Criteria

Secondary Test Objectives (if any)

Detailed Description of Test Maneuvers and Flight Profile

Test Category Classification


4. Temporal and Duration Parameters

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?


5. Altitude Profile and Flight Envelope

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?


Primary Flight Profile Type


6. Restricted Airspace Definition and Geographic Coordinates

Restricted Area Name or Designator

Airspace Classification Type

Horizontal Boundary Definition Method


Complete Coordinate Set with Vertical Limits

Point ID

Latitude (decimal degrees)

Longitude (decimal degrees)

Altitude Reference

Radius (m) if applicable

R-01
40.7128
-74.006
AGL
3000
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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?


Coordination Measures with Adjacent Airspace Users or ATC Facilities

7. Hazard Risk Assessment & Failure Contingency Plan - Preliminary Risk Classification

Conduct a thorough risk assessment for the proposed flight test operation. This section evaluates potential hazards, failure modes, and establishes contingency protocols to ensure safe operations within restricted airspace.


Overall Mission Risk Level Assessment

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

Date of Last Formal Risk Review

8. Systematic Hazard Identification and Probability-Severity Matrix

Rate each hazard category for Probability and Severity

Very Unlikely

Unlikely

Possible

Likely

Very Likely

Mechanical System Failure (structural, propulsion)

Electrical System Failure (avionics, power distribution)

Software/Autopilot Malfunction

Human Error (pilot, ground crew)

Environmental Factors (weather, birds)

Mid-air Collision with Non-participating Aircraft

Uncontrolled Ground Impact

Loss of Positive Aircraft Control

9. Critical Systems Failure Contingency Plans

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

10. Emergency Landing Sites and Flight Termination Planning

Pre-Selected Emergency Landing Sites

Site Name/ID

Latitude

Longitude

Distance from Test Area (nm)

Suitability Rating (1=Poor, 5=Excellent)

ELS-01 Primary
40.715
-74.009
2.5
 
ELS-02 Secondary
40.718
-74.012
4.2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

In-Flight Emergency Procedure Trigger Conditions and Decision Matrix

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


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

11. Risk Mitigation and Safety Enhancement Measures

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?


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


NOTAM or equivalent airspace notification has been or will be coordinated

12. Ground Telemetry & Emergency Services Coordination - Ground Control Station

Establish ground-based monitoring, control, and emergency response coordination capabilities. This ensures real-time situational awareness and rapid response to any contingency.


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

Role

Name

Contact Number

Shift Start (UTC)

Shift End (UTC)

GCS Operator
Carol White
+1-555-0200
1:30 PM
5:00 PM
Safety Monitor
David Brown
+1-555-0201
1:30 PM
5:00 PM
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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


13. Emergency Services and First Responder Coordination

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


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?


On-Site Emergency Equipment and Personnel

14. Communication Protocols and Escalation Procedures

Primary Communication Method with Emergency Services


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

15. Chief Test Pilot & Airworthiness Safety Board Sign-Off - Documentation Verification

Final verification and official approval by responsible authorities. This section must be completed with digital signatures and represents formal acceptance of risk and authorization to proceed.


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

16. Final Approvals and Risk Acceptance

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


Airworthiness Safety Board Final Approval Status



Final Organizational Risk Acceptance Decision

17. Digital Signatures and Formal Authorization

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

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