Federal Public Service Mobility and Transport

Belgian Civil Aviation Authority

Operations Directorate

LOW VISIBILITY OPERATIONS (LVO) APPLICATION FORM (one per a/c)1

This application form shall be in possession of the Belgian CAA at least 28 days before the intended date of
beginning of the planned operations2.

I. Operator

Operator official name :

Address (registered office) :
Post code and Town :
Telephone number :
Responsible manager :
E-mail address :
Type(s) of operation : (mark the used type(s) of operation in the tick boxes below)

☐ CAT ☐ NCC ☐ NCO ☐ SPO

Give types of specialised operations (SPO), if applicable :

II. Aircraft

Aircraft Registration :
Aircraft Type :
Aircraft Mark/Series :
Manufacturers Serial/Construction N° :
Aircraft Category (A, B, C, D) :
Expiry Date of requested LVO
Approval (if applicable or required) :
Remarks :

III. LVO Application

LVO Yes No RVR (m) DH (feet)
Take-off (LVTO) ☐ ☐ N/A
LTS CAT I ☐ ☐
CAT II ☐ ☐
Approach
OTS CAT II ☐ ☐
& Landing
CAT IIIA ☐ ☐
CAT IIIB ☐ ☐

OPS Procedures Form 1161 issue 08/03/2017 page 1/3

 Federal Public Service Mobility and Transport
Belgian Civil Aviation Authority
Operations Directorate

CAT IIIC ☐ ☐
utilising EVS ☐ ☐

IV. LVO Operations

Yes Document No
Details & Evidence
Reference
The LVO airworthiness approval has been obtained. ☐ ☐
A training programme for the flight crew members involved in these
operations has been established taking into account the following
items :
(1) flight crew qualification requirements, including FSTD training; ☐ ☐
(2) description of initial and recurrent training, checking and syllabi. ☐ ☐

Operating procedures have been established specifying :

(1) the equipment to be carried, including its operating limitations ☐ ☐
and appropriate entries in the MEL;
(2) flight crew composition and experience requirements; ☐ ☐

(3) flight planning; ☐ ☐

(4) requirements and procedures for low visibility take-off (LVTO); ☐ ☐

(5) requirements and normal procedures for LTS CAT I / CAT II /

☐ ☐
OTS CAT II / CAT IIIA / CAT IIIB / CAT IIIC approach;
(6) requirements and procedures on the ground; ☐ ☐

(7) procedures for abnormal situations; ☐ ☐

(8) post-flight procedures; ☐ ☐

(9) continuous monitoring of low visibility operations. ☐ ☐

The operations manual or procedures manual contains the duties of

flight crew members during taxiing, take-off, approach, flare, landing, ☐ ☐
rollout and missed approach operations, as appropriate.
The operations manual or procedures manual includes the minimum
equipment that has to be serviceable at the commencement of an LVO
☐ ☐
in accordance with the aircraft flight manual (AFM) or other approved
document, as applicable.
LVO is included in the Compliance Monitoring Program.
☐ ☐
(only required for CAT, NCC and SPO operations)
LVO is taken into account in the SMS (Hazard/Risk Register, Risk
Assessment, Management of Change). ☐ ☐
(only required for CAT, NCC and SPO operations)
In accordance with Commission Regulation (EC) No 965/2012 on Air operations, Annex V Part-SPA,
Subpart E – Low Visibility Operations (LVO).

OPS Procedures Form 1161 issue 08/03/2017 page 2/3

 Federal Public Service Mobility and Transport
Belgian Civil Aviation Authority
Operations Directorate

V. LVO crew experience

Give details of crew experience in LVO operations (Please provide relevant experience of
proposed crew) :

VI. LVO equipment details

Give details of LVO equipment on board of the aircraft :

Date of signature : (dd/mm/yyyy) Name & Signature of responsible manager :

Number of attached annexes :

1 LVO airworthiness approval may need modification to the aircraft.
2 Following documents shall be annexed :
(1) Certificate of Registration (only for non-Belgian aircraft);
(2) Certificate of Airworthiness (only for non-Belgian aircraft);
(3) Airworthiness Review Certificate (only for non-Belgian aircraft);
(4) Noise Certificate (only for non-Belgian aircraft);
(5) Aircraft Radio Station License (only for non-Belgian aircraft);
(6) Electronic Equipment List;
(7) Amendments to the Operations Manual (including MEL, where applicable) or procedures manual (for
NCO);
(8) Training syllabi for initial and recurrent training programmes together with other relevant material;
(9) Aircraft Flight Manual (AFM) amendment or supplement in relation to LVO;
(10) Copy of the manufacturer's statement, service letters STC, etc... in relation to LVO;
(11) Copy of the operator's engineering support attesting of the actions taken to implement the
manufacturer's service bulletin, etc... (only in case there is no LVO statement of the manufacturer).

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