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All of the medical flight test items should be observed and assessed by the flight examiner, but additional
tests may be added as deemed necessary at the time of the testing. A medical flight test should be
conducted when assessing borderline cases described below. The descriptions apply mainly to general
aviation pilots but the same principles are relevant to professional pilot operations.
Deformity or absence of extremities
An applicant might be assessed as fit if able to demonstrate:
a) Ability to reach readily and operate effectively all controls that would normally require use of the
deficient extremity (or extremities), noting any unusual body position required to compensate for
the defect.
b) Ability to perform satisfactorily emergency procedures in flight, such as recovery from stalls and
power-off control, as well as on the ground, including evacuation of the aircraft.
ICAO Preliminary Unedited Version — October 2008 I-3-14
Defective hearing
Defects in hearing would not normally necessitate tests under actual flight conditions since all pertinent
factors may be readily simulated. Whether conducted on the ground or in flight conditions, the main
considerations to be assessed in such cases are:
a) Ability to hear radio voice and signal communications.
b) Ability to understand ordinary conversational voice on the ground, in the cockpit with engine on
and engine off. (The examiner should guard against the applicant lip-reading.)
Speech defects – stammering, stuttering
An applicant might be assessed as fit, if able to demonstrate ability to converse and be clearly understood
in direct conversation and over the radio.
Visual deficiencies
The following circumstances represent some of the typical conditions defining the visual abilities required
of a general aviation pilot. Possession of these abilities by an applicant or the applicant’s inability to meet
the required level of proficiency may be established by simulation or, more realistically, in actual flight
conditions. In either case, the ability of an applicant to perform specified tasks is a practical requirement
which is not easily established by a conventional test. Suggested testing procedures may determine the
following:
a) Ability to select emergency landing fields from a distance, preferably over unfamiliar terrain and
from high altitude.
b) Ability to undertake simulated forced landings in difficult fields. Note the manner of approach,
rate of descent, and comparative distance at which obstructions (stumps, boulders, ditches) are
recognized.
c) Ability to recognize other aircraft approaching on a collision course (possibly by pre-arrangement),
especially aircraft approaching from the far right or far left.
d) Ability to judge distances (compared with the examiner’s judgement), such as distance from other
aircraft and from the ground, and to recognize landmarks at the limit of the examiner’s vision.
e) Manner in which landings are made, including crosswind landings.
f) Ability to read aeronautical maps in flight and to tune the radio on a predetermined station
accurately and quickly.
g) Ability to read instrument panels quickly and correctly (including overhead panel, if any).
Additional colour perception tests
An applicant failing to obtain a satisfactory score when tested with pseudo-isochromatic plates may
nevertheless be assessed as fit, as specified in Annex 1, 6.2.4.4, provided the applicant is able to readily
distinguish the colours used in air navigation and correctly identify aviation coloured lights. This can be
tested, usually for aviation red, green and white light, by means of a colour perception lantern recognized
by the Licensing Authority. Failure of the applicant to name each colour correctly within the time during
ICAO Preliminary Unedited Version — October 2008 I-3-15
which the light is being shown (usually about four seconds) shall indicate failure of the test. Several such
lanterns are in use in States.
Additional diagnostic testing may be carried out by anomaloscopy.
Medical flight test reports
All results of special medical flight tests should be reported to the Licensing Authority. The report should
include information about:
a) deficiency, test and recommendations;
b) any additional procedures deemed necessary by the examiner;
c) any physical attributes of the examiner relevant to comparison of the examiner’s abilities with those
of the applicant;
d) marginal or simulated marginal conditions for the test;
e) the applicant’s susceptibility to distraction caused by simultaneous tasks; and
f) any recommended operating limitations for the licence concerned or, alternatively, the fact
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Manual of Civil Aviation Medicine 1(26)
