Discussion: CRM Differences

Perform – Mitigate, Eliminate, Evaluate

Using personal minimums checklist to make some decisions in advance of the flight. If you are unsure of how to develop personal minimums, take a look at the methods presented in the three documents below. Choose one that works for you, and stick to it!

Develop a list of good alternatives during your processing phase. In marginal weather, for instance, you might mitigate the risk by identifying a reasonable alternative airport for every 25-30 nm segment of your route.

Preflight your passengers by preparing them for the possibility of delay and diversion, and involve them in your evaluation process.

To PERFORM, determine the best course of action. Your goal is to mitigate or eliminate the adverse impact, and then evaluate to ensure that your course of action is having the desired effect.

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Common Errors in Single Pilot ADM

Pilot mistakes are often called “pilot error,” formally defined as:

An action or inaction that leads to a deviation from intenions and expectations . t There are three basic types of pilot error in aviation:

Motor or control errors associated with “physical airplane” skills.

Turning the wrong knob on the GPS navigator is an example of error associated with “mental airplane” systems.

A “decisional” error, which involves a combination of cognitive activities and judgments, is associated with ADM skills.

Pilot mistakes are often called “pilot error,” formally defined as:

An action or inaction that leads to a deviation from intentions and expectations.

Sometimes, pilot error involves deficiencies in aircraft control, or "physical airplane," skill. These errors can be prevented through maneuvers-based training and practice.

In other cases, accidents attributed to pilot error result from shortcomings in the pilot's "mental airplane" systems knowledge. Examples might include misprogramming the autopilot, or turning the wrong knob on the GPS navigator. Use of aircraft training devices, computer-based training, and regular practice in the aircraft can help prevent these errors.

Since this course focuses on aeronautical decision-making, this chapter will take a closer look at factors involved in "decisional errors," which usually involve a combination of cognitive activities and judgments.

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Human Limitations

Filtering: In any flight, especially one with challenging weather, we may unconsciously screen out vital information. Use of the PAVE checklist as a guide to your ongoing mental hazard scan can help prevent inappropriate filtering, because it provides a comprehensive and methodical approach to the information gathering process.

Human limitations can play a significant role in how we perceive, process, and perform in complex activities, like flying. For example:

Filtering: The brain's working memory capacity is limited to about seven (7) pieces, or “chunks,” of information at one time, so one of the life skills we acquire is the ability to filter the flood of information arriving through our senses.

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Human Limitations

Filling in the Gaps: When there is more information than the brain can accurately perceive and process, it compensates by filling in the gaps and producing an interpretation that is not correct.

Runway illusions, which can result in unsafe decisions when flying an approach, are a good example of this type of human error.

Human Limitations

Patterns and Expectations: The brain uses existing knowledge and experience as a shortcut to processing new information. This tendency can be useful, but it can also be dangerous.

When you are processing information from an unfamiliar GPS navigator, you might unconsciously make incorrect assumptions on the basis of how information is accessed or displayed on the one you normally use.

• If previous experience at a familiar airport leads you to expect a clearance to land on runway 10, you may "hear" a clearance to land on “one-zero,” even if the controller in fact clears you to land on runway 01.

Human Limitations

Confirmation Bias: Human beings also have a tendency to look for information that confirms a decision we have already made. For example, imagine that you have decided to continue a flight you have already started. You call Flight Watch for updated weather information on several nearby airports, but you might unconsciously give more weight to the information that supports your decision to press ahead.

The "reality" part of the systematic ADM process is especially useful in countering errors associated with patterns, expectations, and confirmation bias. Make a conscious effort to identify your expectations, and then be alert to how reality differs.

Human Limitations

Framing: When you evaluate options for a decision, be sensitive to how you state, or "frame," your alternatives. Assume you are deciding whether to continue a flight in deteriorating weather. If you frame the “continue” decision in positive terms (e.g., “I can save a lot of time and inconvenience if I go on”), you are probably more likely to decide on continuing. If, on the other hand, you frame the decision in negative terms (e.g., “I could get myself in real trouble if I push on”), you are more likely to divert to a safer destination.

Error Prevention, Detection, and Management

No matter how hard we try, it is simply not possible for human beings to avoid errors entirely, especially when complex systems are involved.

