Use the space below to record the weather as it is received.

A/C Reg:
DATE:

Version 990706A
CLEARANCE: To:
ENROUTE WEATHER DESTINATION WEATHER Tach/HOBBS Times WATCH TIMES
Location REPORTED Location REPORTED Via (departure): Rwy: Tach ON Time START

Tach OFF Time UP

Tach TIME Time DOWN

Altitude: Squawk:
Time OFF

Dep Freq: Init Course: ATIS

Position TANK TIME

TANK
Time
ON OFF ON OFF

POSTION REPORT
Altitude
NOTAMS/SPECIAL INFO LEFT
Type of Flight
RIGHT
Next Rept.Point

ETA (+/-3 min) LEFT AUX.

Succeeding Pt RIGHT AUX.

EN-ROUTE NAVIGATION

NAVAID TIME OFF

CHECK POINTS
Ground
Ident Winds Distance
Track Speed
Altitude
(Fixes) Frequency (Airway) Direction Leg Estimated Leg ETE ETA

Strength Remaining Actual Revised ATA

WINDS ALOFT HAZARDOUS WEATHER (SIGMETS)

Location: Location: Location TYPE

3 3

6 6

9 9

WEIGHT AND BALANCE

FUEL CALCULATION
Weight Moment C of G

EMPTY WEIGHT: TIME GPH TOTAL

Start, Taxi, and Takeoff:

Pilot &Front Pass:
Climb to Destination:

Rear Passengers:
Cruise to Destination:

To Destination and
Baggage Area 1:
Approach:

Climb to Alternate:
Baggage Area 2:
Cruise to Alternate:
Sub-Total:
To Alternate
and Approach:
FUEL: Reserve:: 45 min

TOTAL: TOTAL FUEL

REQUIRED:

DIR & DIST TO VFR WEATHER: Totals: DIST ETE

 ICAO Flight Plan VFR Position Report: Hourly on 126.7 RADAR ALERTING MANOEUVRES
PRIORITY ADDRESSES Aircraft VFR
Position Time Altitude Destination
Ident Flight Plan
<< FF RONLY FULL FAILURE
120
IFR Approaches: Uncontrolled Airport Procedures Fly to RIGHT Fly to LEFT
degree
<< turns
FILING TIME ORIGINATOR

<< PIREP - ORDER OF REPORTING

SPECIFIC IDENTIFICATION OF ADDRESSEES AND/OR ORIGINATOR
1. Location and time of Phenomenon
(ident, radial, distance, time)
3. MESSAGE TYPE 7. AIRCRAFT IDENTIFICATION 8. FLIGHT RULES TYPE OF FLIGHT 2. Altitude
<< (FPL << 3. Aircraft Type
4. Cloud (base, amount, top)
9. NUMBER TYPE OF AIRCRAFT WAKE TURBULENCE CAT. 10. EQUIPMENT
5. Temperature
/ << 6. Wind direction and speed
13. DEPARTURE AERODROME TIME 7. Turbulence (intensity, type, alt)
<< 8. Icing (intensity, type, altitude)
15. CRUISING SPEED ALTITUDE/LEVEL ROUTE
9. Remarks

EN-ROUTE NAVIGATION (continued from previous page)

16. DESTINATION TOTAL EET
<<
SAR
DAYS HRS MINS HRS MINS ALTN AERODROME 2ND ALTN AERODROME
AERODROME NAVAID TIME OFF
<< CHECK POINTS
Ground
18. OTHER INFORMATION Ident Winds Distance
Track Speed
Altitude
(Fixes) Frequency (Airway) Direction Leg Estimated Leg ETE ETA

Strength Remaining Actual Revised ATA

) <<
ENDURANCE EMERGENCY RADIO
19. PERSONS ON BOARD
HRS MINS UHF VHF ELBA ELT

E/ P/ R/ U V E
SURVIVAL EQUIPMENT JACKETS
POLAR DESERT MARITIME JUNGLE LIGHT FLOURES UHF VHF

S / P D M J J / L F U V
DINGHIES
NUMBER CAPACITY COVER COLOUR

D / C <<
AIRCRAFT COLOUR AND MARKINGS WHEELS SEAPLANE SKIS AMPHIB

A/
REMARKS

N / <<
AN ARRIVAL REPORT WILL BE FILED WITH

NAME AND PHONE NUMBER OR ADDRESS OF PERSONS TO BE NOTIFIED IF SEARCH AND RESCUE ACTION INITIATED

PILOT IN COMMAND PILOT’S LICENCE No.

C/ ) <<
FILED BY SPACE RESERVED FOR ADDITIONAL REQUIREMENTS

Totals: DIST ETE

Route:
Alternate Route:
TIME
DISTANCE: G/S: ETE: OFF: ETA: