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MEDICAL STANDARDS FOR FLIGHT CREW,

By Henry Freeman,2014-12-03 03:01
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MEDICAL STANDARDS FOR FLIGHT CREW,

    CONFIDENTIAL APPENDIX 16

    CAA-105

    CIVIL AVIATION AUTHORITY

    INITIAL MEDICAL EXAMINATION BY BOARD FOR AIRCREW

    MEMBERS OTHER THAN PRIVATE OR GLIDER PILOTS

    At on For Licence Class Full Name (Block Letters) Father's / Husband Name Address Nationality Place & Date of Birth

Questions to be put by the Medical Examiner to the Examinee whose answers are to be entered in

    the spaces provided.

     (i) Category of Licence:

     (ii) Licence No.:

     (iii) Date of Expiry

    Have you any history of:-

     Nervous Trouble or Nervous Breakdown

     Insomnia, Nightmares, Sleep-walking, Bed-wetting

     Frequent Headaches Migraine

     Fits or convulsions of any kind; Epilepsy

     Sun Stroke or Heat Stroke

     Head injury or Concussion

     Unconsciousness for any reasons

     Other Nervous Aliments

     Bronchitis, Pneumonia or Plpurisy

     Pulmonary Tuberculosis

     Any Lung trouble

     Asthma or Hay Fever

     Heart Diseases Week or Strained Heart

     Palpitation, Breathlessness

     Hypertension or Hypotension

     Fainting attacks or Giddiness

     Rheumatism, Rheumatic Fever or 'Growing Pains’

     Frequent Sore Throats or Tonsillitis

     Diphteria, Scarlet Fever (Scarlatina)

     Stomach or Bowel Trouble

    Chronic Indigestion or pain after food

    Kidney or Bladder Trouble or Kidney Stone

    Sugar or Albumen in Urine

    Any Tropical diseases

    Chronic Malaria

    Chronic dysentery

    Eye Trouble of any kind

    Wearing of Glasses of Contact Lenses

    Colour Blindness

    Difficulty in seeing at night or in the dark

    Ear Trouble, Earache or Discharge from the Ears

    Deafness, Noises in the Ears or Dizziness

    Frequent Colds, Catarrh or Nasal Obstruction

    Prolonged Hoarseness or Loss of voice

    Sea, Car or Train sickness (motion sickness)

    Discomfort on Swings, Roundabouts or switchbacks

    Any drug or narcotic habit

    Aviation or any other accident

    Any illness or injury not mentioned above

    Have you undergone any surgical operations

     1

    Note: Any falsification made, may render cancellation of licence and any Other penal action by

     DGCAA according to Civil Aviation Rules.

Have either your parents or your brothers or sisters suffered from Consumption, Diabetes,

    Hemophilia, Heart Diseases, Hypertension, Nervous Ailment, Mental Trouble or "Fits"? "

What is your present occupation?

    Give details of any previous flying experience

    If you have been previously medically examined for Service or Civil flying, enter here the date and

    result of the last examination

    Have you ever been declared Unfit for flying duties? If so, when and where

Have you ever been declared Unfit by any Medical Board? If so, when and where

I hereby declare that I have carefully considered the statements made above, that to the best of my

    belief they are complete and correct, and that I have not withheld any relevant information or made

    any misleading statement.

Dated: .Signature Witness

    of the person examined

    Aviation Medical Examiner

GENERAL MEDICAL AND SURGICAL EXAMINATION

Height (without footwear) inches

    Weight (without clothes) lbs

    Any Body Mark, Scars or Deformities

    Any evidence of Wounds, injuries or Operations

Any Thyroid enlargement

    Any evidence of Splentic, Hepatic or Glandular enlargement

    Any evidence of Metabolic, Nutritional or Endocrine disorder

    Any evidence of Hernia, Varicose Veins, Hydrocele or Varicocele

    Any abnormality of movement of the joints

    Any abnormal skin condition

    Chest circumference on Inspiration on Expiration

    Impression given by Physique

    Pulse rate sitting Standing

    Condition of Arterial Wails

    Blood Pressure Systolic Diastolic

Heart Size Sound Rhythm

    Any evidence of abnormality of the Cardiovascular system

Any evidence of abnormality of the Respiratory System

    Result of X-Ray of the Chest

    Any evidence of abnormality of the Nervous System

Reflexes knee Ankle Triceps Abdominal

    Plantar Any evidence of Cranial injury

Cranial Nerves

Tremors .Fingers Eyelids

    Any evidence of abnormality of the Alimentary system

Any evidence of abnormality of the Urogenital System

    Urinalysis

    Albumen Sugar Microscopic

    Blood Sugar

    Psycho-active substances

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Additional remarks by the Medical Examiner

    Date Signature

    EAR, NOSE AND THROAT EXAMINATION

Any previous relevant history of Ear, Nose or Throat trouble

Is there any evidence of disease, injury or malformation of the External Ear, the

    meatus the tympanic membrance of the Eustachian tubes

    Is there any evidence of past or present Mastoid infection

    Is there any evidence of abnormality of the Cochlear apparatus

    or of the Vestibular apparatus

    Is there any evidence of disease, injury or malformation of the

    Buccal Cavity

    The Teeth

    The Gums

    The Pharynx

    The Larynx

    The Nose

    The Naso-pharynx

    The Nasal Accessory Sinuses

    Is there any evidence of speech impediment

Auditory Acuity:

    At what distance can a forced whisper be heard (in a quiet room)

    In the Right Ear .in the Left Ear

    At what distance can a Conversational voice be heard (in a quite room)

    In the Right Ear in the Left Ear

    The record of a pure tone audiogram.

    R.E. FREQUENCIES L.E.

     4,000

     3,000

     2,000

     1,000

     500

    The result of Weber's Test

     3

The Result of Rinee’s Test

Additional remarks by the Medical Examiner

Date: Signature

    EYE EXAMINATION

Any previous relevant history of eye trouble

    Is there any evidence of disease or abnormality of the Lids, the Lacrymal Apparatus or the Orbit

    _____

Is there any evidence of abnormality of the Occular Funds or Media

    Is there any evidence of deficiency in the power of Convergence

Is there any lack of accommodative power

    Is there any evidence of manifest or latent squint or other disorder or movement of the eyes

VISUAL ACUITY:

Distant Vision Without Glasses R.E. L.E.

     With Glasses R.E. L.E.

    Near Vision Without Glasses R.E. L.E.

     With Glasses R.E. L.E.

    Is there any limitation of the fields of Vision

Prescription of glasses if worn for distant or near vision

Contact lenses

    What is the measure of his manifest Hypermetroia if present

    R.E. L.E.

Note: If the candidate require correcting glasses to bring his vision upto required standard,

    does he possess glasses suitable for that purpose? (Two sets)

COLOUR VISION

    Is this normal as tested by pseudo-isochromatic (ishihara) type plates

    If abnormal, is he able to distinguish readily the Colours displayed by a Giles-Archer

    or Martin colour perception Lantern in a completely darkened room

Additional remarks by the Medical Examiner

Date: Signature

OBSERVATION AND FINDINGS

Date: Signature

    President Civil Aviation Medical Board

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REMARKS

    On the above Examination this candidate:

    Fit Senior Commercial/Commercial Pilot

    Unfit Airline Transport Pilot Class-I

    Temporanly for a period of __________as: Flight Engineer/Flight Navigator

     Flight Radio Telephone Operator

    Signature

    Chief of Aviation Medicine

    Date: CIVIL AVIATION AUTHORITY

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