PatientAirLift Services 

# A't\L5 120 Adams Boulevard Farmingdale, NewYork 11735 631-694-PALS (7257)(p) 631-755-2184(£) \V\vw.palservices.org 

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## J: OO IPATIENT AIRLIFT SERVICES! Changing lives, one flight atatime
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Board ofDirectors

ALAN SHEINESS CHAIRMAN

JOE HOWLEY PRE:SIDE:NT VICE:· CHAIRMAN

DONNA COLLINS TRE:ASURE:R

MICHAEL CROWLEY SECRETARY

MARK HANSON

BRIAN LISOSKI
JAMES MCCLOUD
RHODA KUPFERBERG

JAMES O'ROURKE

SCOTT PAIGE
JAMES PLATZ

JOHN ROCHELLE

RUTHANNE RUZIKA
STUART WALDRUM

KEITH WARD

WILLIAM WEAVER Board Member Emeritus

PETER RYAN

HAROLD LEVY March 30, 2015 by 

### UnitedStates PostalService- ExpressMail U.S. Department ofTransportation Docket Operations, M-30 West Building ground floor Room W12-140 I200 NewJersey Avenue, SE Washington, D.C. 20590
Re: Exemption No. 10294 Regulatory Docket No. FAA-2011-0324

-- Request ForExtension
DearMr. Duncan: On June 22, 20II, the Administration's Flight Standards Service issued the attached letter advising Patient AirLift Services, Inc. ("PALS") that your office had granted PALS' Petition For An Exemption from Section 61.113(c) ofTitle 14, Code of Federal Regulations (14 CFR) to allow the reimbursement ofits volunteer pilots for fuel costs incurred in conducting charitable flights. Subsequently, we filed for and received an extension to that exemption that letter stated that "exemption terminates on June 30, 20I5 unless sooner superseded orrescinded." We are writing to you at this time to request at least an additional two (2) year extension ofExemption No. I0294. Not all pilots can afford to make charitable flights that sometimes can require hundreds ofdollars of aviation fuel for a single flight. As a result ofExemption No. I0294, PALS has been able to encourage pilots to volunteer their time and aircraft for flights transporting children and adults for access to healthcare and for other humanitarian purposes. The program has been highly successful. PALS would not have been able to carry out all ofits humanitarian flights without the fuel reimbursement exemption. The benefits from this type of charity flying were recognized by Congress in Section 821 ofPublic Law 112-95, and acknowledged in the FAA's Policy Clarification on Charitable Medical Flights, published in the Federal Register on February 2, 2013.

PatimtAirLiftS ervices is a501(c)(3) ta.x-exen!pf public charityPALS has carefully implemented the terms ofits Exemption No. 10294, and PALS has continued to stress pilot education and safety with all ofits volunteer pilots. Pilots wishing to qualify for in the PALS fuel reimbursement program must pass through a series ofsteps. Pilots must first supply all documentation proving they meet PALS standards to serve as Command Pilots, and provide a copy oftheir Class II Medical Certificate. In compliance with the terms ofFAA ExemptionNo. 10294, PALS has engaged Mid Island Air Services (MIAS), operators ofan FAA approved flying school based at Islip, New York, to develop andradminister an initial and recurrent training program tailored to cover the specific items required under ExemptionNo. 10294. Pilots receive a Log Book endorsement from MIAS, and PALS receives a certification ofthe same from MIAS. Prior to each flight, PALS obtains the required pilot documentation, including a pilot affirmation that all Exemption requirements are adhered to. This includes the specific "Pilot Go/No Go Checklist" defined in Exemption No. 10294. Upon completion ofthe flight, pilots fill out reimbursement requests, which are verified and recorded. The program under the Exemption has been very important to the mission of PALS. The first training class was completed in February of2012. Since that time, 69 pilots have completed training. PALS volunteer pilots have flown 254 flights transporting, for example, burn victims, wounded warriors, children receiving major medical treatments, and many others. Accordingly, PALS requests that your office extend Exemption No. 10294. An extension would allow PALS to continue to use fuel reimbursement to encourage pilots, who could not otherwise afford to participate in our program, to continue to volunteer their time and aircraft in support ofPALS' humanitarian services. We sincerely appreciate the FAA's support ofthe fuel reimbursement program.
Should you have any questions, please do not hesitate to contact the undersigned.

cc: John Rochelle Eileen Minogue Very truly yours,

Alan heiness Chairman ofthe Board ofDirectors Patient AirLift Services, Inc. Alan.Sheiness@palservices.org (949) 289-3672Enhanced Affirm!'ltion for Fuel Reimbursement**Fli~!'lts** -**6_.2S.20~4** _ . Pilot;
. Mission No: Date:
1promise notto act as a-Command Pilotfpr any Patient AirliftServices flight referred to me unless at the tim·e of each such flight: 1. I hold aValid and current pilot certificate forth.e. aircraft category, class and type (ifatype rating· is .required) In whic;h 1

### will be acting as piloHii-cofnrriiu1d. 2. 1hold at_ least ava·lid and cu·rreht**Cl~ss_**ilmedicalceitificate

_ 3. I ani IFR rate_cf, current and qualified in the aircraft·category, class andtype (ifatype rating is required) to be flown.

. . . 4. La'min co_r:npliance_-with all Fed_eral A_yiati<?_n Regulati()ns,**ircludin~tbo~e** reg4lations**rel~ti_l')g** to**c~:~r:rency** for .carrying passengers, flight reviews, night flying, fuel·reserves and instrument flight. 5_. -

### i.a·min compliance Witb all Fe_deraiAviation Regulations reJating tothe use of.alcohol and.dri.Jgs,:including reporting requirements specifie_d 

### ln the-regu(aticms. 6. Whether flying rented or owned aircraft, I have in force liability insurance applicable tothe flight providing minimum coverage of$1,000;000 per**occurren~e** and $100,000 per seat. 7. I am flying an airplane with-a valid standard airworthiness certificate (normal, ut_ility, acrobatic,·commu-ter or .transport cate·gory). 8. If!·am rentil']g an aircraft for themission; I attestthat Ihave_ S(!tisfied the requirements and condjtions_ofthe re_nting**agency~** 9. I have flown at least SO hours as**pilot~i_n~command** in the last 12 calendar months: 10. i have flown a minimumof

