Medical Certificate of Fitness

Medical Fitness Certificate

South African Hang Gliding and Paragliding Association

Operations and Procedures Manual - Addendum C

Revision 1.2 dated November 2003

Effective January 2003

APPENDIX R62.22

Pilot's Declaration of Medical Fitness

This form shall be signed by every pilot before commencing training, and also at each licence renewal. Tandem pilots, pilots over the age of 60 or where a medical condition exists must have the section overleaf signed by a medical practitioner.

I, hereby declare that I have never suffered, nor suffer currently, from any of the following, which I understand may create, or lead to, a dangerous situation in flight.

– Epilepsy, Fits, Severe Head Injury;

– Recurrent fainting, Giddiness or Blackouts. Unusually High Blood Pressure;

– A Coronary;

– Any defect or disability (including excessive eyesight deficiency) that may jeopardize flight safety;

– Any previously sustained injury that could affect my ability to control the aircraft.

I further declare that -

– I am not regularly taking insulin for the control of Diabetes;

– I am not addicted to any drug or narcotic substance (including alcohol) that may affect my faculties in any manner that may jeopardize flight safety;

– I do not suffer from any defect or disability (including excessive eyesight deficiency) that could affect my flying safety;

– Any previously sustained injury that could affect my ability to control the aircraft.

– In the event of my contracting, or suspecting, any of the above conditions in the future, I will not exercise the privileges of my pilot licence until I have been examined by a suitably qualified medical practitioner and be declared physically fit to fly hang gliders or paragliders, including powered hang gliders or paragliders.

1. Where a person feels unable to sign the Pilot's Declaration or where an aviation training organisation or an authorised Licensing & Safety Officer is reluctant to accept the above declaration, a Medical Practitioner’s Declaration may be submitted instead. (See overleaf for Doctor’s Declaration.)

2. A Medical practitioner’s Declaration is required in respect of the holder of a recreational pilot licence with a tandem rating endorsement, or pilots over the age of 60 in addition to the Pilot’s Declaration (if any). See overleaf.

South African Hang Gliding and Paragliding Association

Operations and Procedures Manual - Addendum C

Revision 1.2 dated November 2003     Effective January 2003

Medical Practitioner's Declaration

The Medical Practitioner's Declaration must be provided before pilots may carry passengers, or the pilot is over the age of 60, or where a medical condition exists.

I, am –

I understand that the applicant wishes to engage in flying hang gliders or paragliders or to carry passengers while engaged hang gliding or paragliding operations. (Delete portion not applicable, if any)

In my opinion, it is safe for him/her to do so.

Full name of applicant in respect of which this declaration is issued:

Medical Practitioner's name and practice number:

Note:

The following conditions may cause difficulty while flying. Any person who suffers, or has suffered, from any of these conditions is advised to seek medical opinion:

– Chronic Bronchitis, Severe Asthma, Chronic Sinus Disease, Chronic Ear Disease, Eye Trouble (e.g. Inability to read a car number plate at 25 metres - corrective glasses may be used). Regular severe Migraine.

– Diabetes in any form, Rheumatic Fever, Kidney Stones, Psychiatric Disorders, Severe Motion or Travel Sickness, Any condition requiring the regular use of drugs (includes any medication whatsoever).

– Injuries which were previously sustained and which may inhibit control of an aircraft.

Exemptions

Exemption to the requirements above exists for pilots holding a current Student, Private or Commercial Pilot License, or equivalent Service, Medical Certificate. Foreign certificates may be accepted provided there is proof that these meet the above standards.