**PACIFIC REGION HEADQUARTERS**

## CIVIL AIR PATROL

**TACTICAL RISK MANAGEMENT ASSESSMENT FORM**

+-----------------------------------+----------------------------------+
| DATE                              | MISSION SYMBOL                   |
| \_\_\_\_\                         | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                  |
| TIME                              |                                  |
| \_\_\_\_\_\_\_\                   |                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                  |
+-----------------------------------+----------------------------------+
| A/C N No.:                        | CAPFLIGHT CALLSIGN: CPF          |
| \_\_\_\_\_\_\                     | \_\_\_\_                         |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------+----------------------------------+
| PIC                               |                                  |
| \_\                               |                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                  |
|                                   |                                  |
| Name Grade Unit                   |                                  |
+-----------------------------------+----------------------------------+
| MISSION NO.                       | SORTIE NO.                       |
| \_\_\_\_\_\_\_\_\_\               | \_\_\_\_\_                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------+----------------------------------+
| FRO:                              |                                  |
| \_\_\_\_\_\_\_                    |                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                  |
|                                   |                                  |
| Name Grade Unit Signature         |                                  |
+-----------------------------------+----------------------------------+

+---+---------------+-----------+---+---------------+---+------------+---+
|   | **Hazard      | **Low**   | # | **Moderate**  | # | **High**   | * |
|   | Ide           |           | # |               | # |            | * |
|   | ntification** |           | # |               | # |            | P |
|   |               |           |   |               |   |            | t |
|   |               |           | P |               | P |            | s |
|   |               |           | t |               | t |            | * |
|   |               |           | s |               | s |            | * |
+---+---------------+-----------+---+---------------+---+------------+---+
| # |               |           |   |               |   |            |   |
| # |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| A |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| - |               |           |   |               |   |            |   |
| - |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| H |               |           |   |               |   |            |   |
| u |               |           |   |               |   |            |   |
| m |               |           |   |               |   |            |   |
| a |               |           |   |               |   |            |   |
| n |               |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 1 | Flight        | \> 1000   | 0 | 250-1000      | 5 | \< 250     | 1 |
|   | Experience    | hours PIC |   | Hours PIC     |   | Hours PIC  | 0 |
+---+---------------+-----------+---+---------------+---+------------+---+
| 2 | Mission       | \> 100    | 0 | 50-100 Hours  | 5 | \< 50      | 1 |
|   | Experience    | Hrs       |   | Mission Time  |   | Hours      | 0 |
|   |               | Mission   |   |               |   | Mission    |   |
|   |               | Time      |   |               |   | Time       |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 3 | Rec           | \> 10 Hrs | 0 | 5-10 Hours    | 5 | \< 5 Hrs   | 1 |
|   | ency/Currency | Last 90   |   | Last 90 Days  |   | Last 90    | 0 |
|   | (in Group,    | Days      |   |               |   | Days       |   |
|   | per CAPM      |           |   |               |   |            |   |
|   | 60-1, Table   |           |   |               |   |            |   |
|   | 3-1)          |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 4 | Crew          | 2^nd^     | 0 | Observer,     | 5 | Solo       | 1 |
|   | Complement    | Pilot     |   | Scanner,      |   |            | 0 |
|   |               |           |   | Passenger     |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 5 | Crew Rest     | Rested    | 0 | Some Fatigue  | 5 | Fatigued   | R |
|   |               |           |   | Noted         |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 6 | Health        | Good      | 0 | Minor         | 5 | Taking     | R |
|   |               |           |   | Problems, No  |   | Medication |   |
|   |               |           |   | Medication    |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 7 | Mission       | Routine   | 0 | Complex       | 5 | Complex    | 1 |
|   | Complexity    | Tasks     |   | Tasks; No New |   | Tasks; New | 0 |
|   |               |           |   | Technology    |   | Technology |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| # |               |           |   |               |   |            |   |
| # |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| B |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| - |               |           |   |               |   |            |   |
| - |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| M |               |           |   |               |   |            |   |
| a |               |           |   |               |   |            |   |
| c |               |           |   |               |   |            |   |
| h |               |           |   |               |   |            |   |
| i |               |           |   |               |   |            |   |
| n |               |           |   |               |   |            |   |
| e |               |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 1 | Maintenance   | Fully     | 0 | Squawks;      | 5 | Squawks,   | N |