### i2 h9urs**~s** PIC duringth_e 90 days i111mediately**prec~ding** the mission, or in the alternative, I have

### comple_t~d 2

### ho~rs ofdu_al training with a certif!ed flight.instructor wit.hin

### th~·p·r~ceding 3 calel)dar months priortq the m·o.nth C?'f.{light. (This 12 hours is inci\Jded i_n**t~e** tota! ofSO,and i_s not additional) 1-1. I am under 78 years ofage_. Otherwise, I·have obtained a waiver**from·th~** P-ilot Safety committee. 12. I am in compliance with**the.Pati~nt** Airlift Services Manual, including,:but not lim.ited to: · a. For the operation of any single engine piston aircraft; the pilot shall have ·a minimumtotal time of 

### sao·hours, with not lessthan 400 hours as pilot-in-command (PIC), SO hours of such PIC time having been in the_ same ma_ke and l_llodel aircraft. b. For the operation ofany multi-engine orturbin·e powered aircr.aftthe.pilot shall have a minimum total time a_s pilot-in-command (PIC) on;ooo h-ours, with a minimum of 100 hours in the specific make and model for atwin engine aircraft and 100 hours in type for a single ·engine turbine aircraft b!Jt not less than 

### so hours'in make and rnodel, (Jnless disp_ensation shall have been**pre~iousiy** granted to·said pilot by the Safety Committee,but in noevent shall such dispensation·be for less than the qualifications as set forth in paragraph (a) above. Pilot Name (print)-------------- Membership Number:

__ ;....__--"-**Signature:----'---..,.----,,...-------~---** Date:----------- 1understandthat itis l)ly respon-sibility anp obligation to decline.to serve as pilot-in-command on any flight re'ferreq tb nie by-Patient Airlift SerVices unless ALL ofthe above.-statements are·true atthe time.ofthe**flig~~.** This documentis to be signedands_ubmitted to PAI,.S along with all.;.,_aivers and W&B before eachfuel reimbursementf/jght. Additionally-for Fuel Reimbursement Flights Only: ./ lfthis is a Fuel Reimbutsementflight, check at left and complete the Enhanced Affirmatio·n and**ttie·Pre~Fiight** Risk Assessment Tool 

### on the. followingpages.
Patient Airlift Services; 120Adams Blv_d, Farmingdale, NY 11735 PALSMail@palservices.org -Fax: 631-755-2184Enhanced Affirmation for Fuel. Reimbursement**Flights~** 6.25.2014. 2 Pilot: Mission No: Date:

·.; Certificates, qualifications,.and aeronautical experience I hereby certifythat I.meetthe following certificates, qualifications, and ·aeronautical experience requirements (please .check all that.apply): 

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0 An instrument rating or privilege that is appropriate to the aircraft being flown; For the operation ofany single-engine piston aircraft; a minimum total time OfSOO**hou~s,** with.no less than400 hours·as pilot in command (PIC), and a minimum ofSO hours in the specific make and model ofsingle-engine aircraft b'¢ingflown; · · · · ·· · · For the opera'ting any multiengine.aircraft, a minimum total time of 1,000 hours as PIC in any aircraft;.a minimum of2SO**hdur~** in inulti-engil'!e aircraft, and a. min_imum of

### so hours**ir:"~:the** make and hio.del of**multfe"~gine**'aircraft being flown; For the operation ofany single- or multieng.ine**tur~ine-powered** aircraft, a minimum total time ofl,OOO hours as PIC, a minimum of 100 hours in turbinecpowered aircraft, and a minimum of-SO hours inthe make and model of turbine-powered aircraft.being flown; A minimum ofSO hours as PI( sl:lall.have been logged within the precedingl2 calendar months-immediately. preceding the month ofthe**flig~t;** . A minimum of 12 hours flown and logged,.or 2 hours ofdual flight trainingwith acertifi,cated.flight instructor, within the**prece~ing.~** calendar**mon,t~s** prior.tothe mqntl:l of**~he** fl!ght_;. A 2nd class medical certificate (per§§ 61.23( d)(2)(i) and 61.2); Within the preceding 12**cal~ndar** months, an instrument proficiency ched<(IPC) meeting the requirements of §61.S7( d), or aflight review meeting the requirements found in§**6~.SG(a).** The IPC orflight review must consist of at least 1 hour offlighttraining and 1 hour ofground training. This requirement can substituted by a FAA practical test for any pilot certificate or rating; · A**currentflightre~iew** (per§ 61.S6(a)) in the same aircraft category, c·iass, and type (if atype rating is required) being flown; Instrumentc.urrent·(per§ 6LS7(c) or (d), as appropriate) in the same aircraftcategory, class, and type (if atype rating is required)·being.flown; ahd For all operations underthis•exemption, the pilot must be current.for night operations (per §6l.S7 (b)) In an aircraftofthe same.category, class, and type(ifa type rating is required)

.

.Flight duty, rest, and fiighttime limitations l'h.ereby certify that prior to (and atthe conclusion of)Jhis mission I am (and will be) in compliance with the foflowing:flight duty,**re~i,_and.flighttime** limitations**(pl~ase'check** all that apply):

. . . . 

### 0 No pilot may fly morethan 8 hours offllght**tiin~** (per§ 61 .1) within any24-co.nsecutive-hour duty day period;

.0 No pilot may perform a**~luty** day in excess of 12 conseiutjve**h~urs.** (A duty**d~y st.~rts**  when the**pil~t** arrives.at the ·airport and begins preparation forthe·ftight and ten'ninates upon com'pletion

### ofthe post flight ofthe aircraft); and 

### 0 Once tlie·pilot has performed 12**co'n~ec·utj:ve** n·our!(ofduty, the pilot·must re·st.:a period ofat'lea·sn2 hours before conducting another flight,6. · · · ' Fiight requirements

. I hereb.v certifY to conduct this flight in compliance with the following'flight requirements (piease check all that apply): 

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### 0 _All flights**opera_t~d** under this exemption must**acthrc_~te** an IFR flight p_lan. The earliest the flight plan may be canceled..is upon acceptance ofavisual approach clearance from airtraffic control; For flights in instrument meteor.ological conditions(IM,C), each pilotmay_only_use.airports**~hat** have·a functioning!· published, precision approach procedure; 

### 0 Pilot must add 100feet to all instrument approach minimums; 0 Ail 'circling approaches ati1ight are prohibited; 

### O Pilots must add SO percent to· pilot operating handbook (POH) runway length performance for obstacle clearance on takeoff and landing under ambient conditions; · 

### 0 For IMC takeoff minimums,the pilot.must (lpply SO percent above the approach landing minimums (example: Baltimore-Washington International Airport**minimum~** 200/1/2, then**theta~eqff minimu~ms**  will**b~.;:~t.le!lst** 300 feet and 3/4-statute-mile visibility); · · PatientAirlift Services,120**Adams~~~~~** F.;umingdale, 1\JY 11735
..PALSMail@palservices.o·rg Fax:.6.31-755-tl84.Enhanced**Affirm~tion** for Fuel Reimbursement-Flights- 6:?5.2014

