AMC & GM to Part ATCO.AR — Issue 2

Acceptable Means of Compliance and Guidance Material to Part ATCO.AR

Issue 2 8 June 2026

ANNEX II – PART ATCO.AR – REQUIREMENTS FOR COMPETENT AUTHORITIES

SUBPART A – GENERAL REQUIREMENTS

GM1 ATCO.AR.A.015(b) Means of compliance

ALTERNATIVE MEANS OF COMPLIANCE — GENERAL

(a) A competent authority may establish means to comply with Commission Regulation (EU) 2015/340 which are different from the acceptable means of compliance (AMC) established by EASA. (b) In that case, the competent authority is responsible for demonstrating how those alternative means of compliance (AltMoC) assist it to establish compliance with Commission Regulation (EU) 2015/340. (c) AltMoC that are used by a competent authority, or by an organisation under its oversight, may be used by other competent authorities, or by other organisations, only if they are processed by those authorities in accordance with point ATCO.AR.A.015, and by those organisations in accordance with point ATCO.OR.B.005. (d) AltMoC that are issued by the competent authority may cover the following cases: (1) AltMoC to be used by organisations under the oversight of the competent authority, and which are made available to those organisations; and (2) AltMoC to be used by the competent authority itself to discharge its responsibilities. AMC1 ATCO.AR.A.015(b);(c) Means of compliance

PROCESSING OF ALTERNATIVE MEANS OF COMPLIANCE (AltMoC)

To meet the objectives of points (b) and (c) of point ATCO.AR.A.015: (a) the competent authority should establish the means to consistently evaluate over time that all the AltMoC that are used by itself or by organisations under its oversight allow for the establishment of compliance with Commission Regulation (EU) 2015/340; (b) if the competent authority issues AltMoC for itself or for the organisations under its oversight, it should: (1) make them available to all relevant organisations; and (2) notify EASA of the AltMoC as soon as it is / they are issued, including the information that is described in point (d); (c) the competent authority should evaluate the AltMoC that is/are proposed by an organisation by analysing the documentation provided and, if considered necessary, by inspecting the organisation; when the competent authority finds that the AltMoC is/are in accordance with Commission Regulation (EU) 2015/340, it should: Annex ΙΙΙ to ED Decision 2026/004/R Page 4 of 34 (1) notify the applicant that the AltMoC is/are approved; (2) indicate that this/those AltMoC may be implemented, and agree when the organisation documents are to be amended accordingly; and (3) notify EASA of the AltMoC approval as soon as it is / they are approved, including the information that is described in point (d); and (d) the competent authority should provide EASA with the following information: (1) a summary of the AltMoC; (2) the content of the AltMoC; (3) a statement that compliance with Commission Regulation (EU) 2015/340 is achieved; and (4) in support of that statement, an assessment which demonstrates that the AltMoC reaches/reach an acceptable level of safety, taking into account the level of safety that is achieved by the corresponding EASA AMC. (e) All these elements that describe the AltMoC are an integral part of the records to be kept, which are managed in accordance with point ATCO.AR.A.015. AMC1 ATCO.AR.A.020(b) Information to the Agency

PROVISION OF SAFETY-SIGNIFICANT INFORMATION TO THE AGENCY

Each competent authority should appoint a coordinator to act as the point of contact for the provision of safety-significant information to the Agency. GM1 ATCO.AR.A.020(b) Information to the Agency

MEANING OF SAFETY-SIGNIFICANT INFORMATION STEMMING FROM OCCURRENCE REPORTS

Safety-significant information stemming from occurrence reports means a conclusive safety analysis that summarises individual occurrence data and provides an in-depth analysis of a safety issue, which may be relevant for the Agency’s safety action planning. GM2 ATCO.AR.A.020(b) Information to the Agency

SAFETY-SIGNIFICANT INFORMATION STEMMING FROM OCCURRENCE REPORTS

The conclusive safety analysis based on occurrence reports should contain the following: (a) a detailed description of the safety issue, including the scenario in which the safety issue takes place; and (b) an indication of the stakeholders affected by the safety issue, including types of operations and organisations; and, as appropriate: (c) a risk assessment establishing the severity and probability of all the possible consequences of the safety issue; (d) information about the existing safety barriers that the aviation system has in place to prevent the likely safety-issue-related consequences from occurring; Annex ΙΙΙ to ED Decision 2026/004/R Page 5 of 34 (e) any mitigating actions already in place or developed to address the safety issue; (f) recommendations for future actions to control the risk; and (g) any other element(s) the competent authority considers essential for the Agency to properly assess the safety issue. GM1 ATCO.AR.A.015(b);(c) Means of compliance

CASES FOR WHICH THERE IS NO CORRESPONDING EASA AMC

When there is no EASA AMC to a certain requirement in Commission Regulation (EU) 2015/340, the competent authority may choose to develop national guides or other types of documents to assist the organisations under its oversight to demonstrate compliance. The competent authority may inform EASA about such national guides or other types of documents so that they may be considered later for incorporation into the AMC that EASA issues and publishes through its rulemaking procedure. AMC1 ATCO.AR.A.025A Immediate reaction to an information security incident or vulnerability with an impact on aviation safety (a) To appropriately collect and analyse information related to information security incidents and vulnerabilities with a potential impact on aviation safety, the competent authority should implement means that ensure the necessary confidentiality. (b) When disseminating information related to information security incidents and vulnerabilities with a potential impact on aviation safety, the competent authority should properly select the appropriate recipient(s) to prevent the content of a report from being exploited to the detriment of aviation safety, by revealing, for instance, uncorrected vulnerabilities. [Applicable from 22 February 2026 – ED Decision 2023/010/R] GM1 ATCO.AR.A.025A Immediate reaction to an information security incident or vulnerability with an impact on aviation safety When deemed necessary, a two-step mechanism could be used: a report alerting about the information security event or incident and the availability of additional data that would require controlled and confidential distribution. This report should only alert recipients of the urgency and the necessity for organisations and competent authorities to establish further communication through secure means. Therefore, the report should consist of two parts: one limited to mostly public information and one containing the sensitive data that should be restricted to the recipients who need to know. Wherever possible, reports should be based on an agreed taxonomy. [Applicable from 22 February 2026 – ED Decision 2023/010/R]

SUBPART B – MANAGEMENT

AMC1 ATCO.AR.B.001(a)(2) Management system

TRAINING PROGRAMME AND RECURRENT TRAINING

(a) The competent authority should establish a training programme for its personnel and a plan for its implementation. The training programme should include, as appropriate to the role, current knowledge, experience and skills of the personnel, at least the following: (1) organisation and structure of the aviation legislation; (2) the Chicago Convention, its relevant annexes and documents, the applicable requirements of Regulation (EU) No 2018/1139, its delegated and implementing acts and related Acceptable Means of Compliance, Certification Specifications and Guidance Material, as well as an assessment methodology of the alternative means of compliance and the applicable national legislation; (3) the applicable requirements and procedures; and (4) areas of particular interest. (b) The training programme and plan should be updated, as needed, to reflect, at least, changes in aviation legislation and industry. The training programme should also cover the specific needs of the personnel and the competent authority. (c) The competent authority should ensure that its personnel, including its ATM/ANS inspectors, receive recurrent training at regular intervals as defined by the competent authority or whenever deemed necessary, in order to be kept up to date. GM1 ATCO.AR.B.001(c) Management system

EXCHANGE OF ALL NECESSARY INFORMATION

‘All necessary information’ refers to information that relates to the oversight of persons and organisations concerned (exercising activities within the territory of the Member State, but overseen, certified or licensed by the competent authority of another Member State or the Agency), as agreed between these competent authorities. AMC1 ATCO.AR.B.001(d) Management system

PROCEDURES AVAILABLE TO THE AGENCY

(a) Copies of the procedures related to the competent authority’s management system and their amendments to be made available to the Agency for the purpose of standardisation should provide at least the following information: (1) Regarding oversight functions undertaken by the competent authority, the competent authority’s organisational structure with description of the main processes. This information should demonstrate the allocation of responsibilities within the competent authority, and that the competent authority is capable of carrying out the full range of tasks regarding the size and complexity of the Member State’s aviation industry. It should also consider the overall proficiency and authorisation scope of the competent authority’s personnel. (2) For personnel involved in oversight activities, the minimum professional qualification requirements as well as experience and procedures leading to appointment (e.g. assessment). (3) How the following are carried out: assessing applications and evaluating compliance, issuing of certificates, performance of oversight, follow-up of findings, enforcement measures and resolution of safety concerns. (4) Principles of managing exemptions and derogations. (5) Systems used to disseminate applicable safety information for timely reaction to a safety problem. (6) Criteria for planning oversight (oversight programme). (7) Outline of the initial training of newly recruited oversight personnel (taking future activities into account), and the basic framework for continuation training of oversight personnel. (b) As part of the continuous monitoring of a competent authority, the Agency may request details of the working methods used, in addition to the copy of the procedures of the competent authority’s management system (and amendments thereto). These additional details are the procedures and related guidance material describing working methods for competent authority personnel conducting oversight. (c) Information related to the competent authority’s management system may be submitted in electronic format. GM1 ATCO.AR.B.005 Allocation of tasks to qualified entities [applicable until 21 February 2026 - ED Decision 2015/010/R] GM1 ATCO.AR.B.005 Allocation of tasks [applicable from 22 February 2026 – ED Decision 2023/010/R]

GENERAL

The competent authority may decide to allocate to qualified entities certain or all its tasks that are assigned to such competent authority under this Regulation. GM1 ATCO.AR.B.015 Record keeping

STORAGE

Records may be stored electronically. GM1 ATCO.AR.B.015(b)(5) Record keeping

DETAILS OF COURSES

Details of courses provided by training organisations may consist of subjects, subject objectives, topics and subtopics, where applicable.

SUBPART C – OVERSIGHT AND ENFORCEMENT

AMC1 ATCO.AR.C.005 Oversight programme

AUDIT AND INSPECTION

(a) The audit and inspection of a certified training organisation should be conducted through checking of the facility for compliance, interviewing personnel and sampling relevant training courses to assess their conduct and standard. (b) Such audit and inspection should focus in addition to the items of AMC1 ATCO.AR.E.001(a);(b) on: (1) information on the competence of instructors and assessors; (2) evidence of sufficient funding. (3) adequacy of the facilities to the courses being conducted and to the number of persons undertaking training; (4) synthetic training devices; (5) documentation, in particular documents related to courses, information on the updating system, training and operations manual; (6) training records and forms.

SUBPART D – ISSUE, REVALIDATION, RENEWAL, SUSPENSION AND REVOCATION OF LICENCES, RATINGS, ENDORSEMENTS AND AUTHORISATIONS

AMC1 ATCO.AR.D.001(a) Procedure for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations PROCEDURES The competent authority may develop procedures to allow privileges to be exercised by the licence holder for a maximum period of eight weeks after successful completion of the applicable examination(s) and assessment(s), pending the issue of the licence, rating or endorsement. Such procedures may cover licences, ratings and endorsements, but not the temporary authorisations. GM1 ATCO.AR.D.001(a) Procedure for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations APPLICATION FORM FOR THE ISSUE, REVALIDATION AND RENEWAL OF LICENCES, RATINGS AND ENDORSEMENTS

APPLICATION FOR THE ISSUE/REVALIDATION/RENEWAL OF (STUDENT) AIR TRAFFIC CONTROLLER (ATCO) LICENCES, RATINGS AND ENDORSEMENTS

Part A: APPLICANT’S DETAILS

Name: Permanent address:………………………………………………………………………………………………………………… Tel.:……………………………………… Mobile:………………… E-mail address:………………………………………… Nationality: ……………… Date (dd/mm/yyyy) and place of birth:……………………………………………………………………………. (STUDENT) ATCO LICENCE DETAILS (if applicable): Licence serial number:…………………………………… Date of issue (dd/mm/yyyy): ……………………………… EMPLOYER’S DETAILS (if applicable): Name:

Part B: APPLICATION FOR (Tick the relevant boxes)

Issue of Student ATCO licence, rating(s) and rating endorsement(s) (Part C, E and F of this form) Language proficiency endorsement(s) (Part C, E and F of this form) Issue of ATCO licence, rating(s) and rating endorsement(s) (Part C, E and F of this form) Revalidation of ATCO licence rating(s) and rating endorsement(s) (Part C, D, E and F of this form) Renewal of ATCO licence rating(s) and rating endorsement(s) (Part C, D, E and F of this form)

Part C: RATING/RATING ENDORSEMENT/ATC UNIT/Sector

ADC (Unit, sector, working position) SUR APS (Unit, sector, working position) PAR SRA ACS (Unit, sector, working position) OCN ACP (Unit, sector, working position) OCN ADV (Unit, sector, working position) APP (Unit, sector, working position) Licence endorsements OJTI STDI Assessor Language proficiency endorsement Local (specify language): - level 4 ___ language proficiency - level 5 endorsement* - level 6 - level 4 - level 5 - level 6 * Optional, if imposed by the Member State for safety reasons at the ATC unit as published in the AIP.

Part D: Unit endorsement revalidation/renewal

The applicant meets the requirements of Regulation (EU) …/… and of the ……unit competence scheme. The unit endorsements annotated below are revalidated/renewed (insert as appropriate). Unit endorsement: Valid until: Unit endorsement: Valid until: Unit endorsement: Valid until:

Unit endorsement: Valid until: Unit endorsement: Valid until: Unit endorsement: Valid until: I certify that the data is complete and Name: Assessor’s licence number: Signature: true. Authorised assessor:

Part E: Declaration

I hereby:

1. apply for the issue/revalidation/renewal of (Student) ATCO licence, ratings and/or endorsements, as indicated;

2. confirm that the information contained herein is correct at the time of the application;

3. confirm that I do not hold any (Student) ATCO licence issued in another Member State;

4. confirm that I have not applied for any (Student) ATCO licence in another Member State; and

5. confirm that I have never held a (Student) ATCO licence issued in another Member State which has been revoked or suspended in any other Member State. I understand that any incorrect information provided herein could prohibit me from holding a (Student) ATCO licence.

Signature: . . . . . . . . . . . . . . . . . . . . Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date (dd/mm/yyyy): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part F: Certificates/Documents

Please enclose all relevant certificates and/or documents: 1. Copy of Student ATCO licence, if applicable 2. Copy of passport or other national ID 3. Copy of medical certificate 4. Copy of relevant training certificate/documents proving the successful completion of: (a) Initial training (integrated) (b) Basic training (c) Rating training (d) Unit training (e) Practical instructor training (f) Assessor training (g) Refresher training 5. Copy of language proficiency certificate(s): language(s)

6. Certificate by ATC provider proving that the licence holder has fulfilled the requirements in accordance with the approved unit competence scheme

7. Copy of the competence assessment form

8. Any other copy(ies), as necessary

GM2 ATCO.AR.D.001(a) Procedure for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations

APPLICATION FOR THE ISSUE, REVALIDATION AND RENEWAL OF LICENCES, RATINGS, ENDORSEMENTS AND AUTHORISATIONS

Application for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations together with all relevant certificates and/or documents supporting the application might be submitted by secure electronic means. GM1 ATCO.AR.D.001(b) Procedure for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations

DATE OF SUCCESSFUL COMPLETION OF THE TRAINING

The date of successful completion of the training relevant to the rating and/or rating endorsement to be included in the (Student) ATCO Licence should be the date indicated in the certificate of successful completion of the relevant training issued by the training organisation. GM1 ATCO.AR.D.001(c) Procedure for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations

FORMAT FOR LICENCES (APPENDIX I TO ANNEX II)

The competent authority may enter into point (XIII) of the licence format all additional licensing information, such as national licence endorsements or holding a radio telephony (R/T) licence. GM1 ATCO.AR.D.001(d) Procedure for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations

UNIQUE DATE OF VALIDITY FOR ENDORSEMENTS

The procedure for establishing a unique date of validity for several endorsements should be applied when requested by the air traffic services provider or the applicant. GM1 ATCO.AR.D.001(e) Procedure for the issue, revalidation and renewal of licences, ratings, endorsements and authorisations

ADMINISTRATIVE REASONS

For the purpose of issuing a new licence, administrative reasons may be the following but are not limited to: (a) loss; (b) theft; (c) significant damage leading to illegibility. AMC1 ATCO.AR.D.003(a)(1) Change of competent authority

LICENCE VERIFICATION FORM

This form should be filled in and signed by the issuing competent authority of the licence being transferred. ITEM DESCRIPTION 1 State of licence(s) issue Country

2 Title of licence ATCO or Student ATCO

3 Licence issue date

4 Full name LAST NAME 1, LAST NAME 2, etc. (Last and first names) First name 1, First name 2, etc. 5 Date of birth (dd/mm/yyyy) xx/xx/xxxx 6 Address (if indicated on the licence) 7 Contact details: e.g. email: example@example.eu phone number: +(country code) xxxxxxxx

8 Nationality Country 9 Transferring competent authority Country and authority 10 Valid and non-expired unit, instructor and Endorsements Valid until assessor endorsements held (dd/mm/yyyy)

e.g. xx/xx/xxxx EDDK APS/SRA

e.g. xx/xx/xxxx OJTI STDI Assessor

11 Ratings and rating endorsements held Ratings and rating Date of first issue

endorsements (dd/mm/yyyy)

e.g. xx/xx/xxxx ADI ACS RAD PAR

12 Remarks, i.e. licence endorsements relating to Language proficiency endorsements language proficiency level and validity (English,

Language Level Validity

others)

(dd/mm/yyyy)

13 Past or pending enforcement action* Yes  No  (If yes, please provide details on a separate page.)

* Item 13: Specify whether there is an ongoing investigation into the medical certificate and licence, or its suspension or revocation. AMC1 ATCO.AR.D.003(a)(2) Change of competent authority

TRANSFER OF MEDICAL RECORDS

When transferring the summary of an applicant’s relevant medical history and copies of medical records to the receiving competent authority, the transferring competent authority should include at least all the following: (a) copy of: (1) the most recent aero-medical report containing detailed results of aero-medical examinations and assessments that are required for a class 3 medical certificate; (2) the application form, the examination form, and the medical certificate issued; (3) the most recent electrocardiogram (ECG), ophthalmological and ear-nose-throat (ENT), including audiometry, examination reports, as applicable for a class 3 medical certificate; (4) the initial medical examination or the supporting documents for the last medical-file transfer between licensing authorities; where this is not available, alternatively, a copy of the medical report from the last three aero-medical examinations should be transferred; (5) the mental health assessment, as applicable for a class 3 medical certificate; and (6) any other relevant medical documentation; and (b) the ‘Summary of medical history’ form of AMC2 ATCO.AR.D.003(a)(2), filled in and signed or electronically authenticated by the medical assessor. AMC2 ATCO.AR.D.003(a)(2) Change of competent authority

SUMMARY OF MEDICAL HISTORY — FORM FOR THE TRANSFER OF ATCO MEDICAL RECORDS

SUMMARY OF MEDICAL HISTORY — FORM FOR THE TRANSFER OF ATCO MEDICAL RECORDS

MEDICAL CONFIDENTIALITY SHALL BE ENSURED AT ALL TIMES AS PER POINT ATCO.MED.A.015

Item Description

1 State of licence(s) issue Country 2 Title of licence and corresponding serial UN country code ATCO.xxx number of the licence(s) held (or national medical reference number) 3 Full name LAST NAME 1, LAST NAME 2, etc. (Last and first names) First name 1, First name 2, etc. 4 Date of birth (dd/mm/yyyy) dd/mm/yyyy 5 Address 6 Contact details: e.g. (a) email: (a) example@example.eu (b) phone number: (b) +(country code) xxxxxxxxxx 7 Nationality Country 8 Transferring authority Country and authority 9 Date of issue dd/mm/yyyy Date of examination dd/mm/yyyy

Initial medical certificate or the first Type (European Class 3, medical certificate available in the Part ATCO.MED, or competent authority: national)

10 Dates of last three revalidation/renewal examinations (if any)

11 Limitations (if any) 12 Comments on any relevant aspect of the applicant’s medical history or examination (if appropriate, please enclose reports). Enclose as minimum the examinations and investigation results as required by AMC1 ATCO.AR.D.003 Change of competent authority, point (a). 13 Past or pending enforcement action* Yes  No  (If yes, please provide details on a separate page.)

If there is insufficient space on this form for further information, please use an additional page. Certification I, Dr ……………………………, medical assessor of the (competent authority name)………………………., certify that the details given above and on any additional pages included are true and correct. Date Signature Transferring authority and stamp/seal * Item 13: Specify whether there is a current investigation into the medical certificate and licence, or its suspension or revocation. GM1 ATCO.AR.D.005 Revocation and suspension of licences, ratings and endorsements

EXAMINATIONS AND ASSESSMENTS

Examinations and assessments conducted by an assessor, during suspension or after the revocation of his/her assessor endorsement or by an OJTI or an STDI during suspension or after revocation of his/her OJTI or STDI endorsement respectively, should be invalid.

SUBPART E – CERTIFICATION PROCEDURE FOR AIR TRAFFIC CONTROLLER TRAINING ORGANISATIONS

AMC1 ATCO.AR.E.001(a);(b) Certification procedure for training organisations and issue of certificates

VERIFICATION OF COMPLIANCE

(a) The competent authority should verify the applicant’s compliance through an audit of the organisation, including interviews of personnel and inspections carried out at the organisation’s facilities. (b) The competent authority should only conduct such audit after being satisfied that the application for a certificate complies with the applicable requirements. (c) The audit should include but should not be limited to the following areas: (1) detailed management structure, including names and qualifications of personnel required by point ATCO.OR.C.010, adequacy of the organisation and management structure; (2) adequacy of number and qualifications of personnel; (3) safety management and compliance monitoring with applicable requirements; (4) adequacy of the facilities with regard to the organisation’s scope of training; (5) documentation on the basis of which the certificate shall be granted (organisation documentation as required by Annex III (Part ATCO.OR), including manuals, training plans and course documentation). (d) In case of non-compliance, the applicant should be informed in writing of the corrections required. GM1 ATCO.AR.E.001(e) Certification procedure for training organisations and issue of certificates

REMARKS TO THE CERTIFICATE

Remarks in the attachment to the ATCO training organisation certificates may, as appropriate, be related to: (a) sites where the initial training is to be provided, if different from the principal place of the operation; (b) provision of information reasonably required for the verification of the continuous compliance with the applicable requirements; (c) contracts, agreements or other arrangements concluded between the training organisation and a third party, and which concern the training to be provided; (d) any possible (legal) conditions, which are not specific to the training to be provided, etc. AMC1 ATCO.AR.E.010 Changes to the training organisations

