FBORFQOIRPELCO.pdf

Inspection Report (OIR) Date ____________

From: (POC: name and phone number)__________________________________________

Order Number:

Repair:

Line Item: NIIN/NSN:_ 5820-01-628-2821_ P/N: ES41P36-5W Revision:

S/N: RA number: ______________

Problem(s) found:

Recommended solution: List Material/Parts

Anticipated Material Cost:

Anticipated Labor Hrs: Total Anticipated Repair Cost:

Cost includes Open/Inspect fee? YES NO

Or

BER:

Line Item: ____ NIIN/NSN:5820-01-628-2821 P/N: 2 ES41P36-5W Revision: ____ S/N: _______________ RA number: _______________________ Problem(s) found: ____

Recommended solution: List Material/Parts____

Anticipated Material Cost: ____

Anticipated Labor Hrs: ____ Total Anticipated Repair Cost: ____ Cost includes Open/Inspect fee? YES NO Obsolete Material/Parts: ____

Or

No Fault Found:

Line Item: ____ NIIN/NSN: 5820-01-628-2821 P/N: ES41P36-5W Revision: ____ S/N: ______________ RA number: ____ Effort made to determine the item was operational. Include any programming, alignment, set-up or material changes: ____

Inspection Report (OIR) Date: _________ From: (POC: name and phone number)

REPAIR:

Order Number:

Line Item: ________________ S/N: _____________________

NIIN/NSN: 5820-01-628-2821

P/N: _____ ES41P36-5W _______________________ Revision: ______________ Problem(s) found: ________________________________________________________ Recommended solution (List Material/Parts): __________________________________ Anticipated Material Cost: ___________Anticipated Labor Hrs: ___________ Total Anticipated Repair Cost: _____________ Cost includes Open/Inspect fee? YES NO

OR

BEYOND ECONOMICAL REPAIR (BER):

Line Item: ________________ S/N: _____________________

NIIN/NSN: 5820-01-628-2821

P/N: ___ ES41P36-5W ____________________________ Revision: _________ Problem(s) found: ________________________________________________________ Recommended solution (List Material/Parts/Replacement): _______________________ Obsolete Material/Parts: __________________________________________________________________ Labor Hrs: ______ Cost (if any): __________ Cost includes Open/Inspect fee? YES NO

OR

NO FAULT FOUND:

Line Item: ________________ S/N: _____________________ RA number: ___________

NIIN/NSN: 5820-01-628-2821

P/N: _____ ES41P36-5W __ Revision: _________ Effort made to determine the item was operational (Include any programming, alignment, set-up or material changes):

Labor Hours: ______ Cost (if any):_________ Cost includes Open/Inspect fee? YES NO

Email completed form to Jay.P.Ladehoff@uscg.mil

Phone Number is 757-638-2778 mailto:Jay.P.Ladehoff@uscg.mil