Pilo.t: Missiorj No: Qate: Aircraft·engine,.propeller; and all components I hereby certify the following as to aircraft engine, propeller, and all components (please check): 

### 0 The aircraft engine, propeller, and all components.have not reached the airframe, engine, or propeller manufacturer's recommended time between overhaul: Passenger and medical crew briefing I here_by certify to provide the folloy./ing reqyifea**passeng~r** and medical crew briefing: ./ The flight is being**peril)lt~ed uhd~r** 

### agrantof**e~em~ti_o[l** to)?ALS

.. P.A.LS is nota certificated commercial operator; ./ When, where, and under what conditions smoking·is allowed; ./ Use ofsafety belts, shoulderharnesses, an·d child restraint systems: ./ When,where, ,and under whatconditions·it is necessary to have safety belts and, if installed1shoulder harnesses, fastened; ./ The placement ofseat backs in**c;~n** upright position·**b~fore** takeoffand landing; ./ Location and ml;!ans for".n6rmal<!ndemergency egress; ./ :;location·ofsurvival equipment; ./ Use ofnormal and emergency oxygen, if installed; and
- ./ Location and operation offire extinguishers.- In addition ll}_ere_by c;ertjfy-!ci e!'lsut_e th.e**.f911b~t~lrig:** -· 3

./**Pri~>r** to t;!ach**-ta~eoff, the.PIC~l,!St** **erisur~** that**th~_p_cit!ent,who** may need**ttl~** assistance-of a·nother person to exit the**aircra~** ifan emergen_cy occurs, has**receive~~ briefing~-~**  to the procedures to be**followe~** ifan evacuation occurs. This paragraph does not !Jpply to a pers.on who has**ti~en,given** a briefing before a previous leg ofaflight il'l 'the same aircraft. ._.. • - ·· ./ Tti'e pilot must ensure.that allpassengers are restrained by FAA-approved seatbelts or FAA-apprqveg**c-hil~** safety seat atali times during the flight; Tlie only·exception shall be change ofseat'"pqsitions; qui_cblccess·t:o·lugga€fe, care and/orfeeding ofchild, or use oflavatory; · · · ./ Pilots will utilize and brief passengers on sterile cockpit procedures as defined·under§ 135.100. ·
Domestic·operations I**unders~a_nd** this**~xemptiori** foryuel**reimbursem.~~~ appliesto-fligh~.s** **fOrid_uc~e~** Within-domestic United**s~.ates ~irspe~ce.** 

1 understand ·that the conditions ·and· limitations**i~cluded** .witli. the PALS**ex~rnpti(>n,** for 'fuel reimbursemenLare not based 

## on specific regulations, but ·.are. the FAA's means of en·suring ·an

### _eqt,~ivaJent**l.ev.~l** of safety:

### !hi~**nec~ssitates limita!ion~**  that

# go**:bey~nd·**the established_

### r~~ulat.ions due to the 'fact that the**propbs~d~ OP..er~~ibn**  is

## .PY its need:for**~-n·_exemption,_** outside _the: normal regl!latory structure.: I have. read an<;I**unc:J~rs~Qod** th_e .PALS·FAA**exeinption~aild'** I am in full.**complia~ce·**with all the conditions_arid limitations.applicableeto,me.as,PIC.of.this**flight.~·**

Pilot signature
..Airman Certificate·No -Mission.No Date

Patient**Airli~** Services, 12Q Ada!Tis**Blvd~** Fai'IJ'liilgdale, NV 11735 ·.PALSMail@palservices.org Fax: 631-755-2-184Enhanced Affirm.ation:for Fuel Reimbur.semenHiights- 6.25_.2014 4 Pilot: Mission No: Date: 

### Pre:-flight Risk Assessment

### Tool_

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### -- - . ,. . . -**---~** This Risk Assessment Tool cannot·guarantee a safe flight- safety is ultimatelythe**re~po~sibility** ofthe pilot. This ·risk.number should be used·to con.trol riskbefore aflight takes place. Ose/completion of.this tool replaces the Pilot Go/No-Go Checklist_. Utilization/completion ofthis tool'is mandatory.

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## :~ Operating Environment 1 No published approaches_ - -- -

. - .. - 2 Circling**approac~** (best**avai_labl~** approach)
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- -3 VOR/GPS/LOC/ADF (Best approach availablew/o vertical guidance) 4 No weather reporting at destination " 5

- Alternate airport not selected

. 6 Uncontrolled airport

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### . .7 Control tower not6peratiorial'at ETAor ETD &. Mountainous airport ;-1 Night operation _,. .. . -

2 Twilight operat!on' ' 3 Winter operatiC?n .. 4 Pop up trip (Less'than 4 hours crew notice) 1 Stopping distance**gr~ater** than 80% ofavailable runway 2 Runway braking action less than good 3 .Contaminated runway 4 Wet runway .,

- 1 Severe turbulence 2 Icing (moderate-severe) 3'**Thuri~erstorms** at departure and/ordestination ·4 Crosswinds greaterthan 15 knots 5 Surface winds greaterthan 30 kl)ots 6· l;leavy rain.at**departure·~nd/or-** destination 

### - 7 Frozen precipitation at dep-ar:ture and/or qestination

.. 8 Ceiling & visibility at destin-ation less than 500ft. 

### I 2sm T9tal Factor Score- 

### * Cumulative risk factor score of:23 or above Command Pilot is required to consult with_Safety Committee member priorto Go/No Go decision. Contact: John Rochelle, Safety Committee Chair cell: 973-219-0100. --

COMPLETED TOOL MUST BE SENT TO PALS PRIOR TO DEPARTURE. r--

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This docum_entis to be signedandsubmittedto PALS aiong with allaffirmations, waiver:s and W&B before each_ fuel reimbursem_entflight.
Patient Airlift Services, 120Adams Blvd, Farmingdale, NY 11735_ PALSMail@palservices.org Fax: 631-755-2184

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### PALS

### -lnitiai.'Pilot Training·Course·Outline 

## :For Parficipation in Fuel Reimbursement Program This program is designed to meeUexceed the requirements of FAA Exemption No. 10294A, paragraphs 8 and 16, containing the applicable requirements of 14 CFR 