By using a systematic approach to continuous ADM, however, and developing awareness of common types of human ADM error, we can seek to minimize mistakes.

Consistent use of these tools can also help with quick recognition of errors we do make, and safe management of the resulting situation.

Workload management

Workload management is crucial for the single seat pilot because he or she has fewer resources and therefore must carefully prioritize tasks

Learning to prioritize while avoiding distraction from the primary duty of flying the aircraft requires training and practice

Learning to prioritize often receives too little emphasis during training

Learning to request assistance from ATC during heavy workloads

Asking for help from dispatcher

Prudent use of autopilot

Involving trained specialists on certain flights

Captains of multipilot crews are encouraged to manage the cockpit workload by sharing duties with other crew members. Workload management is even more important to the single pilot, because he or she has few resources and therefore must carefully prioritize tasks.

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Situational Awareness

SA is key to detecting changes

Situational awareness is “the accurate perception and understanding of all factors and conditions that affect safety before, during, and after the flight”

When situationally aware, a pilot has an overall understanding of the entire flight operation, and does not fixate purely on any one perceived element of flight

What is going on around you….what is happening, what has happened, and what will happen in the future.

Situational awareness is the accurate perception of the factors that affect the aircraft….simply put…knowing what is going on around you.

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Situational Awareness and SP

Examples of good SA are:

having a clear mental picture of the current weather situation around the airplane and at the destination

keen awareness of the orientation of the flightpath to surrounding terrain

acute knowledge of operational factors such as fuel status, engine status, and other airplane systems

knowing what comes next—anticipating future workload conditions of the flight

Helicopters normally operate in airspace that is considered hazardous by many jet crews, below 10,000 feet MSL. SA becomes imperative in this environment. Maintaining a high level of awareness is more challenging for a single pilot, and automation and other resources should be used effectively.

When operating in an area where takeoffs and landings are occurring, special vigilance must be maintained. Other required tasks– entering navigation coordinates and communicating with base operations or with passengers may need to be delayed, to focus full attention on the hazards of other air traffic.

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Four Fundamental Risk Elements

All choices made within the scope of the DECIDE model are based upon the individual elements of risk associated within four specific groups, each affecting decision making in unique ways

Pilot

Aircraft

Environment

Operation

Risk Element: Single Pilot

Although pilots have to receive periodic medical examinations, it remains their responsibility to self-assess their fitness before each flight

In a sense, pilots have to remember to pre-flight inspect themselves as well as their airplanes

To help pilots objectively preflight themselves, the FAA developed the I’MSAFE checklist

Risk Management – the I’MSAFE Model

Illness- Do I have any symptoms?

Medication- Have I been taking prescription or over-the-counter drugs?

Stress- Am I under psychological pressure from the job? Worried about financial matters, heath problems, or family discord?

Alcohol- Have I been drinking within 8 hours? Within 24 hours?

Fatigue- Am I tired and not adequately rested?

Experience- Am I current/proficient in the tasks required for this flight? Do current/forecast conditions meet my minimums?

Risk Element: Aircraft

Pilots frequently base go/no-go decisions upon aircraft airworthiness

Not only must the right equipment be operational for the planned flight, but the pilot must also know how to use it within its proper limitations

The aircraft’s performance is also a limiting factor that pilots must account for on each and every flight

Risk Element: Environment

Includes all risk factors not associated with the pilot or the aircraft

Major environmental factors include:

ATC

Airport conditions

Operational status of nav facilities

Terrain

Obstacles to takeoff/landing paths

Weather

Risk Element: Environment

Weather continues to account for the greatest percentage of fatality rates in general aviation pilots

Most common to weather-related accidents is the scenario where a pilot continues visual flight into instrument meteorological conditions, known as controlled flight into terrain (CFIT)

While CFIT accidents resulted in only 2.2 percent of all accidents in 2001, 84 percent of those were fatal, making weather-related decision making a paramount issue confronting pilots of light aircraft

Risk Element: Operation

Perhaps no other single risk element has more control over a pilot’s decision making abilities than the basic motivation to conduct that flight

Whether flying for pleasure or profession, most pilots have a natural urge to complete a flight as planned

Attempting to maintain an unrealistic schedule in the face of numerous hazards has lured many pilots into a dangerous situation

Cockpit Distractions

Human susceptibility to distractions is one of the most frequent causes of hazardous events in air-transport operations

Cockpit distractions are often the result of routine cockpit tasks interrupting or preventing the pilot’s performance of other routine tasks

A single pilot must recognize and prevent distractions, while performing the primary task of flying the aircraft.

