IMSAFE Checklist: Pilot’s Health Readiness

Pilots · 6 min read · Jul 22, 2022
imsafe checklist

Safety is definitely a top priority in the aviation industry, and this is the reason for having so many rules and regulations set to ensure aviation operations run as smoothly as possible.

For instance, pilots must run a pre-flight checklist before every one of their flights to verify there is nothing that might affect flight performance.

Of course, a pre-flight checklist is not the only measure taken to guarantee safety in aviation. Authorities like the Federal Aviation Administration provide other regulations and recommendations to do so. Among them, we can find the IMSAFE checklist, the PAVE checklist, as well as the 5 P’s.

If you want to discover what these checklists are and how they help to ensure safety in aviation, keep reading as we disclose all the details.

What does the acronym PAVE stand for?

While the focus of this guide is the IMSAFE checklist, it is better that we cover the PAVE checklist first since it contains other vital safety requirements for flights.

The acronym PAVE stands for Personal/Pilot, Aircraft, EnVironment, and External Pressures. In other words, it represents all the possible risks associated with flying. While most pilots pay careful attention to factors associated with aircraft performance, the environment, and external pressures, the truth is that sometimes they forget or even disregard human factors.

But how can pilots evaluate human factors, especially when it comes to evaluating themselves? Well, here is where the IMSAFE checklist plays a critical role.

Two pilots in a cockpit flying an airplane high above clouds.

What is the IMSAFE checklist?

The IMSAFE checklist is a mnemonic device that every certified flight instructor must teach to student pilots since it will help them perform a personal pre-flight health assessment to ensure they are fit to fly.

The idea of the checklist is to counter the several physical ailments and psychological stress causes that can have a negative impact on the pilot performance.

IMSAFE stands for Illness, Medication, Stress, Alcohol, Fatigue, and Emotion. These components of the IMSAFE checklist are more important for a safe flight than you might initially think. Let’s take a closer look at each of them.


FAA regulations require all pilots to pass a medical exam to obtain a medical certificate based on the license they are getting. However, the medical certificate does not make pilots immune to getting sick. Therefore, illness should not be taken lightly to mitigate risk since it can limit the awareness of the pilots and their ability to work in the flight environment.

  • Aviation Medical Examiner (AME)

The AME is the physician in charge of performing the medical exam to obtain the certificate we mentioned above, so they are professionals who work closely with aviation regulations. However, when it comes to the IMSAFE checklist, the illness component is the responsibility of the pilots.

Rule FAR 91.3 states that, “The pilot in command is directly responsible for the operation of the flight. The pilot alone is responsible for ensuring his own health is up to par before taking the controls.”

A simple cold or the flu can become dangerous inside a civil aircraft, or any aircraft for that matter. From a runny nose that would distract the pilot to sinus pressure that could make the pain unbearable and even seriously damage the pilot’s ears due to pressure differential, whenever pilots identify symptoms, they should restrain themselves from flying.

A person with an illness holding a thermometer and a tissue.


After verifying the presence of an illness, a pilot may decide not to fly. Of course, he or she will look for treatment to counter the disease. In other cases, pilots may have conditions that require medication like any other human being.

Unfortunately, many medications come with side effects such as fatigue, unusual weakness, nausea, dizziness, headaches, drowsiness and other symptoms that can result in a dangerous situation when flying.

  • Prescription and over-the-counter medications

When a pilot needs to take any prescription or over-the-counter medications, he or she needs to be aware of the side effects and the possible consequences of flying under those effects. If the side-effects are not clear, it is recommended for the pilot to contact an AME before flying to determine whether it is safe or if the side effects can cause the pilot to lose the abilities required in the cockpit.

Moreover, the FAA recommends waiting until at least five dosage periods have passed to return to flying. So, while only a recommendation, it is a good idea to follow it to guarantee flight safety.


Stress is well known for being a cause of many problems to people in general, not only pilots. Now, the fact is that stress can negatively affect the flight environment and put everyone on the plane in danger.

Psychological stress, physiological stress, and environmental stress are the three types of stress that can affect every human being, pilots included.

Psychological stress refers to the one caused by difficult situations in life that cause psychological pressure and affect the mindset of the pilot, anything from financial troubles to divorce or similar can cause strain on the pilot’s abilities of decision-making and situational awareness. A pilot experiencing this kind of stress can overreact or not react at all when exposed to a difficult flight situation like engine failure.

Physiological stress involves everything that affects the pilot’s body, such as strenuous exercise, illness like a common cold, or lack of as well as poor sleep from changing time zones. This is usually connected with fatigue, which we will be covering below.

When it comes to environmental stress, the causes are external factors like extreme temperatures, and loud noises, among others. What can be worse is that these can come as a combination of several factors.

It is important to highlight that stress can be acute lasting short periods, but also chronic which means it lasts for a prolonged period, which can easily cause a bigger problem.

A person experiencing a lot of stress: they are holding their head between their hands.


Everyone knows that driving under the effects of alcohol is dangerous, and it is prohibited by law. Therefore, it is easy to imagine that the same applies to flying aircraft.

FAA rule FAR 91.17 states that “no person may act or attempt to act as a crew member of a civil aircraft within 8 hours after the consumption of any alcoholic beverage, while under the influence of alcohol, while using any drug that affects the person’s faculties in any way contrary to safety, or with a blood alcohol content of .04 percent or greater.

In any case, the FAA recommends pilots wait at least 24 hours after drinking to sit in front of the controls.


Fatigue is common in many different jobs. When it comes to flying, a long flight route can already be a cause of fatigue.

We mentioned above that physiological stress can result in fatigue. Yet, fatigue affects each person differently, it is important that pilots are taught early how to manage fatigue. For example, some pilots may experience extreme fatigue after a long flight, so they need to make sure they are adequately rested before the next one to ensure a safe flight. Others may need the same amount of rest as with any other flight to be fit to fly.

Of course, regulations and company policies are set to help ensure pilots get the needed rest between flights. However, pilots must understand their own body’s response to the possible causes of fatigue, and avoid taking the “macho attitude”, one of the five hazardous attitudes identified by the FAA.

A person experiencing fatigue: yawning and covering their mouth with their hand.


In order to maintain control of an aircraft, pilots must be in control of their emotions, which can be quite a difficult task for any person. An emotionally disturbed pilot can transform a safe flight into a highly dangerous one since he or she will have problems focusing on the main task, flying the aircraft.

Emotion is usually associated with psychological factors. Therefore, it is critical that the pilot avoids flying when exposed to situations such as family problems that may cause feelings of anger, depression, or anxiety.

Some conclusions

We started this guide by highlighting the importance of safety for the aviation industry. We also mentioned that human factors are critical to ensure the safety of a flight, but also to guarantee safety in all the operations that take place in the industry.

In short, it is clear that a pilot is at the front line for passengers to fly safely. However, there are other essential aspects of safety like having the right aircraft maintenance to keep the aircraft ready to fly and do it safely. Therefore, checklists like the one we described here can also apply to other professionals like aircraft maintenance technicians to guarantee they are psychologically and physically fit to do their work.

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Jet pilot @NASA

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