GENERAL

(a) The competent authority should be informed of any changes to personnel specified in Annex III (Part ATCO.OR) that may affect the certificate or the training approval attached to it. (b) A simple management system documentation system status sheet should be maintained, which contains information on when an amendment was received by the competent authority and when it was approved. (c) The competent authority should receive from the organisation each management system documentation amendment, including amendments that do not require prior approval by the competent authority. (1) Where the amendment requires the competent authority’s approval, the competent authority, when satisfied, should approve in writing. (2) Where the amendment does not require prior approval, the competent authority should acknowledge receipt of the notification in writing within 10 working days from receipt. AMC1 ATCO.AR.E.010(a) Changes to the training organisations

CHANGES REQUIRING PRIOR APPROVAL

(a) Upon receipt of an application for a proposed change that requires prior approval, the competent authority should, in due time: (1) assess the proposed change in relation to the training organisation’s certificate or the training approval attached or the management system of it, and the applicable requirements of Part ATCO.OR, as well as any other applicable requirements; (2) assess the actions proposed by the training organisation in order to show compliance; and (3) notify the training organisation of its approval/rejection without delay. (b) The competent authority should, in due time, verify the compliance of the training organisation and, depending on the change, examine the need for prescribing any condition for the operation of it during the change. (c) For changes requiring prior approval, the competent authority may conduct an audit of the organisation in order to verify the training organisation’s compliance with the applicable requirements. (d) When notifying the training organisation, the competent authority should also inform the organisation of the right to appeal, as provided for under the applicable national legislation. GM1 ATCO.AR.E.010 Changes to the training organisations

CHANGE OF NAME OF THE TRAINING ORGANISATION

(a) Upon receipt of the application and the relevant parts of the organisation’s documentation as required by Annex III (Part ATCO.OR), the competent authority should reissue the certificate. (b) A name change alone does not require the competent authority to audit the organisation unless there is evidence that other aspects of the organisation have changed. GM1 ATCO.AR.E.010(b) Changes to the training organisations

ADEQUATE ACTION

Adequate action by the competent authority may include suspension, limitation or revocation of the training organisation’s certificate. GM1 ATCO.AR.E.015 Findings and corrective actions

LEVEL 1

For a level 1 finding, it may be necessary for the competent authority to ensure that further training by the organisation is carried out and audited by the competent authority before the activity is resumed, dependent upon the nature of the finding. Only the certifying competent authority may take action on the certificate.

SUBPART F – SPECIFIC REQUIREMENTS RELATING TO AERO- MEDICAL CERTIFICATION

SECTION 2 – DOCUMENTATION AMC1 ATCO.AR.F.005 Medical certificate

STANDARD MEDICAL CERTIFICATE FORMAT

Competent authority’s name and logo Requirements: (English and any language(s) determined by the competent authority) ‘European Union’ to be deleted for non-EU Member EUROPEAN UNION States. (English only) The size of each page should be one eighth A4. Class 3 MEDICAL CERTIFICATE English and any language(s) determined by the Pertaining to a Part ATCO licence competent authority. (English and any language(s) determined by the competent authority) Issued in accordance with Part ATCO.MED This medical certificate complies with the ICAO Standards

(English and any language(s) determined by the competent authority)

I Authority that issued or is to issue the ATCO XIII Limitations: licence: Code: Description: III Certificate number: X Date of issue*: IV Last and first name of holder: XIV Date of birth: (dd/mm/yyyy) Signature of issuing AME/medical assessor: VI Nationality: XI Stamp: VII Signature of holder:

2 3

IX Expiry date of this certificate: dd/mm/yyyy

Examination date: (dd/mm/yyyy)

4 Annex ΙΙΙ to ED Decision 2026/004/R Page 19 of 34

* Date of issue is the date when the certificate is issued and signed. AMC1 ATCO.AR.F.020 Aero-medical forms

AERO-MEDICAL FORMS

The forms referred to in ATCO.AR.F.020 should reflect the information indicated in the following forms and corresponding instructions for completion. APPLICATION FORM FOR A MEDICAL CERTIFICATE

MEDICAL IN CONFIDENCE

Complete this page fully and in block capitals — Refer to instructions for completion.

(1) State of licence issue: (2) Medical certificate applied for: Class 1 ☐ Class 2 ☐ Class 3 ☐ (3) Surname: (4) Previous surname(s): (12) Application: Initial ☐ Revalidation/Renewal ☐ (5) Forename(s): (6) Date of birth (7) Sex: (13) Reference number: (dd/mm/yyyy): Male ☐ Female ☐ (8) Place and country of birth: (9) Nationality: (14) Type of licence applied for: (10) Permanent address: (11) Postal address (if different): (15) Occupation (principal): (16) Employer: Country: Country: (17) Last aero-medical examination: Telephone No: Telephone No: Date: Mobile No: Place: E-mail: (18) Licence(s) held (type): (19) Any limitations on licence(s)/medical certificate held: Licence(s) number(s): No ☐ Yes ☐ Details: (20) Have you ever had a medical (21) Flight time total: (22) Flight time since last aerocertificate denied, suspended or revoked? medical examination: No ☐ Hrs n/a ☐ Hrs n/a ☐ Yes ☐ Date: Country: (23) Aircraft class/type(s) currently flown: n/a ☐ Details: (24) Any aviation accident or reported (25) Type of flying intended: n/a ☐ incident since last aero-medical examination? (26) Current pilot activity: Single pilot ☐ Multi-pilot ☐ No ☐ n/a ☐ Current ATCO activity: ADI ☐ APS ☐ ACS ☐ Yes ☐ Date: Place: Details: (27) Do you drink alcohol? (28) Do you currently use any medication? No ☐ Yes ☐ If yes, amount No ☐ (29) Do you smoke tobacco? Yes ☐ state medication, dose, date started and why: No, never ☐

No, stopped ☐ state date:

Yes ☐ state type and amount:

General and medical history: Do you have, or have you ever had, any of the following? (Please tick). If yes, give details in the remarks section (30).

Yes No Yes No Yes No Family history of: Yes No

112 Nose, 101 Eye 123 Malaria or throat or 170 Heart trouble/eye other tropical speech disease operation disease disorder

113 Head 124 A positive 171 High blood 102 Spectacles injury or HIV test pressure and/or contact concussion

lenses ever 114 Frequent 125 Sexually 172 High worn or severe transmitted cholesterol level headaches disease

115 Dizziness 126 Sleep 103 or fainting disorder/apnoe 173 Epilepsy Spectacle/cont spells a syndrome act lens 127 prescriptions 116 Musculoskeleta change since Unconsciousn 174 Mental l last medical ess for any illness illness/impairm exam. reason ent

104 Hay fever, 117 128 Any other 175 Diabetes other allergy Neurological illness or injury

disorders:

stroke, 105 Asthma, 129 Admission epilepsy, 176 Tuberculosis lung disease to hospital seizure,

paralysis, etc.

106 Heart or 130 Visit to 118 177 Allergy/ vascular medical Psychological asthma/eczema trouble practitioner / psychiatric 107 High or since last aerotrouble of 178 Inherited low blood medical any sort disorders pressure examination

119 108 Kidney Alcohol/drug 131 Refusal of stone or blood 179 Glaucoma / substance life insurance in urine abuse

109 Diabetes, 120 132 Refusal of

hormone Attempted pilot/ATCO

disorder suicide licence

Females only: 110 Stomach, 121 Motion 133 Medical 150 liver or sickness rejection from Gynaecological, intestinal requiring or for military menstrual trouble medication service problems

111 Deafness, 122 134 Award of 151 Are you

ear disorder Anaemia/sick pension or pregnant?

le cell compensation trait/other for injury or blood illness disorders (30) Remarks: If previously reported and no change since, so state.