Common operational factor distractions

Traffic watch

Checklist

ATC communications

Studying approach chart

Radar monitoring

Looking for airport

Fatigue

Source: NASA ASRS study Harris, Joel, NASA ASRS

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Common single pilot errors

1. Inadvertent flight VFR pilot into instrument flight conditions

2. Lack of recognition and understanding of what can lead a pilot into a stall spin situation.

3. Feeling homesick and wanting to hurry back home which could potentially place aviation safety at risk

4. Inadequate, incorrect, or no fuel planning

5 Inadequate flight planning. (weather, terrain, fuel . . .)

6. Flying in mountainous terrain without proper training in high terrain operations.

Common single pilot errors

7. Dependency on GPS for all navigation. (lack of situational awareness)

8. Failure to use checklists religiously.

9. Ego bigger than pilot skills.

10.Failure to stay proficient. (occasional or weekend pilot)

11. Human error is most often the immediate cause of accidents. Mechanical failures rarely lead to accidents because modern, properly maintained aircraft are very reliable machines.

Risk Element: Operation

Fight the self-imposed stress of having to complete a flight as planned by:

Schedule flexibility into your flight

Be alert to operational pressures: avoid certain pitfalls by flying commercial or going by car

Plan for adequate fuel stops—don’t push the limit

Avoid return-to-base trips on Sunday afternoons, before the start of a new work week

Stress management

The effects of stress often are difficult to recognize

Single pilots must be especially vigilant through self-awareness and comments of others– to recognize the stress generated by personal issues (e.g. divorce, illness, dissatisfactions, etc.)

Stress can degrade judgment, decision-making, SA, and communication skills – all of which can be hazardous

Preparation

Preflight preparation is also of special importance to the single pilot operator

He/she may commit to memory information – frequencies and emergency procedures, that otherwise might be difficult to confirm in an emergency or unexpected high-workload situation

Careful cockpit organization also simplifies many tasks and allows the single pilot to do more with less

The “5P” Check and the SRM Process

Plan – Plane -- Pilot – Passengers – Programming

The SRM process is simple. At least five times, before and during the flight, the pilot should review and consider the “Plan, the Plane, the Pilot, the Passengers, and the Programming” and make the appropriate decision required by the current situation.

It is often said that failure to make a decision is a decision. Under SRM and the 5P’s, even the decision to make no changes to the current plan, is made through a careful consideration of all the risk factors present.

The 5P’s consist of “the Plan, the Plane, the Pilot, the Passengers, and the Programming”. Each of these areas consists of a set of challenges and opportunities that face a single pilot. And each can substantially increase or decrease the risk of successfully completing the flight based on the pilot’s ability to make informed and timely decisions. The 5P’s are used to evaluate the pilot’s current situation at key decision points during the flight, or when an emergency arises. These decision points include, pre-flight, pre-takeoff, hourly or at the midpoint of the flight, pre-descent, and just prior to the final approach fix or for VFR operations, just prior to entering the traffic pattern. The 5P’s are based on the idea that the pilots have essentially five variables that impact his or her environment and that can cause the pilot to make a single critical decision, or several less critical decisions, that when added together can create a critical outcome.

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5 Key Decision Points

Pre-Flight in the flight planning room, where all the information is readily available to make a sound decision, and where communication and FBO services are readily available to make alternate travel plans.

Just prior to take-off.

The mid-point of the flight.

Just prior to decent into the terminal area.

Just prior to the final approach fix, or if VFR just prior to entering the traffic pattern, as preparations for landing commence.

The 5P concept relies on the pilot to adopt a “scheduled” review of the critical variables at points in the flight where decisions are most likely to be effective. For instance, the easiest point to cancel a flight due to bad weather is before the pilot and passengers walk out the door and load the aircraft. So the first decision point is Pre-Flight in the flight planning room, where all the information is readily available to make a sound decision, and where communication and FBO services are readily available to make alternate travel plans.