|   |               | Op        |   | Airworthy     |   | Not        | G |
|   |               | erational |   |               |   | Airworthy  |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 2 | Avionics      | All       | 0 | Single        | 5 | No Nav/Com | R |
|   | (VFR)         | Op        |   | Nav/Com       |   |            |   |
|   |               | erational |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 3 | Avionics      | All       | 0 | Single        | 1 | No Nav/Com | N |
|   | (IFR)         | Op        |   | Nav/Com       | 0 |            | G |
|   |               | erational |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 4 | Performance   | \< 5,000  | 0 | 5000-9000 Ft  | 5 | \> 9000 Ft | 1 |
|   | Factors       | Ft        |   | Density Alt   |   | Density    | 0 |
|   |               | Density   |   |               |   | Alt        |   |
|   |               | Alt       |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| # |               |           |   |               |   |            |   |
| # |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| C |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| - |               |           |   |               |   |            |   |
| - |               |           |   |               |   |            |   |
|   |               |           |   |               |   |            |   |
| E |               |           |   |               |   |            |   |
| n |               |           |   |               |   |            |   |
| v |               |           |   |               |   |            |   |
| i |               |           |   |               |   |            |   |
| r |               |           |   |               |   |            |   |
| o |               |           |   |               |   |            |   |
| n |               |           |   |               |   |            |   |
| m |               |           |   |               |   |            |   |
| e |               |           |   |               |   |            |   |
| n |               |           |   |               |   |            |   |
| t |               |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 1 | Ceiling in    | \> 3000   | 0 | 1000-3000     | 5 | \< 1000    | R |
|   | Mission Area  | Feet      |   | Feet          |   | Feet       |   |
|   | (VFR)         |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 2 | Visibility in | \> 7 SM   | 0 | 3-7 SM        | 5 | \< 3 SM    | R |
|   | Mission Area  |           |   |               |   |            |   |
|   | (VFR)         |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 3 | Pilot IFR     | \> 1000   | 0 | \< 1000 Ft/3  | 5 | Approach   | 1 |
|   | Rated and     | Ft/3      |   | Miles         |   | Minimums   | 0 |
|   | Current       | Miles Vis |   | Visibility    |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 4 | Icing /       | None      | 0 | Forecast      | 5 | Know       | N |
|   | Freezing      | reported; |   | icing at or   |   | n/Reported | G |
|   | Level (FL)    | FL above  |   | below highest |   | icing at   |   |
|   |               | highest   |   | mission       |   | or below   |   |
|   |               | msn alt.  |   | altitude      |   | highest    |   |
|   |               |           |   |               |   | msn alt.   |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 5 | Surface Winds | \< 10 Kts | 0 | 10-20 Kts     | 5 | \> 20 Kts  | 1 |
|   |               |           |   |               |   |            | 0 |
+---+---------------+-----------+---+---------------+---+------------+---+
| 6 | Winds Aloft   | \< 10 Kts | 0 | 10-25 Kts     | 5 | \> 25 Kts  | 1 |
|   | Forecast\     |           |   |               |   |            | 0 |
|   | (at mission   |           |   |               |   |            |   |
|   | altitude)     |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 7 | Turbulence    | None      | 0 | Light to      | 5 | Moderate   | R |
|   | (reported or  |           |   | Moderate      |   | to Severe  |   |
|   | fore­­cast at   |           |   |               |   |            |   |
|   | or below msn  |           |   |               |   |            |   |
|   | alt)          |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 8 | Terrain       | Low/un    | 0 | Med           | 5 | High/M     | 1 |
|   |               | demanding |   | ium/Foothills |   | ountainous | 0 |
+---+---------------+-----------+---+---------------+---+------------+---+
| 9 | Over-Water    | Not       | 0 | No Portion of | 5 | Some       | 1 |
|   | Flights       | O         |   | Flight Beyond |   | Portion    | 0 |
|   |               | ver-water |   | Normal        |   | Beyond     |   |
|   |               |           |   | Gliding       |   | Gliding    |   |
|   |               |           |   | Distance to   |   | Distance   |   |
|   |               |           |   | Land          |   | to Land    |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 1 | Night,        | Daylight  | 0 | Dusk or Good  | 5 | Night, No  | 1 |
| 0 | Ambient       |           |   | Moonlight     |   | Moonlight  | 0 |
|   | Lighting      |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
| 1 | Mission       | Familiar  | 0 | Unfamiliar /  | 5 | Unfamiliar | 1 |
| 1 | Airfields     |           |   | Few or No     |   | / Hazards  | 0 |
|   |               |           |   | Hazards       |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
|   |               |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
|   |               |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
|   |               |           |   | Sub-Total:    |   | Sub-Total: |   |
+---+---------------+-----------+---+---------------+---+------------+---+
|   |               |           |   |               |   |            |   |
+---+---------------+-----------+---+---------------+---+------------+---+
|   |               |           |   |               |   | TOTAL      |   |
|   |               |           |   |               |   | POINTS:    |   |
+---+---------------+-----------+---+---------------+---+------------+---+