### 135.345. Fuel Reimbursement Training Introduction to the FAA waiver Aviation Safety Statistics & Analysis Accident Trends for General Aviation Risk and Hazard Identification Risk**Mitig~tiol1** Warning Against Complacency arid TechnologyDependemce Flight Planning Aerqnautical Decisic;m Making (ADM) Proper Fueling and Fuel Contamination Fuel Planning and Fuel Reserves Flight Planning Considerations for IFR Flight Navigqtion, Nqvigational aids Principles and Methods for Determjning Weight and Balance Takeoff and Landing Performance Runway Limitations Weather Fronts Pressure systems Clouds/Fog Precipitation Wind· Wind shear Turbulence Thunderstorms Icing Air Traffic Control System Procedure Phraseology VFR Into IMC Instrument Flying Technique Deficient IFHTechnique Unusual Attitude Recovery Partial Panel InstrumentMalfunction Mountainous Terrain InstrumentApproaches Hazards on Approach

. Most recent revision: June 2!?, ?014-.·

Distraction Decent below DHIOA/MDA
·Visual cues required Approach**Disci~line** Go Arounds and Missed Approaches

. Landing and Landing Hazards Emergency Procedures.· Factors Affecting Flight Safety Single pilot IFR Night operations Mission mentality Distractions Missed approaches/go around Incomplete or stale weather briefings Communications Air Traffic Control ·workload and time management Effects of fatigue Effects of stress ADM and judgement Mission Mentality/Pressure PALS .Exemption Requirements Pilot Rest Passenger Briefing Recurrent Training Aircraft Maintenance United States Airspace Flight Plan Requirement (Flight Locating) Airport Selection Approach Minimums Night Operations Takeoff/Landing. Performance IMC Takeoff Minimums Safety Belt Briefing Sterile Cockpit Go/No-'Go Checklist, Preflight Risk Assessment

Most recent revision: June 25, 2014PALS Recurrent Pilot Training Course Outline For Participation in Fuel Reimbursement Program This program is designed to meet/exceed the requirements of FAA Exemption No. 10294A, paragraphs 8 and 16, containing the applicable requirements 

### of 14 CFR135.345,
Initial Pilottraining Review Accident Statistics and Analysis Accident Trendsfor General Aviation Risk .and Hazard Identification Risk.Mitigation Warning Against Complacency and Technology Dependence Preflight Preparation Flight Planning Principles and Methods for Determining**W~ight** and**Balanc~** Takeo.ff and Landing Performance Runway Limitatfons Weather and Weather Hazards Thunderstorms Icing Wind Wind shear Turbulence Safe Operating Procedures Review Taxi Takeoff Climp Cruise Maneuvering Flight Instrument Flying Technique Deficient IFR Technique Unusual Attitude Recovery Partial Panel Instrument Malfunction Decent InstrumentApproaches Hazard$ on Approaches Dis.traction Decent Below DHIDA/MDA Visual cues required Go Arounds and MissedApprqaches Landings and Landing Hazards Emergency Procedures
Most recent revision: .June 25, 2014Factors Affecting Flight Safety Single pilot IFR Night operations M_ission mentality Distractions Missed approaches/go around Incomplete or stale weather briefings Communications Air Traffic Control Workload and time management Effects of fatigue Effects of stress ADM and judgement Mission Mentality/Pressure PALS Exemption Requirements Pilot Rest Passenger Briefing Recurrent Trai_ning Aircraft**M~intenance** United StatesAirspace Flight Plan Requirement (Flight Locating) Airport Selection Approach Minimums Night Operations Takeoff/Landing Performance IMC Takeoff Minimums Safety Belt Briefing Sterile Cockpit Go/No-Go Checklist, Prefli_ght Risk Assessr:nent

Mostrecent revision: Jun-e 25, 2014 ·'·U.S.Deportment ofTransportation Federal Aviation Administration'

June 19,2013

Mr. Joseph Howley Chairman ofthe Board ofDirectors Patient AirLift Services, Inc. 120 Adams Boulevard Farmingdale, NY 11735 Dear Mr. Howley: ExemptionNo. 1 0294A 800 Independence Ave

.. S.W. Washinglon. D.C. 20591

Regulatory DocketNo. FAA-2011-0324

This letter is to inform you that we have extended and amended ExemptionNo. 10294. ·It explains the basis for our decision, describes its effect, and lists the revised conditions and limitations. The Basis for. Our Decision By letterdated February 28, 2013, you petitioned the Federal Avi(!.tion Administration (FAA) on behalfofPatient AirLift Services, Inc. (PALS), for an exemption from § 61.113(c) of Title 14, Code ofFederal Regulations (14 CFR) to the extent necessary to allow for reimbursement ofits volunteerpilots for**fu~l** costs incurred in conducting charitable flights. In yourpetition, you indicate that there has been no change in the conditions and reasons relative to public interest and safety that"were the basis for granting the original exemption. The FAA has determined that good cause exists for not publishing a summary ofthe petition in the Federal Register because the requested exemption would not set a precedent, and any delay in acting on this petition would be detrimental to PALS.

AFS-13-297-EOurDecision The FAA hasmodified and/or added to the conditions and limitations ofExemption No.10294 to address several issues raised by another exemptionholder. These changes were in order to cla,rify original content, and further define the intent and provide consistency of safety-related aspects ofthe conditions and limitations. Please note that the conditions and limitations included with an exemption are notbased on specific regulations, but are the FAA'smeans ot;ensuring an equivalent level ofsafety. This

. 1- may necessitate limitations that go beyond thei'established regulations due to the fact that the proposed operation is by its need for an exerhption, outside the normal regulatory structure. Previous Condition/LimitationNos. 1-4 and 6-14 have been edited for clarity or for standardization with other similar grants ofexemption. Condition/Limitation 1 was added to re-enforce thatthis exemption is solely for charitable medical (Patient AirLift) flights. Condition/Limitation 2 was added to clarify PALS tax exemptionrequirements as noted in Public Law 112-95 Section 821. Condition/Limitation 3 was updated to ensure that PALS pilots meet qualification, training, and recurrency requirements along with ensuring that the operator is maintaining documentation. Condition/Limitation 4(h) was updated to require an instrument proficiency check orflight review within the previous 12 calendar months. This condition/limitation gives the FAA assurance that annual proficiency checking and testing (required in Condition/Limitation 9) will include a review ofthe basic requirements in§§ 61.56 or 61.57. · Condition/Limitation 8 (topics for the required initial pilot training program) has been modified to remove some redundant topics that are already covered in private pilotpractical test standards and on required§ 61.57 flight reviews. · 2

Condition/Limitation 15 requires a transition to a preflight risk assessment tool, replacing the Pilot Go/No-Go Checklist. We made this change because we feel the preflight risk assessment tool offers a more effective evaluation ofthe pilots' readiness for flight. We are providing 12 months to complete this transition. Condition/Limitation 16 requires a transition to an initial and recurrent ground training program based on the requirements of§ 135.345
..We made this change because we feel these ground training themes (for air-taxi operations) are more comparable to your operation. We are providing 12 months to complete this transition.3 Condition/Limitation 1 7 was added to ensure that the FAA General Aviation & Commercial· Divisionhas the latest version ofthe preflight risk assessment tool and initiaVrecurrent ground training program. · Under the authority contained in 49 U.S.C. 