(31) Declaration: I hereby declare that I have carefully considered the statements made above and to the best of my belief they are complete and correct and that I have not withheld any relevant information or made any misleading statements. I understand that if I have made any false or misleading statements in connection with this application, or fail to release the supporting medical information, the licensing authority may refuse to grant me a medical certificate or may withdraw any medical certificate granted, without prejudice to any other action applicable under national law. CONSENT TO RELEASE OF MEDICAL INFORMATION: I hereby authorise the release of all information contained in this report and any or all attachments to the AME and, where necessary, to the medical assessor of the licensing authority, recognising that these documents or electronically stored data are to be used for completion of a medical assessment and will become and remain the property of the licensing authority, providing that I or my physician may have access to them according to national law. Medical confidentiality will be respected at all times.

------------------------------------ -------------------------------------------- -------------------------------------------- Date Signature of applicant Signature of AME/(medical assessor)

INSTRUCTIONS FOR COMPLETION OF THE APPLICATION FORM FOR A MEDICAL CERTIFICATE This application form and all attached report forms will be transmitted to the licensing authority. Medical confidentiality shall be respected at all times. The applicant should personally complete, in full, all questions (sections) on the application form. Writing should be legible and in block capitals, using a ball-point pen. Completion of this form by typing/printing is also acceptable. If more space is required to answer any questions, a plain sheet of paper should be used, bearing the applicant’s name and signature, and the date of signing. The following numbered instructions apply to the numbered headings on the application form for a medical certificate. Failure to complete the application form in full, or to write legibly, may result in non-acceptance of the application form. The making of false or misleading statements or the withholding of relevant information in respect of this application may result in criminal prosecution, denial of this application and/or withdrawal of any medical certificate(s) granted

1. LICENSING AUTHORITY: 17. LAST APPLICATION FOR A MEDICAL CERTIFICATE:

State name of country this application is to be State date (day, month, year) and place (town, country). forwarded to. Initial applicants state ‘NONE’.

2. MEDICAL CERTIFICATE APPLIED FOR: 18. LICENCE(S) HELD (TYPE):

Tick appropriate box. State type of licence(s) held. Class 1: Professional Pilot Enter licence number and State of issue. Class 2: Private Pilot If no licences are held, state ‘NONE’. Class 3: Air Traffic Controller

3. SURNAME: 19. ANY LIMITATIONS ON THE LICENCE(S)/MEDICAL

State surname/family name. CERTIFICATE: Tick appropriate box and give details of any limitations on your licence(s)/medical certificate, e.g. vision, colour vision, safety pilot, etc.

4. PREVIOUS SURNAME(S): 20. MEDICAL CERTIFICATE DENIAL, SUSPENSION OR

If your surname or family name has changed REVOCATION: for any reason, state previous name(s). Tick ‘YES’ box if you have ever had a medical certificate denied, suspended or revoked, even if only temporary. If ‘YES’, state date (dd/mm/yyyy) and country where it occurred.

5. FORENAME(S): 21. FLIGHT TIME TOTAL:

State first and middle names (maximum State total number of hours flown or, for ATCO’s tick n/a three). box.

6. DATE OF BIRTH: 22. FLIGHT TIME SINCE LAST MEDICAL:

Specify in order dd/mm/yyyy. State number of hours flown since your last aero-medical examination or, for ATCO’s tick n/a box.

7. SEX: 23. AIRCRAFT CLASS/TYPE(S) CURRENTLY FLOWN:

Tick appropriate box. State name of principal aircraft flown, e.g. Boeing 737, Cessna 150, etc. or, for ATCO’s tick n/a box.

8. PLACE AND COUNTRY OF BIRTH: 24. ANY AVIATION ACCIDENT OR REPORTED INCIDENT

State town and country of birth. SINCE LAST AERO-MEDICAL EXAMINATION: If ‘YES’ box ticked, state date (dd/mm/yyyy) and country of accident/incident.

9. NATIONALITY: 25. TYPE OF FLYING INTENDED:

State name of country of citizenship. State whether airline, charter, single pilot, commercial air transport, carrying passengers, agriculture, pleasure, etc., or, for ATCO’s tick n/a box.

10. PERMANENT ADDRESS: 26. CURRENT PILOT/ATCO ACTIVITY:

State permanent postal address and country. Tick appropriate box to indicate whether you fly as the Enter telephone area code as well as SOLE pilot or not or, for ATCO’s whether you operate as telephone number. tower, radar or other.

11. POSTAL ADDRESS (IF DIFFERENT): 27. DO YOU DRINK ALCOHOL?

If different from permanent address, state full Tick applicable box. If yes, state weekly alcohol current postal address including telephone consumption, number and area code. If the same, enter e.g. 2 litres beer. ‘SAME’.

12. APPLICATION: 28. DO YOU CURRENTLY USE ANY MEDICATION?

Tick appropriate box. If ‘YES’, give full details — name, how much you take and when, etc. Include any non-prescription medication.

13. REFERENCE NUMBER: 29. DO YOU SMOKE TOBACCO?

State reference number allocated to you by Tick applicable box. Current smokers state type (cigarettes, the licensing authority. cigars, pipe) and amount (e.g. 2 cigars daily; pipe — 1 oz. Initial applicants enter ‘NONE’. weekly).

14. TYPE OF LICENCE APPLIED FOR: GENERAL AND MEDICAL HISTORY

State type of licence applied for from the All items under this heading from number 101 to 179 following list: inclusive should have the answer ‘YES’ or ‘NO’ ticked. You — Aeroplane Transport Pilot Licence should tick ‘YES’ if you have ever had the condition in your — Multi-Pilot Licence life and describe the condition and approximate date in the — Commercial Pilot Licence/Instrument (30) remarks section. All questions asked are medically Rating important even though this may not be readily apparent. — Commercial Pilot Licence Items numbered 170 to 179 relate to immediate family — Air Traffic Controller Licence history, whereas items numbered 150 to 151 should be — Private Pilot Licence/Instrument Rating answered by female applicants only. — Private Pilot Licence If information has been reported on a previous application — Sailplane Pilot Licence form for a medical certificate and there has been no change — Balloon Pilot Licence in your condition, you may state ‘Previously reported; no

— and whether Fixed Wing/Rotary change since’. However, you should still tick ‘YES’ to the Wing/Both condition. Do not report occasional common illnesses such as colds.

31. DECLARATION AND CONSENT TO OBTAINING AND 15. OCCUPATION (PRINCIPAL): RELEASING INFORMATION:

Indicate your principal employment. Do not sign or date these declarations until indicated to do

16. EMPLOYER: so by the AME who will act as witness and sign accordingly. If principal occupation is pilot/ATCO, then state employer’s name or if self-employed as a pilot, state ‘self’.

AERO-MEDICAL EXAMINATION REPORT FORM FOR CLASS 1, CLASS 2 & CLASS 3 APPLICANTS

(201) Examination category (202) (203) (204) (205) (206) Blood (207) Pulse — Initial ☐ Height Weight Colour Colour pressure — seated resting Revalidation ☐ Renewal ☐ (cm) (kg) eye hair (mmHg) Rate Rhythm: (bpm) regular ☐ Referral ☐ Systolic Diastolic irregular ☐

Clinical exam: Check each item

Normal Abnormal Normal Abnormal (208) Head, face, neck, scalp (218) Abdomen, hernia, liver, spleen (209) Mouth, throat, teeth, (219) Anus, rectum voice, speech (210) Nose, sinuses (220) Genito-urinary system (211) Ears, drums, eardrum (221) Endocrine system motility (212) Eyes — orbit & (222) Upper & lower limbs, adnexa; visual fields joints (213) Eyes — pupils and (223) Spine, other optic fundi musculoskeletal (214) Eyes — ocular (224) Neurologic — reflexes, motility; nystagmus etc. (215) Lungs, chest, breasts (225) Psychiatric (216) Heart (226) Skin, identifying marks and lymphatics (217) Vascular system (227) General systemic (228) Notes: Describe every abnormal finding. Enter applicable item number before each comment.