The second easiest point in the flight to make a critical safety decision is just prior to takeoff. Few pilots have ever had to make an “emergency take-off”. While the point of the 5P check is to help you fly, the correct application of the 5P before takeoff is to assist in making a reasoned go-no-go decision based on all the information available. That decision will usually be to “go”, with certain restrictions and changes, but may also be a “no-go”. The key point is that these two points in the process of flying are critical go-no go points on each and every flight.

The third place to review the 5Ps is at the mid point of the flight. Often, pilots may wait until the ATIS is in range to check weather, yet at this point in the flight many good options have already passed behind the aircraft and pilot. Additionally, fatigue and low altitude hypoxia serve to rob the pilot of much of their energy by the end of a long and tiring flight day. This leads to a transition from a decision-making mode to an acceptance mode on the part of the pilot. If the flight is longer than 2 hours, the 5P check should be conducted hourly.

The last two decision points are just prior to decent into the terminal area and just prior to the final approach fix, or if VFR just prior to entering the traffic pattern, as preparations for landing commence. Most pilots execute approaches with the expectation that they will land out of the approach every time. A healthier approach requires the pilot to assume that changing conditions (the 5Ps again) will cause the pilot to divert or execute the missed approach on every approach. This keeps the pilot alert to all manner of conditions that may increase risk and threaten the safe conduct of the flight. Diverting from cruise altitude saves fuel, allows unhurried use of the autopilot, and is less reactive in nature. Diverting from the final approach fix, while more difficult, still allows the pilot to plan and coordinate better, rather than executing a futile missed approach. Now lets look in detail at each of the “Five P’s”.

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5Ps – The Plan

The plan is ongoing and subject to change at any time before and throughout the flight.

The mission or task includes cross country, weather, route, fuel, publications currency, etc.

Should be reviewed and updated several times during the course of the flight.

The “Plan” can also be called the mission or the task. It contains the basic elements of cross country planning, weather, route, fuel, publications currency, etc. Unlike risk management sheets that pilot fill out before a flight, the “Plan” should be reviewed and updated several times during the course of the flight. A delayed takeoff due to maintenance, fast moving weather, and a short notice Temporary Flight Restriction (TFR) may all radically alter the plan. Several excellent flight planning software packages are available that automate this process, allowing the pilot additional time to evaluate and make decisions. Some include real time and graphical TFR depictions. The “plan” is not just about the flight plan, but the entire days events surrounding the flight and allowing the pilot to accomplish the mission. The plan is always being updated and modified and is especially responsive to changes in the other four remaining P’s. If for no other reason, the 5P check reminds the pilot that the day’s flight plan is real life and subject to change at any time.

Obviously the weather is a huge part of any “plan.” The addition of real time data link weather information give the TAA pilot a real advantage in inclement weather, but only if the pilot is trained to retrieve, and evaluate the weather in real time without sacrificing situational awareness. And of course, weather information should drive a decision, even if that decision is to continue on the current “plan.” Pilots of aircraft without datalink weather should get updated weather in-flight through a Flight Service Station and/or Flight Watch.

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5 Ps – The Plane

Considers a wide array of mechanical and cosmetic issues:

Everything working properly on the aircraft

Fuel supply adequate

Anti-ice equipment

Database currency

Automation status

Emergency backup systems

Other appropriate factors

Both the “plan” and the “plane” are fairly familiar to most pilots. The “plane” consists of the usual array of mechanical and cosmetic issues that every aircraft pilot, owner, or operator can identify. For example, Is everything working properly? Is the fuel situation where you expected it to be at that point? Are you using anti-ice equipment? However, with the advent of the Technically Advanced Aircraft (TAA), the “plane” has expanded to include database currency, automation status, and emergency backup systems that were unknown a few years ago. Much has been written about single pilot IFR flight both with, and without, an autopilot. While this is a personal decision, it is just that, a decision. Low IFR in a non-autopilot equipped aircraft may depend on several of the other “P’s” we will discuss. Pilot proficiency, currency, and fatigue are among them. The TAA offers many new capabilities and simplifies the basic flying tasks, but only if the pilot is properly trained and all the equipment is working as advertised.

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5 Ps – The Pilot

The traditional “IMSAFE” checklist is a good start.