### §§ 40113 and 44701, which the FAA Administratorhas delegated to me, Ihereby grant Patient Airlift.Services Inc., an exemption from 14 CFR 

### § 61.113(c) to the extent necessary to allow for reimbursement ofits volunteer pilots for fuel costs incurred in conducting charitable flights, subject to the following revised conditions and limitations. 

### Conditions and Limitations 1. This exemption may be exercised only for charitable medical flights. Operations where PALS clients are not onboard for the purpose ofobtaining medical care may not ·be conducted under the terms ofthis exemption. 2. PALS:must: a. meet the requirements described in section 501(c)(3) ofthe Internal Revenue Code of 1986 and be exempt from taxation undersection 501(a) ofsuch Code; and, b. be organized forthe primary purpose ofproviding, arranging, or otherwise fostering charitable medical transportation. 3. PALS must ensure the following items are available to any representative ofthe FAA Administrator, upon request: a. A detailed description ofPALS'sprocess for verification ofpilot qualification and training. This process must include a means to verify pilots' qualifications to act as pilot-in-command (PIC) priorto each flight; b. Documentation showing all PALS pilots' flight experience, airman certificate information, and currency ofF AA medical certificate; c. Documentation from each pilot showing that at the time he/she accepts a flight under this exemption, he/she meets all minimum standards and appropriate currency requirements established by PALS, part 61, and all conditions and limitations ofthis exemption; and d. Documentation ofeach flight and reimbursement containing the following information, at a minimum: 1. Name and certificate number ofthe PIC; u. Name and identifier ofthe departure and arrival airports; u1. Name ofall occupants ofthe airplane excluding the PIC; tv. Date and time ofdeparture and arrival; and v. Amount·offuel reimbursement.e. All the documentation require9 under ConditionNo.3 must be maintained by PALS for a minimum of24 calendar months. 4. All operatingunderthe terms ofthis exemption must possess the following certificates, qualifications, and aeronautical experience

- a. An instrumentrating orprivilege (instrument privilege relates to the airline transport pilot certificate) that is appropriate to the aircraft being flown; 4

b. For the operation ofany single-enginepiston aircraft, a minimum total time of 500 hours, with no less than 400 hours as pilot in command (PIC), and a minimum of50 hours in the specific make and model ofsingle-engine aircraft being flown; c. For the operating any multiengine aircraft, a minimum total time of
· I,000 hours as PIC in any aircraft, a minimum of250 hours in multiengine

aircraft, and a minimum of50 hours in the make and model ofmultiengine aircraft being flown;
. d. For the operation ofany single- or multiengine turbine-powered aircraft, a minimum total time of 1,000 hours as PIC, a minimum of 100 hours in turbine-powered aircraft, and a minimum of50 hours in the make and model of turbine-powered aircraft being flown; e. A minimum of50 hours as PIC shall have been logged within the preceding 12 calendar months immediately preceding the month ofthe flight; 

### f. A minimum of 12 hours flown and logged, or 2 hours ofdual flight training with a certificated flight instructor, within the preceding 3 calendar months prior tothe month ofthe flight; g. ·A 2nd class medical certificate (per§§ 61.23(d)(2)(i) and 61.2); h. Within the preceding 12 calendar months, an instrument proficiency check (IPC) meeting the requirements of§ 61.57(d), or a flight review meeting the requirements found in§ 61.56(a). The IPC or flight review must consist ofat least 1hour offlight training and 1hour ofground training. This requirement can substituted by a FAA practical test for any pilot certificate orrating; 1. A current flight review (per§ 61.56(a)) in the same aircraft category, class, and type (ifa type rating is required) being flown; J. Instrument current (per§ 61.57(c) or (d), as appropriate) in the same aircraft category, class, ari.d type (ifatype rating is required) being flown; and k. For all operations underthis exemption, the pilot must be current for night operations (per§ 61.57 (b)) in an aircraft ofthe same category, class, and type (ifa type rating is required). 5. All operations under this exemption must be in compliance with the following flight duty, rest, and flight time limitations: a. No pilot may fly more than 8 hours offlight time (per §61.1) within any 24-consecutive-hourduty day period;b. No pilot may perform a·duty day in excess of 12 consecutive hours. (A duty day starts when the pilot arrives at the airport and begins preparation for the flight and terminates upon completion ofthe post flight ofthe aircraft); and c. Once the pilot has performed 12 consecutive hours ofduty, the pilot must rest a period ofat least 12 hours before conducting another flight. 6. Passenger and medical crew briefing requirements. Prior to each takeoff, the PIC must ensure that all passengers have been orally briefed on the followinga. The flight is beingpermitted under this grant ofexemption and'that the operator is not a certificated commercial operator; b. When, where, and under what conditions smoking is allowed; c. Use ofsafety belts, shoulder harnesses, and child restraint systems: When, where, and under what conditions it is necessary to have his orher safetybelt and, ifinstalled, his orher shoulder harness fastened about him or her; 5

d. The placement ofseat backs in an upright positionbefore takeoffand landing; e. Location and means for normal and emergency egress; f. Location ofsurvival equipment; g. Use ofnormal and emergency oxygen, ifinstalled; and h. Location and operation offire extinguishers. 7. Priorto each takeoff, the PIC must ensure that the patient, who may need the assistance ofanotherpersonto exit the aircraft ifan emergency occurs, has received a briefing as to the procedures to be followed ifan evacuation occurs. This paragraph does not apply to a person who has been given a briefing before a previous leg ofa flight in the same aircraft. 8. PALSmust establish an initial pilot training program**tha~** includes the following elements. All pilots must complete this training program:prior to conducting flights under this grant ofexemptiona. Risk, hazard identification; b. Accidenttrends for general aviation aircraft. c. Flight planning and aeronautical decision-making:
1. Improper pre-flight planning. n. Insufficient fuel reserves. 111. Aircraft systems. 1v. Improperoperation offuel system. v. Fuel contamination.Vl. Improper fueling. vn. Weather and continued visual flight rules into instrument meteorological conditions. vnt. Descending below minimum descent altitude on approach.

