Pilot Fitness Self-Assessment Checklist Form
Complete this checklist to evaluate your fitness and readiness to fly. Please answer all questions honestly for your own safety.
How many hours of uninterrupted sleep did you get in the last 24 hours?
*
Less than 5 hours
5-6 hours
6-7 hours
7-8 hours
More than 8 hours
How alert and well-rested do you feel right now?
*
Very tired
1
2
3
4
Fully alert
5
1 is Very tired, 5 is Fully alert
Are you currently experiencing any of the following symptoms?
*
Headache
Nausea or vomiting
Dizziness
Fever or chills
None of the above
Have you taken any medication (prescription or over-the-counter) in the last 24 hours?
*
Yes
No
Have you consumed alcohol in the past 8 hours?
*
Yes
No
How would you rate your current stress level?
*
No stress
1
2
3
4
Extremely stressed
5
1 is No stress, 5 is Extremely stressed
Have you experienced any significant emotional events (e.g., loss, argument, crisis) in the last 48 hours?
*
Yes
No
When was your last meal?
*
Less than 2 hours ago
2-4 hours ago
More than 4 hours ago
Please rate your current hydration level.
*
Very dehydrated
1
2
3
4
Well hydrated
5
1 is Very dehydrated, 5 is Well hydrated
Self-Assessment Table: Please indicate if you are fit in each category below.
*
Rows
Yes
No
Physical health
1
2
Mental alertness
3
4
Emotional stability
5
6
No recent illness
7
8
No recent injury
9
10
Submit Assessment
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