+----------------------+------------------+---------------------------+
| **TOTAL POINTS**     | **RISK           | # FL                      |
|                      | ASSESSMENT**     | IGHT RELEASE REQUIREMENTS |
+----------------------+------------------+---------------------------+
| 0-50                 | Low to Moderate  | FRO May Authorize Flight  |
|                      | Risk             |                           |
+----------------------+------------------+---------------------------+
| Over 50 Points or    | High Risk        | Must get approval of wing |
| **any** "R"          |                  | commander or his/her      |
|                      |                  | designee                  |
+----------------------+------------------+---------------------------+
| NG = No Go           | A/C Grounded     |                           |
+----------------------+------------------+---------------------------+

See Reverse for Instructions, Explanations and/or Clarifications

**Instructions, Explanations and Clarifications for PACRF 115**

A-2 This line needs only to be completed for CAPR 55-1 Missions

A-3 For the purposes of this form, this line refers to recency/currency
in any aircraft make and model that qualifies under the aircraft
grouping (re: CAPR 60-1, Table 3-1) that the pilot has received his Form
5 initial or annual check ride.

A-4 Crew Complement: Applicable to all flight categories, including
AFROTC and CAP Cadets, who are considered passengers on orientation
rides.

A-5 In addition to the subjective criteria listed herein, the pilot must
adhere to the flight time and duty limitations as stated in CAPR 60-1,
para. 2-14.

A-6 It is incumbent upon all pilots to thoroughly complete and evaluate
their personal health according to FAA guidelines set forth in the FARs
and the AIM. As part of this self-evaluation, CAP pilots are expected to
complete the "IM SAFE" personal checklist (re: CAPR 60-1, Attachment
12-2).

A-7 "New Technology" refers to any avionics that may be required to be
used by the pilot for the successful completion of the mission -- e.g.,
GPS, LORAN, DF equipment, CAP FM radios, etc.

B-1 It shall be the responsibility of the PIC to familiarize him/herself
with any outstanding squawks on the aircraft, and whether any
outstanding squawks would affect the operation of the given mission
(e.g., a burned out navigation light out would affect night operations
only). This should normally be done when scheduling the aircraft for any
given flight. During an actual or practice mission, such squawks shall
be reported to and received from the appropriate dispatch and/or
operations officer.

B-2&3 This information should be received in the form of a squawk from
the aircraft manager prior to preflight. Should the PIC discover any
unreported malfunction of avionics equipment during preflight, the PIC
must contact the FRO prior to takeoff and amend the Form 115
information, as it is possible that the maximum of 50 points could be
exceeded for that flight.

B-4 The FAA requires pilots to familiarize themselves with all aspects
of a flight, including computing density altitude en route and at all
airports of intended use.

C-5 Surface winds shall not exceed the demonstrated crosswind component
of the aircraft, as specified in the owner's manual, for any operations
into or out of any airports during the designated mission. The pilot's
personal ability and recent experience in crosswinds should also be
taken into consideration.

C-6&8 The pilot and FRO should consider the combination of forecast
winds aloft and terrain. High forecast winds and mountainous terrain is
a treacherous combination.

C-8 If the mission will be flown over terrain that is defined as
"high/mountainous," and the PIC has NOT graduated from a CAP or other
officially sponsored and recognized Mountain Flying Clinic, the FRO
should substitute **25 points** (instead of 10).

C-9 Re: PACR Supplement to CAPR 60-1, paragraph 2-1.i., "Over-water
Flights."