tx. Mountainous terrain.
x. Icing. d. Other factors: t. Single pilot IFR; n. Night operations at unfamiliar airports; 111. MissiOI1 mentality; tv. Pressure to complete flight operations; v. Distractions; vt. Missed approach/go around; vn. Incomplete/stale weather briefings; vm. Communications processes; decisions, and coordination, to include communication with airtraffic control and passengers; tx. Workload and time management; x. Situational awareness; xt. Effects offatigue onperformance, avoidance strategies and countermeasures; xn. Effects ofstress and stress reduction strategies; and xnt. Aeronautical decision-making and

### judgmerit. 9. Recurrent training is required for all**pil~ts** operating under the terms ofthis exemption. The annual recurrent training program must include: 6

a. Verification that each pilot is adequately trained, current, and proficient onall ofthe elements in the PALS initial pilot training program; and b. Testing to determine each pilot's aeronautical knowledge, proficiency with the aircraft, and the limitations.ofthis exemption. 10. Each aircraft operated underthis exemption must have a standard airworthiness certificate. 11. All maintenance except when complying with the provisions of 14 CFR 

### §43.7(f) and Appendix A, preventive maintenance items conducted on aircraft operated under this exemption must be performed by anFAA-certificated mechanic, repairman, orrepair7 station. The aircraft engine, propeller, and all components must be overhauledpriorto reaching the airframe, engine, orpropeller manufacturer's recommended time between overhaul. 12. This exemption applies to flights conducted within domestic United States airspace. PALS mayexercise this relieffor overflights within the territory and airspace ofa foreign country only with the specific permission ofthe foreign civil aviation authority. 13. All pilots operating under this exemption must comply with the following requirements: a. All flights operated under this exemption must activate an IFR flight plan. The earliest the flight plan may be canceled is upon acceptance ofa visual approach cleararice from airtraffic control; b. For flights in instrument meteorological conditions (IMC), each pilot may only use airports that have a functioning, published, precision approach procedure; c. Pilot must add 100 feet to all instrument approach minimums; d. All circling approaches at night are prohibited; e. Pilots must add 50 percent to pilot operatinghandbook (POH) runway length performance for obstacle clearance ontakeoffand landing under ambient conditions; f. For IMC takeoffminimums, the pilot must apply 50 percent above the approach landing minimums (example: Baltimore-Washington International Airport minimums 200/1/2, then the takeoffminimums will be at least 300 feet and 3/4-statute-mile visibility);
. g. Thepilot must ensure that all passengers are restrained by FAA-approved seat

.belts orFAA-approved child**s~fety** seat at all times during the flight. The only exception shall be change ofseat positions, quick access to luggage, care and/or feeding ofchild, oruse oflavatory; and h. Pilots will utilize and briefpassengers on sterile cockpit procedures as defined under§ 135.100. 14. Pilots must use the PALS Go/No-Go checklist, patient, passenger, pilot release forms, and post-flightreport. The completed checklist mustbe transmitted to PALS priorto conducting a flight under this exemption. The completed checklist must be retained

. by PALS for a minimum ofthree days. The Go/No-Go checklist will consist ofat

least the following information:8 Pilot Go/No-Go Checklist

EXCELLENT 

### OK MARGINAL PooR Pilot Physical health 0 0 0 0 Mental health 0 0 0 0 Prepared/Confident 0 0 0 ·o Well rested 0 0 0 0 Aircraft Maintenance 0 0 0 0 Fuel reserve 0 0 0 0 Pre-flight 0 0 0 0 Equipment sufficient for the 0 0 0 0 flight conditions Weight and balance Takeoffweight/CO Landing weight/CO EXCELLENT 

### OK MARGINAL POOR Weather Current & WX Forecast 0 0 0 0 Conditions Departure 0 0 0 0 Destination 0 0 0 0 Return 0 0 0 0

### 9 Explain ifMarginal or Poor:

YES No Child safety seat Passengers briefed Pre-departure·weather briefing Verify departing oncorrectrunway Release forms signed Flight# Pilot Signature Date The checklist must be provided to the exemptionholder or left with a responsible person, such as a fixed-base operator, prior to conducting a flight under this exemption. The completed checklist must be retained for 3 days.

### -.

10 15. PALS must develop and implement a preflight risk assessment tool to supplement or replace the Go/No-Go checklist within 12 calendar months ofthe date ofissue ofthis exemption. Once implemented, use 9fthe preflightrisk assessment tool will supersede the requirements ofCondition No. 14. The tool must be completed by the PIC before each flight and must be transmitted to PALS prior to takeofffor any flight operated under this exemption. The completed tool must be retained by PALS for a minimum ofthree days. A sample risk assessment tool is available at FAA Information for Operators (InFO) 07015: http://www.faa.gov/other _visit/aviation _industry/airline_operators/airline_ safety/info/ all_infos/media/2007/inF007015.pdf. 16. Within 12 calendar months ofthe date ofissue ofthis exemption. PALS must develop and implement an initial and recurrent ground training programthat contains the requirements of§ 135.345 that are applicable to the PALS operations. Thisprogram will supplement orreplace the requirements ofConditionNo. 8. Once implemented, use ofthe new initial and recurrent training program will supersede the requirements ofConditionNo. 8. 17. PALS must ensure that the latest version ofits preflightrisk assessment tool (Condition No. 15) and the initial/recurrent ground training program (Condition No. 8 and 16 are sentto the FAA Airman Certification and Training Branch, 800 Independence Ave SW, Washington DC 20591 or via e-mail to 9-AFS-800- Correspondence/ AW 

### AIFAA. These two documents must be clearly labeled to identify the most current version. This exemption terminates on June 30, 2015, unless sooner superseded orrescinded. Sincerely,

# ~~. {) John M
.. Allen Director, Flight Standards Service

### ' '1.

,,**~**

US. Department ofTransportotion Federal Aviation Administration

June 22, 2011

Mr. Joseph Howley Chairman ofthe Board ofDirectors Patient AirLift**Services~** Inc. 120 Adams Boulevard Farmingdale, NY 11735 Dear Mr. Howley: ExemptionNo. l0294 800 Independence Ave

.. S.W. Washington. D.C. 20591

Regulatory DocketNo. FAA-2011-0324

This letter is to inform you that we have granted your request for exemption. 

### Ittransmits our decision, explains its basis, and gives you the conditions and limitations ofthe exemption, including the date it ends. 

### The Basis for OurDecision By letter dated March 24,2011, you petitioned the Federal Aviation Administration (FAA) on behalfofPatient AirLift Services, Inc. (PALS), for an exemption from § 61.113(c) ofTitle 14, Code ofFederal Regulations (14 CFR) to the extent necessary to allow for reimbursement of its volunteer pilots for fuel costs incurred in conducting charitable flights. The FAA has determined that good cause exists for not publishing a summary ofthe petition in the Federal Register because the requested exemption would not set a precedent, and any delay in acting onthis petition would be detrimental to PALS.