Recognize physiological situation you are putting yourself in

Technically advance aircraft?

Late night

Pilot fatigue?

Effects of sustained high altitudes?

This is an area all pilots are learning more and more about each day. Flying, especially when used for business transportation, can expose the pilot to high altitude flying, long distance and endurance, and more challenging weather. Technically Advance Aircraft (TAA), simply due to their advanced capabilities can expose a pilot to even more of these stresses. The traditional “IMSAFE” checklist is a good start. However, each of these factors must be taken in consideration of the cumulative effect of all of them together and the insidious effects of low altitude hypoxia. The authors informal survey of TAA pilots show that almost half fly with pulse oxymeters to display the effects of low altitude hypoxia in a graphic manner.

The combination of late night, pilot fatigue, and the effects of sustained flight above 5,000 feet may cause pilots to become less discerning, less critical of information, less decisive and more compliant and accepting. Just as the most critical portion of the flight approaches (for instance a night instrument approach, in the weather, after a four hour flight) the pilot’s guard is down the most. The “5P” process emphasizes that pilot recognize the physiological situation they are placing themselves in at the end of the flight, before they even takeoff, and continue to update their condition as the flight progresses. Once identified, the pilot is in an infinitely better place to make alternate plans that lessen the effect of these factors and provide a safer solution.

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5 Ps – The Passengers

Another pilot as passenger?

Mission related passenger?

Briefed – clear preflight understanding of roles, responsibilities and communication.

Assigned tasks?

One of the key differences between CRM and SRM is the way passengers interact with the pilot. In the airline industry the passengers have entered into a contractual agreement with the pilots company with a clearly defined set of possible outcomes. In corporate aviation, the relationship between crew and passengers is much closer, yet is still governed by a set of operating guidelines and the more formal lines of corporate authority. However, the pilot of a highly capable single engine aircraft has entered into a very personal relationship with the passengers, in fact, they sit within an arms reach all of the time.

It may be easy, especially in business travel, for the desire of the passengers to make airline connections or important business meetings to enter into the pilot’s decision-making loop. If this is done in a healthy and open way, it is a very positive thing. However, this is not always the case. For instance, imagine a flight to Dulles Airport and the passengers, both close friends and business partners, need to get to Washington D.C. for an important meeting. The weather is VFR all the way to southern Virginia then turns to low IFR as the pilot approaches Dulles. A pilot employing the 5P approach might consider reserving a rental car at an airport in northern North Carolina or southern Virginia to coincide with a refueling stop. Thus, the passengers have a way to get to Washington, and the pilot has an out to avoid being pressured into continuing the flight if the conditions do not improve.

Passengers can also be pilots. The old joke says that when four Certified Flight Instructors (CFI) board a light general aviation, a NOTAM should be posted. There is some truth to this. If no one is designated as pilot in command and unplanned circumstances arise, the decision-making styles of four self confident CFI’s may come into conflict. Another situation arises when an owner pilot flies with a former CFI in the right seat on a business trip. Unless a clear relationship is defined and briefed prior to the flight, the owner pilot may feel some pressure to perform for the Individual Learning Manager (possibly beyond his or her capability), and the Individual Learning Manager may feel inhibited from intervening in small decisions until it is clearly evident that the pilot is making poor decisions. This is actually a CRM situation and requires clear pre-flight understanding of roles, responsibilities, and communication. Non-Pilots can also cause the pilot to review the SRM process.

Pilots need to understand that non-pilots may not understand the level of risk involved in the flight. There is an element of risk in every flight. That’s why SRM calls it risk management not risk elimination. While a pilot may feel comfortable with the risk present in a night IFR flight, the passengers may not and may manifest this during the flight. The human reaction to fear and uncertainty is as varied as the shapes of our ears. Some become quiet, some talk incessantly, and in extreme cases anger and fear are strongly manifested. This may be the last thing the pilot needs to deal with while shooting the ILS to 400 feet and a mile visibility at midnight.

A pilot employing SRM should ensure that the passengers are involved in the decision-making and given tasks and duties to keep them busy and involved. If, upon a factual description of the risks present, the passengers decide to buy an airline ticket or rent a car, then a good decision has generally been made. This discussion also allows the pilot to move past what he or she “thinks” the passengers want to do and find out what they “actually” want to do. This removes a load of self-induced pressure from the pilot.

