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specific requirements of medical fitness.
Medical assessor. A physician, appointed by the Licensing Authority, qualified and experienced
in the practice of aviation medicine and competent in evaluating and assessing conditions of flight
safety significance.
Note 1.- Medical assessors evaluate medical reports submitted to the Licensing Authority by
medical examiners.
Note 2.- Medical assessors are expected to maintain the currency of their professional
knowledge.
Medical examiner. A physician with training in aviation medicine and practical knowledge and
experience of the aviation environment, who is designated by the Licensing Authority to conduct
medical examinations of fitness of applicants for licences or ratings for which medical
requirements are prescribed.
Pilot-in-command. The pilot responsible for the operation and safety of the aircraft during flight
time.
Problematic use of substances. The use of one or more psychoactive substances by aviation
personnel in a way that:
a) constitutes a direct hazard to the user or endangers the lives, health or welfare of others; and/or
b) causes or worsens an occupational, social, mental or physical problem or disorder.
Psychoactive substances. Alcohol, opioids, cannabinoids, sedatives and hypnotics, cocaine, other
psychostimulants, hallucinogens, and volatile solvents, whereas coffee and tobacco are excluded.
Rated air traffic controller. An air traffic controller holding a licence and valid ratings
appropriate to the privileges exercised by him.
Rating. An authorization entered on or associated with a licence and forming part thereof, stating
special conditions, privileges or limitations pertaining to such licence.
Rest period. Any period of time on the ground during which a flight crew member is relieved of
all duties by the operator.
Safety management system. A systematic approach to managing safety, including the necessary
organizational structures, accountabilities, policies and procedures
Safety-sensitive personnel. Persons who might endanger aviation safety if they perform their
duties and functions improperly. This definition includes, but is not limited to, flight crew, cabin
crew, aircraft maintenance personnel and air traffic controllers.
Significant. In the context of the medical provisions in Chapter 6, significant means to a degree
or of a nature that is likely to jeopardize flight safety.
State safety programme. An integrated set of regulations and activities aimed at improving
safety
————————
ICAO Preliminary Unedited Version — October 2008 I-3-1
ICAO Preliminary Unedited Version — October 2008
Chapter 2. MEDICAL REQUIREMENTS
Page
INTRODUCTION ........................................................................................... I-2-1
GENERAL MEDICAL REQUIREMENTS ................................................. I-2-2
Content of Medical Examinations
Mental health and behavioural questions for use by medical examiners
Further reading concerning questions for use by medical examiners
FLEXIBILITY IN THE APPLICATION OF
ANNEX 1 MEDICAL REQUIREMENTS .................................................... I-2-4
The exercise of flexibility .......................................................................... I-2-4
Medical deficiency compensation and flight safety ................................ I-2-5
Society and the individual ........................................................................ I-2-5
The terms “waiver” and “flexibility” ...................................................... I-2-5
The Licensing Authority and accredited medical conclusion ............... I-2-6
Licence limitations .................................................................................... I-2-8
SAMPLE PROCEDURES FOR EVALUATION OF
BORDERLINE CERTIFICATION CASES ................................................. I-2-9
Sample medical flight tests ....................................................................... I-2-9
Deformity or absence of extremities .................................................... I-2-9
Defective hearing ................................................................................. I-2-10
Speech defects – stammering, stuttering .............................................. I-2-10
Visual deficiencies ............................................................................... I-2-10
Additional colour perception tests ........................................................ I-2-10
Medical flight test reports ........................................................................ I-2-11
Attachment A. Chapter 6 of Annex 1 (Tenth edition - 2006) .......................... I-2A-1
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Manual of Civil Aviation Medicine 1(15)
