Radio Operator & Oxygen Endorsement Application

EN-06/09_20240301

Applicant Details

Surname *

Given Name *

SAFA Number *

Email Address *

Address *

City/Suburb *

State *

P/code *

Contact Phone Number *

Endorsement applied for: *

Radio OperatorOxygen

Applicant Declaration

I currently hold an equivalent 'Oxygen use' qualification issued by another ASAO, CASA, or NAA of Contracting states. *

YesNo

If "Yes" please submit or upload a copy of the qualification. *

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I can read, write, clearly speak and understand the English language! *

YesNo

SAFA is unable to process your application.

It is a requirement to be able to read, write, clearly speak and understand the English language (refer CASR Section 61.B.5 - English language proficiency).

I am an Australian Citizen? *

YesNo

If "No" please indicate your nationality? *

I currently hold an Australian Pilot licence or a valid VHF Radio Operators endorsement with another aviation organisation? *

YesNo

I currently hold an Australian Flight Crew licence? *

YesNo

If "Yes" to either of these questions, please submit or upload a copy of the qualification or licence. *

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If "Yes" to either of these questions, please provide your ARN or Licence number? *

I acknowledge that until I have successfully completed the required SAFA Oxygen course and online examination, this endorsement application will not be processed. *

I acknowledge that until I have successfully completed the required SAFA on-line VHF Radio Operators course and examination, this endorsement application will not be processed. *

I *

hereby certify that the information provided in the application is true & correct.

Pilot Signature *

Clear

Declaration SMS Verification *

Send code

The number entered must match the mobile number in your SAFA membership profile. Once entered, click the "Send Code" button. Then enter the code you receive in an SMS and click the "Submit Code" button. It is via your phone number that we will be confirming your identity.

SAFA Number *

Date *

Assessed Skills witnessed by Instructor/SSO

Pilot is knowledgable of, and can describe signs of oxygen deprivation on the human body.
*

Pilot can give a description of 2 oxygen systems and describe each component of the system in use.
*

Pilot knows flow rates required with altitude and system controls required to adjust flow rates.
*

Pilot can mount the oxygen system so that it does not interfere with the glider control, it is accessible in flight to control the rate of oxygen flow and in all flight conditions will not dislodge and cause harm to 3rd party persons or property.
*

Pilot correctly sets up oxygen system and carries out all pre-flight system checks.
*

The pilot has an altimeter and radio and is able to demonstrate effective use of the equipment whilst simulating oxygen use.
*

Pilot can demonstrate a safety conscious attitude towards flight above 10,000 FT AMSL.
*

Radio Setup *

Radio Use *

Radio Fault Finding *

Radio Call including Area Broadcasts *

Non Towered Aerodrome Calls *

Microphone techniques *

Listening Skills *

Flight Instructor / SSO Declaration

I *

SAFA # *

hereby certify that the above named pilot has completed all the practical test requirements to an acceptable level in accordance with the SAFA Qualifications Manual & Training Manual for the issue of a SAFA Oxygen Endorsement.

hereby certify that the above named pilot has completed all the practical test requirements to an acceptable level in accordance with the SAFA Qualifications Manual & Training Manual for the issue of a SAFA Radio Operators Endorsement.

All statements in this application are true and correct, and

I acknowledge that to knowingly make a false or misleading statement in this application, recommendations for pilot’s certificates, authorisations, endorsements, or ratings, may be an offence against the Criminal Code Act 1995.

Date: *

Signature *

Clear

SMS Confirmation *

Send code

The number entered must match the mobile number in your SAFA membership profile. Once entered, click the "Send Code" button. Then enter the code you receive in an SMS and click the "Submit Code" button. It is via your phone number that we will be confirming your identity to recommend the authorisation.

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