· The FAA has issued grants ofexemption in circumstances similar in all material respects to

those presented in your petition. In Grant ofExemption Nos. 10009 and 10019 (copies enclosed), the FAA found that the humanitarian efforts ofthese pilots who volunteer their time and piloting services are commendable, and the FAA wants to encourage this kind of volunteerism and public service for the common good ofourcitizens. The FAA recognizes the fact ofrising costs for fuel and aircraft operating expenses; however, when money is exchanged for transportation, the public expects, and the FAA has a duty to demand, a higher level ofsafety for the flying public. The FAA believes by requiring the petitioners and their AFS-11-314-E·"

pilots to comply with the conditions and limitations set forth in this grant ofexemption, the FAA can ensure that a higher level ofaviation safety for the flying public will be maintained. Having reviewed your reasons for requesting an exemption, I find that2

• they are similar in all material respects to reliefpreviously requested in the enclosed Grant ofExemption Nos. 10009 and 10019; • the reasons stated by the FAA for granting the enclosed Grant ofExemptionNos. 10009 and 10019 also apply to the situation you present; and • a grant ofexemption is in the public interest. Our Decision Under the authority contained in 49 U.S.C. 40113 and 44701, which the FAA Administrator has delegated to me, I hereby grant Patient AirLift Services, Inc., an exemption from 14 CFR § 61.113(c) to the extent necessary to allow for reimbursement ofits volunteerpilots forfuel costs incurred in conducting charitable flights, subject to the conditions and limitations described below. Conditions and Limitations 1. The exemption holder must have in place the following: a. A' structured and documented pilot registration process that has an annual renewal requirement and ensures that only qualified pilots who are registered and trained conductcharitable flights. This process must include a means to verify registration prior to flight; b. On-file documentation authenticating registered pilots' experience, ratings, FAA physical, and any other information pertinent to the pilots' qualifications; c. A system that registers the pilot's assertion, at the time he/she accepts a flight to accomplish, that he/she meets all minimum standards and appropriate currency requirements established by the FAA and all conditions and limitations set forth in this exemption and will conduct the flight in accordance with all applicable Federal regulations; and d. A file ofall flight and reimbursement records that must be made available to the FAA for viewing at a designated office site location. Records shall be kept a minimum of2 years. 2. The FAA may, at any time orplace, conduct inspections ofthe pilot(s) and aircraft being flown in accordance with this exemption. 3. All pilots must possess the following qualifications and aeronautical experience, as appropriate:3
a. Musthold an instrument rating orprivilege (i.e., instrumentprivilege relates to the airline transport pilot certificate) that is appropriate to the aircraft being flown; b. For the operation ofany single-engine piston aircraft, the pilot shall have a minimum total time of500 hours, with no less than 400 hours as pilot in command (PIC), and a minimum of50 hours in the speci:(tc make and model of single-engine aircraft being flown;
c. For the operation ofany multiengine aircraft, a minimum total time of 1,000 hours as PIC, a minimum of250 hours in multiengine aircraft, and a minimum of50 hours in the specific make and model ofmultiengine aircraft being flown; d. Forthe operation ofany turbine-powered aircraft, a minimum total time of 1,000 hours as PIC, a minimum of 100 hours in turbine-powered·aircraft, and a minimum of50 hours inthe specific make and model ofturbine-powered aircraft being flown;
e. A minimum of50 hours as PIC shall have been flown and logged within the preceding 12 calendarmonths immediatelypreceding the month ofthe flight; 

### f. Minimum of 12 hours flown and logged, or 2 hours ofdual flight training with a certificated flight instructor, within the preceding 3 calendar months priorto the month ofthe flight; g. Must hold a 2nd class medical certificate (per§§ 61.23(d)(2)(i) and 61.2); h. Must have a current flight review (per§ 61.56(a)) in the same aircraft category, class, and type (ifa type rating is required) being flown;
1. Shall be instrument-current (per§ 61.57(c) or (d), as appropriate) in the same aircraft category, class, and type (ifa type rating is required) being flown; J. Within the preceding 3 calendar months priorto the flight, the pilot(s) must have logged at least three takeoffs and three landings to a full stop in the same aircraft category, class, and type (ifa type rating is required) being flown. However, this condition may be accomplished by logging at least three takeoffs and three landings to a full stop at night within the preceding 3 calendar months in the same aircraft category, class, and type (ifa type rating is required) being flown; and k. For all operations under this exemption, the pilot must be current for night operations (per§ 61.57 (b)) in an aircraft ofthe same category, class, and type (ifa type rating is required). ·4. Flight duty, rest, and flight time limitations:
a. No pilot may fly more than 8 hours offlight time (per 

### § 61.1) within any 24- consecutive-hour duty day period; 4

b. No pilot may perform a duty day in excess of 12 consecutive hours (a duty day starts when the pilot arrives at the airport and begins preparation for the flight and terminates upon completion ofthe post flight ofthe aircraft); and
c. Once the pilothas performed 12 consecutive hours ofduty, the pilot must rest a period ofat least 12 hours before conducting another flight. 5. Passenger and medical crew briefing requirements: Priorto each takeoff, the PIC must ensure that all passengers have been orally briefed on the following: a. The flight is being permitted under this grant ofexemption and that the operator is not a certificated commercial operator; b. Smoking: When, where, and under what conditions smoking is allowed;
c. Use ofsafety belts, shoulderharnesses, and child restraint systems: When, where, and under what conditions it is necessary to have his orher safety belt and, ifinstalled, his orher shoulder harness fastened about him or her; d. The placement ofseat backs in an upright position before takeoffand landing; e. Location and means for opening the passengerentry door and emergency exits; f. Location ofsurvival equipment; g. Use ofnormal and emergency oxygen installed; h. Location and operation offire extinguishers; and 1. Prior to each takeoff, the PIC must ensure that the patient, who may need the assistance ofanother person to exit the aircraft ifan emergency occurs, has received a briefing as to the procedures to be followed ifan evacuation occurs. 6. Pilot training: The exemption holder must establish an initial pilot training program that includes the following elements. All pilots·must complete this training program prior to conducting flights under this grant ofexemption: a. Risk, hazard identification; b. Accident trends and factors for general aviation fixed wing under 12,500 pounds;
c. Current edition ofthe Aircraft Owners and Pilots Association Air Safety Foundation Nail Report; d. High risk phases offlight-- i. Takeoffand climb;

### u. Takeoffstall/settling; u1. Loss ofairspeed**resu~ting** 

### in nonrecoverable stall or sink rate; 1v. Loss ofcontrol; and v. Crosswinds/other conditions leading to loss ofdirectional control; e. Maneuvering-- !. 