Visual acuity (229) Distant vision (236) Pulmonary function (237) Haemoglobin

vision

Yes No Yes No Right eye Accompanying reports Left eye Not Abnormal/ Normal performed Comment Both eyes (238) ECG (239) Audiogram (231) Near (240) Uncorrected Corrected vision Ophthalmology Yes No Yes No (241) ORL (ENT) Right eye (242) Blood lipids Left eye (243) Pulmonary function Both eyes (244) Other (232) Spectacles (233) Contact lenses (what?) Yes ☐ No ☐ Yes ☐ No ☐ Type: Type: (247) AME recommendation: Name of applicant: Date of birth: Reference number: Refraction Sph Cyl Axis Add Right eye -------------------------- ----------------- --------------------------- Left eye ☐ Fit for class: -------------------- (313) Colour vision Normal ☐ ☐ Medical certificate issued by undersigned (copy Abnormal ☐ attached) for class: ------------------------------- Colour vision testing ☐ Unfit for class: -------------------method/s: Results: ☐ Deferred for further evaluation. If yes, why and to whom? (234) Hearing (248) Comments, limitations (when 239/241 not performed) Right ear Left ear Conversational voice test Yes ☐ Yes ☐ (2m) with back turned to No ☐ No ☐ examiner Audiometry Hz 500 1000 2000 3000 Right Left

(249) AME declaration:

I hereby certify that I/my AME group have personally examined the applicant named on this aero-medical examination report and that this report with any attachment embodies my findings completely and correctly. (250) Place and date: AME name and address: AME certificate No: AME signature: E-mail: Telephone No: Telefax No:

INSTRUCTIONS FOR COMPLETION OF THE AERO-MEDICAL EXAMINATION REPORT FORMS

The AME performing the aero-medical examination should verify the identity of the applicant. All questions (sections) on the aero-medical examination report form should be completed in full. If an otorhinolaryngology examination report form is attached, then questions 209, 210, 211, and 234 may be omitted. If an ophthalmology examination report form is attached, then questions 212, 213, 214, 229, 230, 231, 232, and 233 may be omitted. Writing should be legible and in block capitals using a ball-point pen. Completion of this form by typing/printing is also acceptable. If more space is required to answer any question, a plain sheet of paper should be used, bearing the applicant’s name, the AME’s name and signature, and the date of signing. The following numbered instructions apply to the numbered headings on the aero-medical examination report form. Failure to complete the aero-medical examination report form in full, as required, or to write legibly, may result in non-acceptance of the application in total and may lead to withdrawal of any medical certificate issued. The making of false or misleading statements or the withholding of relevant information by an AME may result in criminal prosecution, denial of an application or withdrawal of any medical certificate(s) granted.

201 EXAMINATION CATEGORY — Tick appropriate box. Initial — Initial examination for either class 1, 2 or 3; also initial examination for upgrading from class 2 to 1 (notate ‘upgrading’ in box 248). Renewal/Revalidation —Subsequent ROUTINE examinations. 202 HEIGHT — Measure height, without shoes, in centimetres to nearest cm. 203 WEIGHT — Measure weight, in indoor clothes, in kilograms to nearest kg. 204 COLOUR EYE — State colour of applicant’s eyes from the following list: brown, blue, green, hazel, grey, multi. 205 COLOUR HAIR — State colour of applicant’s hair from the following list: brown, black, red, fair, bald. 206 BLOOD PRESSURE — Blood pressure readings should be recorded as Phase 1 for systolic pressure and Phase 5 for diastolic pressure. The applicant should be seated and rested. Recordings in mm Hg. 207 PULSE (RESTING) — The pulse rate should be recorded in beats per minute and the rhythm should be recorded as regular or irregular. Further comments if necessary may be written in section 228, 248 or separately. 208 to 227 inclusive constitute the general clinical examination, and each of the boxes should be marked (with a tick) as normal or abnormal. 208 HEAD, FACE, NECK, SCALP — To include appearance, range of neck and facial movements, symmetry, etc. 209 MOUTH, THROAT, TEETH, VOICE, SPEECH — To include voice and speech quality and appearance of buccal cavity, palate motility, tonsillar area, pharynx and also gums, teeth and tongue. 210 NOSE, SINUSES — To include appearance and any evidence of nasal obstruction or sinus tenderness on palpation.

211 EARS, DRUMS, EARDRUM MOTILITY — To include otoscopy of external ear, canal, tympanic membrane. Eardrum motility by valsalva manoeuvre or by pneumatic otoscopy. 212 EYES — ORBIT AND ADNEXA; VISUAL FIELDS — To include appearance, position and movement of eyes and their surrounding structures in general, including eyelids and conjunctiva. Visual fields check by campimetry, perimetry or confrontation. 213 EYES — PUPILS AND OPTIC FUNDI — To include appearance, size, reflexes, red reflex and fundoscopy. Special note of corneal scars. 214 EYES — OCULAR MOTILITY, NYSTAGMUS — To include range of movement of eyes in all directions; symmetry of movement of both eyes; ocular muscle balance; convergence; accommodation; signs of nystagmus. 215 LUNGS, CHEST, BREASTS — To include inspection of chest for deformities, operation scars, abnormality of respiratory movement, auscultation of breath sounds. Physical examination of female applicant’s breasts should only be performed with informed consent. 216 HEART — To include apical heartbeat, position, auscultation for murmurs, carotid bruits, palpation for trills. 217 VASCULAR SYSTEM — To include examination for varicose veins, character and feel of pulse, peripheral pulses, evidence of peripheral circulatory disease. 218 ABDOMEN, HERNIA, LIVER, SPLEEN — To include inspection of abdomen; palpation of internal organs; check for inquinal hernias in particular. 219 ANUS, RECTUM — Examination only with informed consent. 220 GENITO-URINARY SYSTEM — To include renal palpation; inspection palpation male/female reproductive organs only with informed consent. 221 ENDOCRINE SYSTEM — To include inspection, palpation for evidence of hormonal abnormalities/imbalance; thyroid gland. 222 UPPER AND LOWER LIMBS, JOINTS — To include full range of movements of joints and limbs, any deformities, weakness or loss. Evidence of arthritis. 223 SPINE, OTHER MUSCULOSKELETAL — To include range of movements, abnormalities of joints. 224 NEUROLOGIC — REFLEXES, ETC. To include reflexes, sensation, power, vestibular system — balance, romberg test, etc. 225 PSYCHIATRIC — To include appearance, appropriate mood/thought, unusual behaviour. 226 SKIN, IDENTIFYING MARKS AND LYMPHATICS — To include inspection of skin; inspection, palpation for lymphadenopathy, etc. Briefly describe scars, tattoos, birthmarks, etc., which could be used for identification purposes. 227 GENERAL SYSTEMIC — All other areas, systems and nutritional status. 228 NOTES — Any notes, comments or abnormalities to be described — extra notes if required on separate sheet of paper, signed and dated. 229 DISTANT VISION — Each eye to be examined separately and then both together. First without correction, then with spectacles (if used) and lastly with contact lenses, if used. Record visual acuity in appropriate boxes. Visual acuity to be tested with the appropriate chart for the distance. 230 INTERMEDIATE VISION — Each eye to be examined separately and then both together. First without correction, then with spectacles, if used, and lastly with contact lenses, if used. Record visual acuity in appropriate boxes (Yes/No). 231 NEAR VISION — Each eye to be examined separately and then both together. First without correction, then with spectacles if used and lastly with contact lenses, if used. Record visual acuity in appropriate boxes (Yes/No).