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5 Ps – The Programming

Plan in advance when and where the programming for approaches, route changes, and airport information gathering should be accomplished to avoid distractions.

The TAA adds an entirely new dimension to the way General Aviation aircraft are flown. The Glass Cockpit, GPS, and Autopilot are tremendous boons to reduce pilot workload and increase pilot situational awareness. And frankly, the programming and operation of these devises is fairly simple and straightforward. However, unlike the analog instruments they replace, they tend to capture the pilot’s attention and hold it for long periods of time (like a desktop computer). To avoid this phenomenon, the pilot should plan in advance when and where the programming for approaches, route changes, and airport information gathering should be accomplished…as well as times it should not. Pilot familiarity with the equipment, the route, the local air traffic control environment, and their own capabilities vis-à-vis the automation should drive when, where, and how the automation is programmed and used.

The pilot should also consider what his or her capabilities are in response to last minute changes of the approach (and the reprogramming required) and ability to make large-scale changes (a re-route for instance) while hand flying the aircraft. Since formats are not standardized, simply moving from one manufacturer’s equipment to another should give the pilot pause and require more conservative planning and decisions.

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Target-setting to achieve safer flight operations

Target setting is a method that all pilots can use to further hone their decision making skills by applying specific goals to each phase of flight

By reviewing the airplane’s Pilot’s Operating Handbook (POH), pilot’s can determine in advance acceptable target’s to shoot for

Target-setting to achieve safer flight operations

Consider the following example of a Pre-Takeoff Targets Checklist:

Simply write your checklist on a yellow-sticky note, or professionally laminate it

Display your Targets Checklist in your normal instrument scan area or by the canopy window—make it a part of your scan!

Target-setting to achieve safer flight operations

Target setting provides the pilot with pre-determined solutions to problems experienced in-flight

Target setting is a way of accomplishing reflective, informed decisions ahead of time, not during the rush of acceleration to VR or some other time-critical phase of flight

Services available to single seat pilots

CRM strategies single pilots can use:

Don’t wait until a situation of concern turns into a crisis

Don’t allow an issue to grow out of control where options become limited or have little value

Make a call to ATC anytime:

Fuel supply is questionable

Unsure of present position

Necessary equipment fails in-flight

Feelings of sickness or nausea develop

Weather begins to worsen

Services available to Pilots

CRM strategies single pilots can use:

Query ATC for aerodrome information when faced with a precautionary landing

Seek advise on which airports are best suited to repair the malfunction, or respond with fire and rescue services

ATC specialists have access to a wide range of information and can even help locate airports that have hospitals nearby with the right facilities to handle the emergency medical needs of passengers

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Services available to Pilots

CRM strategies single pilots can use:

Time permitting, call a nearby fixed base operator for mechanical problems such as landing gear failing to extend or retract

The experts may be able to help sort through the cause of the malfunction

Services available to Pilots

CRM strategies single pilots can use:

Stay in touch with weather specialists for up-to-date information about the route of flight and destination

Flight Watch is a special division of the Flight Service Stations across America, and can be reached on a discrete frequency above altitudes of 5000 feet above ground level

Flight Watch is staffed by highly trained weather specialists who are also rated pilots

They can answer questions about current and forecast weather situations and can even receive pilot weather reports for conditions actually occurring “in the air”

Establish a set of Personal Minimums

The I’MSAFE checklist calls to mind a number of important factors that each pilot should consider before undertaking any flight

One significant element of the checklist is Experience

Each pilot should consider using a set of personal minimums, or standards by which to fly by

Establish a set of Personal Minimums

The FAA developed a comprehensive set of personal minimums that all light plane pilots can use to help establish their own set of minimums

The Personal Minimums Checklist can be used as a tool to inventory the various risk elements of:

Pilot

Aircraft

Environment

External Pressures

Establish a set of Personal Minimums

The checklist is easy to use and can be tailored to each pilot’s level of skill, knowledge, and ability

By using the checklist, pilots can identify even subtle risk factors that may help them mitigate or avoid risk

Add the Personal Minimums Checklist to your flight bag and use it like you would any other checklist

FAA’s Personal Minimums Checklist