### Stall qr**los~** 

### ofcontrol; and
11. 

### Loss ofairspeed resulting in stall/spin; f. Descent/approach: Beginning ofdescent from cruise altitude to missed approach point orrunway threshold; g. Stalls/spins; h. Loss ofairspeed;
1. 

### Collisions with objects, terrain; J. 

### Loss ofengine power; k. 

### Carburetor icing (ifappropriate, for the aircraft the pilot is assigned to fly); l. 

### Incorrect fuel mixture; m. Wind gusts or wake turbulence; n. Landing-- !. 

### Loss ofdirectional control;
11. 

### Crosswinds;
111. 

### Inadequate airspeed control; IV. 

### Stalls, hard landing, short-long touchdown; v. Runway conditions; and v1. Runway contamination; o. Flight planning and decisionmaking--
1. 

### Flight planning;
11. 

### Improper pre-flight planning;
111. 

### Insufficient fuel reserves; IV. 

### Inadequate in-flight monitoring ofground speed; v. Systems operation; v1. Improper operation offuel system; 5

### vu. Fuel contamination; vm. Improper fueling;

IX. 

### Weather; 6



### x. Continued visual flight rules into. instrument meteorological conditions; XL 

### Deficient instrument flight rules (IFR) technique;
xu. Failure to follow appropriate IFR procedures; XIII. 

### Descending below minimum descent altitude on approach; x1v. Thunderstorm;

xv. Flying too close or penetrating turbulence; xv1. High winds; xv11. Mountainous terrain; XVIII. 

### Icing;

XIX. 

### Loss oflift and performance; and
xx. Instrument malfunction; p. Otherfactors-- 1. Single pilot IFR; 11. Night operations at unfamiliar airports; 111. Mission mentality; IV. 

### Pressure to complete flight operations; v. Distractions; v1. Missed approach/go around; VII. 

### Incomplete/stale weather briefings; vu1. Communications processes, decisions, and coordination, to include communication with air traffic control and passengers; IX. 

### Workload and time management; x. Situational awareness; xi. Effects offatigue on performance, avoidance strategies and countermeasures; xu. Effects ofstress and stress reduction strategies; and XIII. 

### Aeronautical decisionmaking andjudgment.7. Recurrent training: An annual recurrent training program must ensure: a. The pilot remains adequately trained, current, and proficient regarding all of the elements contained in the exemption holder's training program; b. Recurrent training must include testing to determine the crewmember's
. knowledge ofthe aircraft and the exemption holder's program; and
c. Recurrent flight training sufficient to satisfactorily complete the recurrent proficiency flight check. 8. Aircraft requirements: Each aircraft must have a standard airworthiness certificate. 7

9. Aircraft maintenance: All maintenance must be performed by a certificated mechanic, repairman, orrepair station. Aircraft components must be overhauled prior to reaching manufacturer's recommended time between overhaul. 10. Areas ofoperations: All flights must remain within domestic United States airspace. 11. All pilots must adhere to the following best practices policies ofthe exemption holder which are: a. In instrument meteorological conditions (IMC) conditions, each pilot mustplan to land at airport with a precision approach; b. Each pilot must add 100 feet to all instrument approach minimums; c. For night landings, the pilot shall use runways with functional vertical guidance (visual approach slope indicator, precision approach path indicator, instrument flight system); d. Pilot will not attempt circling approaches at night;
e. Add 50 percent to pilot operating handbookrunway length performance to clearthe obstacle for takeoffand landing under ambient conditions; f. For IMC takeoffminimums, the pilot must apply 50 percent above the approach landing minimums (example: Baltimore-Washington International Airport minimums 20011/2, then the takeoffminimums will be at least 300 feet and 3/4-statute-mile visibility); g. Ifdestination is unfamiliar, the pilot must obtain briefing from a pilot orfixedbase operator with experience with that airport priorto flight; h. Pilots are requested to use nonpunitive report process to communicate any and all situations when safety offlight was compromised; 1. Pilots are requested to provide feedback on weather, airports, air traffic control, otherpilots, etc., that could compromise safety for future flights; 

### J. The pilot must ensure that all passengers are restrained by FAA-approved seatbelts orFAA-approved child safety seat. The only exception shall be.·

change ofseat positions, quick access to luggage, care and/or feeding ofchild, or use oflavatory; k. Pilots will consult all available weatherproducts, wind sock, etc., to verify departure will be from the correct runway relative to wind conditions; I. Pilots will utilize computerdevices and reading material only as these are pertinentto safe operation ofthe flight and will refrain from any and all distractions that could compromise safety offlight; and
m. Pilots will utilize and briefpassengers that a sterile cockpit condition exists during taxi and takeoffuntil reaching cruise altitude and also during descent from cruise altitude, descent, approach, landing, and taxi to ramp. 12. Pilots must complete and adhere to the Go/No-Go checklist, patient, passenger, copilot release forms, and post-flight report. The Go/No-Go checklist will consist ofat leastthe following information:
Pilot Go/No-Go Checklist EXCELLENT OK MARGINAL POOR Physical health 0 0 0 Mental health 0 0 0 0 Prepared/Confident 0 0 0 0 Well rested 0 0 0 0 Aircraft Maintenance 0 0 0 0 Fuel reserve 0 0 0 0 Pre-flight 0 0 0 0 Equipment sufficient for the o flight conditions 0 0 0 Weight and balance Takeoffweight/CG

________ _ Landing weight/CO

________ _ 8

### 9 EXCELLENT OK MARGINAL POOR Weather Current & WX Forecast 0 0 0 0 Conditions Departure 0 0 0 0 Destination 0 0 0 0 Return 0 0 0 0 Explain ifMarginal or Poor:

YES No Child safety seat Passengers briefed Pre-departure weatherbriefing Verify departing on correct runway Release forms signed Flight# Pilot Signature Date,, 

# .

. 

### ,·

10 The checklist must be provided to the exemptiol! holder or left with a responsible person, such as a fixed-base operator, priorto conducting a flight under this exemption. The completed checklist must be retained for 3 days. 13. Flight locating procedures required: The pilot must file and activate an IFR flight plan for each flight. The flight planmay be canceled up_on acceptance ofa visual approach clearance from air traffic control. This exemption terminates on June 30, 2013, unless sooner superseded orrescinded. Sincerely,

Melvin Cintron Acting Deputy Director, Flight Standards

Service
Enclosures