Note: Bifocal contact lenses and contact lenses correcting for near vision only are not acceptable. 232 SPECTACLES — Tick appropriate box signifying if spectacles are or are not worn by applicant. If used, state type of lens and frame and use-distance. 233 CONTACT LENSES — Tick appropriate box signifying if contact lenses are or are not worn. If worn, state type from the following list; hard, soft, gas-permeable or disposable. 313 COLOUR VISION — Tick appropriate box signifying if applicant is a normal trichromat or not. Indicate the colour vision testing methodology used and provide the results. 234 HEARING — Tick appropriate box to indicate hearing level ability as tested separately in each ear at 2 m. 235 URINALYSIS — State whether result of urinalysis is normal or not by ticking appropriate box. If no abnormal constituents, state NIL in each appropriate box. 236 PULMONARY FUNCTION — When required or on indication, state actual FEV1/FVC value obtained in % and state if normal or not with reference to height, age, sex and race. 237 HAEMOGLOBIN — Enter actual haemoglobin test result and state units used. Then state whether normal value or not, by ticking appropriate box. 238 to 244 inclusive: ACCOMPANYING REPORTS — One box opposite each of these sections must be ticked. If the test is not required and has not been performed, then tick the NOT PERFORMED box. If the test has been performed (whether required or on indication) complete the normal or abnormal box as appropriate. In the case of question 244, the number of other accompanying reports must be stated. 247 AME RECOMMENDATION — The applicant’s name, date of birth and reference number, should be entered here in block capitals. The applicable class of medical certificate should be indicated by a tick in the appropriate box. If a fit assessment is recommended and a medical certificate has been issued, this should be indicated in the appropriate box. An applicant may be recommended as fit for a lower class of medical certificate (e.g. class 2), but also be deferred or recommended as unfit for a higher class of medical certificate (e.g. class 1). If an unfit recommendation is made, applicable Part MED/Part ATCO.MED paragraph references should be entered. If an applicant is deferred for further evaluation, the reason and the specialist or licensing authority to whom the applicant is referred should be indicated. 248 COMMENTS, LIMITATIONS, ETC. — The AME’s findings and assessment of any abnormality in the history or examination, should be entered here. The AME should also state any limitation required. 249 AME DETAILS — The AME should sign the declaration, complete his/her name and address in block capitals, contact details and lastly stamp the relevant section with his/her designated AME stamp incorporating his/her AME number. 250 PLACE AND DATE — The place (town or city) and the date of the aero-medical examination should be entered here. The date of examination is the date of the general examination and not the date of finalisation of the form. If the aero-medical examination report is finalised on a different date, the date of finalisation should be entered in section 248 as ‘Report finalised on ...’.

OPHTHALMOLOGY EXAMINATION REPORT FORM Complete this page fully and in block capitals — Refer to instructions for completion.

MEDICAL IN CONFIDENCE Applicant’s details (1) Licensing authority: (2) Medical certificate applied for: Class 1 ☐ Class 2 ☐ Class 3 ☐ (3) Surname: (4) Previous surname(s): (12) Application: Initial ☐ Revalidation/Renewal ☐ (5) Forename(s): (6) Date of birth: (7) Sex: (13) Reference number: Male ☐ Female ☐ (301) Consent to release of medical information: I hereby authorise the release of all information contained in this report and any or all attachments to the AME and, where necessary, to the medical assessor of the licensing authority, recognising that these documents or electronically stored data, are to be used for completion of a medical assessment and will become and remain the property of the licensing authority, providing that I or my physician may have access to them according to national law. Medical confidentiality will be respected at all times.

--------------------------------------- -------------------------------------------------- ------------------------------------------ --------- Date Signature of applicant Signature of AME

(302) Examination category: (303) Ophthalmological history: Initial ☐ Revalidation ☐ Renewal ☐ Referral ☐

Clinical examination Visual acuity

Check each item Normal Abnormal (314) Distant vision

(304) Eyes, external & eyelids Uncorrected Spectacles Contact lenses Right eye Corrected to (305) Eyes, Exterior Left eye Corrected (slit lamp, ophth.) to Both eyes Corrected to (306) Eye position and motility (315) Intermediate vision Spectacles Contact lenses Uncorrected (307) Visual fields Right eye Corrected to (308) Pupillary reflexes Left eye Corrected to (309) Fundi (Ophthalmoscopy) Both eyes Corrected to

(310) Convergence cm (316) Near vision Spectacles Contact lenses Uncorrected (311) Accommodation D Right eye Corrected to Left eye Corrected to Both eyes Corrected to (312) Ocular muscle balance (in prisme dioptres) Ortho Ortho (317) Sph Cylinder Axis Near Refraction (add) Eso Eso Right eye Exo Exo Left eye Hyper Hyper Actual refraction examined Spectacles prescription based Cyclo Cyclo Tropia Yes No Phoria Yes No (318) Spectacles (319) Contact lenses Fusional reserve testing Yes ☐ No ☐ Yes ☐No ☐ Not performed Normal Abnormal (313) Colour vision Type: Type: Colour vision testing method/s: Results: (320) Intra-ocular pressure Normal trichromat Yes ☐ No ☐ Right (mmHg) Left (mmHg)

Method Normal ☐ Abnormal ☐

(321) Ophthalmological remarks and recommendation: (322) Examiner’s declaration:

I hereby certify that I/my AME group have personally examined the applicant named on this medical examination report and that this report with any attachment embodies my findings completely and correctly. (323) Place and date: Ophth. examiner’s name and address: AME or specialist stamp AME or specialist signature: (block capitals) with No:

E-mail: Telephone No: Telefax No:

INSTRUCTIONS FOR COMPLETION OF THE OPHTHALMOLOGY EXAMINATION REPORT FORM

Writing should be legible and in block capitals using a ball-point pen. Completion of this form by typing or printing is also acceptable. If more space is required to answer any question, a plain sheet of paper should be used, bearing the applicant’s name, the name and signature of the AME or ophthalmology specialist performing

