I

I All UD "TYPE OF FLIGHT" is G (General aviation)

I VFR "N"NO TYPE(Helicopter) Equipment:

VFR I IFR
Cross Country Risk Assessment I Departure DEPART TIME Cruise Speed Altitude ROUTE
Before each cross country flight, evaluate each of following conditions and pick a number of 1 to 5 in rating I
column. Add up the entries in the rating column to obtain the final risk estimate, and determine if the risk is I DEST TIME ENROUTE Alternate REMARKS:
acceptable to continue the flight. Total risk score: I
1 2 3 4 5 Rating I
Flight Type VFR IFR(VMC) N/A N/A N/A I FUEL ON BOARD PERSONS ON BOARD PIC
Dual/Solo Dual PIC(Dual Pilots) Solo N/A N/A HOURS/MINUTES ADDRESS
I
Day/Night Day N/A Night N/A N/A I PHONE
Visibility >10 miles 6-9 miles 3-5 miles 1-3 miles 1mile orLess I BASE
Ceiling >6,000' 2000-6000' 1000-1999 500'-999' 500' or Less I COLOR/MARKING DESTINATION CONTACT(UD record only) CLOSE WITH (FSS)
Highest Wind calm 1-5 kts 10-15 kts 15-25 kts >25 kts I
Rest in last 24 hr >8 hrs N/A 6-7 hrs N/A <6 hrs I
Last meal >3 hrs 3-4 hrs >5 hrs 5-6 hrs >7 hrs I WEATHER Briefing Resource (udflight@dbq.edu):

Duration of flight <3 hrs 3 hrs 4 hrs 5 hrs >6 hrs I

Hours in aircraft type >100 hrs 75-99 hrs 50-74 hrs 30-49 hrs <30 hrs I
Hour in the last 90 days >20 hrs 15-20 hrs 10-14 hrs 5-9 hrs <5 hrs I
Total hours >200 hrs 100-200 hrs 50-99 hrs 30-49 hrs <30 hrs I
<32 No unusual hazards. Use normal flight planning and established personal minimums I
Low risk: and follow UD operating procedures. I
32-37 or Higher risk than usual. Conduct flight planning with extra care. Review personal WEIGHT AND BALANCE Attached (stapled to flight plan)
I
Elevated risk a "5" in any minimums and UD operating procedures to ensure that all standards are being
I
spot met. Consider alternate plans to reduce risk.
I COMPLETED BY PIC (signature/print) Received by: (CFI NAME, CERT#, DATE)
>37 or Conditions present much higher than normal risk. Conduct flight planning with extra care I
a "5" in any and review all elements to identify those that could be modified to reduce risk. If
I
2 spots available, consult with UD senior instructor for guidance before flight. Develop
High risk: I
contingency plans before flight to deal with high risk items. Decide beforehand on Date
alternates and on special precautions to be taken during the flight. Consider delaying flight I
until conditions improve I
Day of Departure Checklist I
* Weather briefing and Route Briefing received I
* UD Risk assessment completed I
* Lesson meets the UD TCOs requirement I
* Cross country form (Navlog) completed in accordance with current UD flight procedure I
* Approval for late night operation (After 22:00 Central time) I
(Require assistant to hangar aircraft) I
* Approval for airport (previous experience, fuel service/ or approved by UD CFI) I REQUIRED CONTACT INFO
* Duty period with aircraft: (max. 16 hrs within preceding 24 hrs) I Pilot Address Phone
* I ensure enroute altitudes will be 2000’ AGL or greater._________ I
* Rest Period: I Passenger Address Phone
(Must have 10 hrs rest time if your duty period with aircraft is at or greater than 12 hrs) I
* ETA at final destination:
* ETA(date/time) to return back to KDBQ(overnight):
 Navaid Wind TC TH MH Dist. GS. Time off GPH
Checkpoints Mag.
(Fixes) Ident. Course Altitude Dir. Vel. TAS -L -E CH Leg Est.
+/-
(Route) +R +W
Freq. Dev. Rem. ETE ETA Fuel
Temp. WCA Var. Act
ATE ATA Rem. Departure ATIS GND TWR DEP. CTAF FSS UNICOM Clearance Del.

Arrival ATIS GND TWR APCH. CTAF FSS UNICOM

Airport Diagram TPA Elevation

Departure

Arrival

Note:

Performance Calculation
Departure Airport Destination Airport
Temp: Pressure Alt: Temp: Pressure Alt:
IGE: Density Alt IGE: Density ALT:
OGE: OGE:
Notam √ Notam √
Wind: Velocity: Wind Velocity:

CFI Contact Info Enroute procedures Checklist

In the event of Emergency Contact: Start timer
Open flight plan with FSS
Expected time to close Flight plan:
:

Verify FLT PLN CLOSED after full stop

Totals