the examination and the date of signing. The following numbered instructions apply to the numbered headings on the ophthalmology examination report form. Failure to complete the medical examination report form in full, as required, or to write legibly may result in non-acceptance of the application in total and may lead to withdrawal of any medical certificate issued. The making of false or misleading statements or the withholding of relevant information by an examiner may result in criminal prosecution, denial of an application or withdrawal of any medical certificate granted. The AME or ophthalmology specialist performing the examination should verify the identity of the applicant. The applicant should then be requested to complete the sections 1, 2, 3, 4, 5, 6, 7, 12 and 13 on the form and then sign and date the consent to release of medical information (section 301) with the examiner countersigning as witness. 302 EXAMINATION CATEGORY — Tick appropriate box. Initial — Initial examination for either class 1 or 2 or 3; also initial examination for upgrading from class 2 to 1 (notate ‘upgrading’ in section 303). Renewal/Revalidation — Subsequent comprehensive ophthalmological examinations (due to refractive error). Special referral — NON-ROUTINE examination for assessment of an ophthalmological symptom or finding. 303 OPHTHALMOLOGICAL HISTORY — Detail here any history of note or reasons for special referral. 304 to 309 inclusive: CLINICAL EXAMINATION — These sections together cover the general clinical examination and each of the sections should be marked (with a tick) as normal or abnormal. Any abnormal findings or comments on findings should be entered in section 321. 310 CONVERGENCE — Enter near point of convergence in cm, as measured using RAF near point rule or equivalent. Tick whether normal or abnormal. Any abnormal findings or comments on findings should be entered in section 321. 311 ACCOMMODATION — Enter measurement recorded in dioptres using RAF near point rule or equivalent. Tick whether normal or abnormal. Any abnormal findings or comments on findings should be entered in section 321. 312 OCULAR MUSCLE BALANCE — Ocular muscle balance is tested at distant 5 or 6 m and near at 30–50 cm and results recorded. Presence of tropia or phoria must be entered accordingly and also whether fusional reserve testing was NOT performed and if performed whether normal or not. 313 COLOUR VISION —Tick appropriate box signifying if applicant is a normal trichromat or not. Indicate the colour vision testing methodology used and provide results. 314–316 VISUAL ACUITY TESTING AT 5 m/6m, 1m and 30–50cm — Record actual visual acuity obtained in appropriate boxes. If correction not worn nor required, put line through corrected vision boxes. Distant visual acuity to be tested at either 5 m or 6 m with the appropriate chart for that distance. 317 REFRACTION — Record results of refraction. Indicate also whether for class 2 applicants, refraction details are based upon spectacle prescription. 318 SPECTACLES — Tick appropriate box signifying if spectacles are or are not worn by applicant. If used, state whether unifocal, bifocal, varifocal or look-over. 319 CONTACT LENSES — Tick appropriate box signifying if contact lenses are or are not worn. If worn, state type from the following list; hard, soft, gas-permeable, disposable. 320 INTRA-OCULAR PRESSURE — Enter intra-ocular pressure recorded for right and left eyes and indicate whether normal or not. Also indicate method used —applanation, air, etc. 321 OPHTHALMOLOGICAL REMARKS AND RECOMMENDATION — Enter here all remarks, abnormal findings and assessment results. Also enter any limitations recommended. If there is any doubt about findings or

recommendations, the examiner may contact the medical assessor for advice before finalising the report form. 322 OPHTHALMOLOGY EXAMINER’S DETAILS — The ophthalmology examiner must sign the declaration, complete his/her name and address in block capitals, contact details and lastly stamp the report with his/her designated stamp incorporating his/her AME or specialist number. 323 PLACE AND DATE — Enter the place (town or city) and the date of examination. The date of examination is the date of the clinical examination and not the date of finalisation of form. If the ophthalmology examination report is finalised on a different date, enter date of finalisation on section 321 as ‘Report finalised on...’.

OTORHINOLARYNGOLOGY EXAMINATION REPORT FORM Complete this page fully and in block capitals — Refer to instructions for completion.

MEDICAL IN CONFIDENCE Applicant’s details (1) Licensing authority: (2) Medical certificate applied for: class 1 ☐ class 2 ☐ class 3 ☐ (3) Surname: (4) Previous surname(s): (12) Application: Initial ☐ Revalidation/Renewal ☐ (5) Forename(s): (6) Date of birth: (7) Sex: (13) Reference number: Male ☐ Female ☐ (401) Consent to release of medical information: I hereby authorise the release of all information contained in this report and any or all attachments to the AME and, where necessary, to the medical assessor of the licensing authority, recognising that these documents, or any electronically stored data, are to be used for completion of a medical assessment and will become and remain the property of the licensing authority, providing that I or my physician may have access to them according to national law. Medical confidentiality will be respected at all times.

------------------------------------ ----------------------------------------------------- -------------------------------------------------- Date Signature of applicant Signature of AME

(402) Examination category: (403) Otorhinolaryngological history:

Initial ☐ Revalidation/renewal ☐ Referral ☐

Clinical examination

Check each item Normal Abnormal (419) Pure tone audiometry (404) Head, face, neck, scalp dB HL (hearing level) (405) Buccal cavity, teeth Hz Right ear Left ear (406) Pharynx 250 (407) Nasal passages and naso-pharynx 500 (incl. anterior rhinoscopy) 1000 (408) Vestibular system incl. Romberg test 2000 (409) Speech/voice 3000 (410) Sinuses 4000

(411) Ext. acoustic meati, tympanic 6000 membranes (412) Pneumatic otoscopy 8000 (413) Impedance tympanometry including Valsalva manoeuvre (initial only) (420) Audiogram o = Right – – – = Air

E-mail: Telephone No: Telefax No:

INSTRUCTIONS FOR COMPLETION OF THE OTORHINOLARYNGOLOGY EXAMINATION REPORT FORM

Writing should be legible and in block capitals using a ball-point pen. Completion of this form by typing or printing is also acceptable. If more space is required to answer any question, a plain sheet of paper should be used, bearing the applicant’s name, the name and signature of the AME or otorhinolaryngology specialist performing the examination and the date of signing. The following numbered instructions apply to the numbered headings on the otorhinolaryngology examination report form. Failure to complete the medical examination report form in full, as required, or to write legibly may result in non-acceptance of the application in total and may lead to withdrawal of any medical certificate issued. The making of false or misleading statements or the withholding of relevant information by an examiner may result in criminal prosecution, denial of an application or withdrawal of any medical certificate granted. The AME or otorhinolaryngology specialist performing the examination should verify the identity of the applicant. The applicant should then be requested to complete the sections 1, 2, 3, 4, 5, 6, 7, 12 and 13 on the form and then sign and date the consent to release of medical information (section 401) with the examiner countersigning as witness. 402 EXAMINATION CATEGORY — Tick appropriate box.

Initial — Initial examination for class 1 or class 3; also initial examination for upgrading from class 2 to 1 or 3 (notate ‘upgrading’ in section 403). Referral — NON-ROUTINE examination for assessment of an ORL symptom or finding. 403 OTORHINOLARYNGOLOGICAL HISTORY — Detail here any history of note or reasons for referral. 404–413 inclusive: CLINICAL EXAMINATION — These sections together cover the general clinical examination and each of the sections should be marked (with a tick) as normal or abnormal. Any abnormal findings or comments on findings should be entered in section 421. 414–418 inclusive: ADDITIONAL TESTING — These tests are only required to be performed if indicated by history or clinical findings and are not routinely required. For each test one of the boxes must be completed — if the test is not performed then tick that box — if the test has been performed then tick the appropriate box for a normal or abnormal result. All remarks and abnormal findings should be entered in section 421. 419 PURE TONE AUDIOMETRY — Complete figures for dB HL (hearing level) in each ear at all listed frequencies. 420 AUDIOGRAM — Complete audiogram from figures as listed in section 419. 421 OTORHINOLARYNGOLOGY REMARKS AND RECOMMENDATION — Enter here all remarks, abnormal findings and assessment results. Also enter any limitations recommended. If there is any doubt about findings or recommendations the examiner may contact the medical assessor for advice before finalising the report form. 422 OTORHINOLARYNGOLOGY EXAMINER’S DETAILS — The otorhinolaryngology examiner must sign the declaration, complete his/her name and address in block capitals, contact details and lastly stamp the report with his/her designated stamp incorporating his/her AME or specialist number. 423 PLACE AND DATE — Enter the place (town or city) and the date of examination. The date of examination is the date of the clinical examination and not the date of finalisation of form. If the ORL examination report is finalised on a different date, enter date of finalisation in section 421 as ‘Report finalised on...’.

APPENDICES TO ANNEX II

GM1 APPENDIX 1 TO ANNEX II — Format for licence ((a)2(XII))

SIGNATURE/STAMP IN ITEM XIIa

The signature/stamp of the authority or the licence number and signature of the assessor are required in item XIIa of the licence when entries are made after the date the licence has been signed and sealed or stamped in items X and XI. Other case(s) where the signature/stamp of the authority or the licence number and signature of the assessor is to be included in item XIIa may be detailed in the procedure referred to in point ATCO.AR.D.001(a)(2).