PWS_Attachment 4 ARL Modified DA Form 2404 (SEMI-ANNUAL PM).pdf
PDF 95 KB Posted
- Solicitation number
- W911QX26QA021
About this file
DA Form 2404 is a Department of the Army Equipment Inspection and Maintenance Worksheet used to document equipment condition assessments and maintenance activities in accordance with diagnostic procedures and technical manual standards. The form serves as an official record for inspections conducted by maintenance personnel and is referenced in DA PAM 750-8, with the proponent agency being DCS, G-4.
The form contains five operational columns for recording inspection data: Column A captures the Technical Manual (TM) item number being inspected; Column B documents the applicable condition status symbol indicating equipment operability; Column C records specific deficiencies and shortcomings identified during inspection; Column D details the corrective action taken to address identified defects; and Column E requires the initial and signature of personnel confirming completion of corrective actions. Status symbols are standardized across all users, with an "X" indicating inoperable deficiencies, a circled "X" indicating deficiencies allowing limited operation under higher authority restrictions, a horizontal dash indicating overdue inspections or modifications, and a diagonal slash indicating material defects affecting efficiency. The form includes header fields for organization, equipment nomenclature and model, registration/serial/NSN, operational hours/miles/rounds fired/hot starts, inspection date, inspection type, applicable technical manual references, and signature blocks for both the inspecting personnel and maintenance supervisor with corresponding time entries. The document includes a sample completed section with seven standard inspection items: greased and lubricated vehicle, checked all fluids, checked lights, cleaned battery, checked tire PSI, tested anti-freeze, and other miscellaneous items.
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Text version
ALL INSPECTIONS AND EQUIPMENT CONDITIONS RECORDED ON THIS FORM HAVE BEEN DETERMINED
IN ACCORDANCE WITH DIAGNOSTIC PROCEDURES AND STANDARDS IN THE TM CITED HEREON.
EQUIPMENT INSPECTION AND MAINTENANCE WORKSHEET
For use of this form, see DA PAM 750-8; the proponent agency is DCS, G-4.
HOT
STARTS
d.b. HOURS ROUNDS
FIRED
c.
10.9a. SIGNATURE
3. REGISTRATION/SERIAL/NSN
1. ORGANIZATION 2. NOMENCLATURE AND MODEL
5. DATE 6. TYPE INSPECTION
APPLICABLE REFERENCE7.
TM NUMBER TM DATE TM NUMBER TM DATE
COLUMN a COLUMN b COLUMN c
Enter TM item number.
Enter the applicable condition status symbol.
Enter deficiencies and shortcomings.
COLUMN d shortcoming listed in Column c.
Show corrective action for deficiency or
STATUS SYMBOLS
COLUMN e action initial in this column.
Individual ascertaining completed corrective
Indicates a deficiency in the equipment that places"X" it in an inoperable status.
Indicates a deficiency, however, the CIRCLED "X"
Indicates that a requiredHORIZONTAL DASH "(-)"
Indicates a material defect otherDIAGONAL "(/)"
LAST NAME INITIAL IN BLACK, BLUE-BLACK INK,
FOR AIRCRAFT - Status symbols will be recorded in red.
(Maintenance Supervisor) MANHOURS
REQUIRED
TM
ITEM
NO.
a
STATUS
b
DEFICIENCIES AND SHORTCOMINGS
c
INITIAL
WHEN
CORRECTED
e
CORRECTIVE ACTION
d
DA FORM 2404, FEB 2011 PREVIOUS EDITIONS ARE OBSOLETE. APD LC v1.00ES
4a. MILES
8b. TIME 9b. TIME8a. SIGNATURE (Person(s) performing inspection) equipment may be operated under specific limitations as directed by higher authority or as prescribed locally, until corrective action can be accomplished.
inspection, component replacement, maintenance operation check, or test flight is due but has not been accomplished, or an overdue MWO has not been accomplished.
OR PENCIL - Indicates that a completely satisfactory condition exists.
than a deficiency which must be corrected to increase efficiency or to make the item completely serviceable.
DEFICIENCIES AND SHORTCOMINGS
TM
ITEM
NO.
a
STATUS
b c
INITIAL
WHEN
CORRECTED
e
CORRECTIVE ACTION
d
DA FORM 2404, FEB 2011 APD LC v1.00ES
ALL INSPECTIONS AND EQUIPMENT CONDITIONS RECORDED ON THIS FORM HAVE BEEN DETERMINED IN ACCORDANCE WITH DIAGNOSTIC PROCEDURES AND STANDARDS IN THE TM CITED HEREON.
EQUIPMENT INSPECTION AND MAINTENANCE WORKSHEET
For use of this form, see DA PAM 750-8; the proponent agency is DCS, G-4.
HOT STARTS
d.
b. HOURS
ROUNDS FIRED
c.
10.
9a. SIGNATURE
3. REGISTRATION/SERIAL/NSN
1. ORGANIZATION
2. NOMENCLATURE AND MODEL
5. DATE
6. TYPE INSPECTION
APPLICABLE REFERENCE
7.
TM NUMBER
TM DATE
TM NUMBER
TM DATE
COLUMN a COLUMN b COLUMN c Enter TM item number.
Enter the applicable condition status symbol.
Enter deficiencies and shortcomings.
COLUMN d shortcoming listed in Column c.
Show corrective action for deficiency or
STATUS SYMBOLS
COLUMN e action initial in this column.
Individual ascertaining completed corrective Indicates a deficiency in the equipment that places "X" it in an inoperable status.
Indicates a deficiency, however, the
CIRCLED "X"
Indicates that a required
HORIZONTAL DASH "(-)"
Indicates a material defect other
DIAGONAL "(/)"
LAST NAME INITIAL IN BLACK, BLUE-BLACK INK,
FOR AIRCRAFT - Status symbols will be recorded in red.
(Maintenance Supervisor)
MANHOURS REQUIRED
TM ITEM NO.
a
STATUS
b
DEFICIENCIES AND SHORTCOMINGS
c
INITIAL
WHEN
CORRECTED
e
CORRECTIVE ACTION
d
DA FORM 2404, FEB 2011
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES 4a. MILES 8b. TIME 9b. TIME 8a. SIGNATURE (Person(s) performing inspection) equipment may be operated under specific limitations as directed by higher authority or as prescribed locally, until corrective action can be accomplished.
inspection, component replacement, maintenance operation check, or test flight is due but has not been accomplished, or an overdue MWO has not been accomplished.
OR PENCIL - Indicates that a completely satisfactory condition exists.
than a deficiency which must be corrected to increase efficiency or to make the item completely serviceable.
DEFICIENCIES AND SHORTCOMINGS
TM ITEM NO.
a
STATUS
b c
INITIAL
WHEN CORRECTED
e
CORRECTIVE ACTION
d
DA FORM 2404, FEB 2011
APD LC v1.00ES 1.00
DA FORM 2404, FEB 2011
EQUIPMENT INSPECTION AND MAINTENANCE WORKSHEET
APD
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| TIME_A: |
| MANHOURS: |
| ORGANIZ: |
| REGISTRAT: |
| NOMENMODEL: |
| TYPEINSPEC: SEMI-ANNUAL PM |
| TMNO: 1 |
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| TMNO_2: 2 |
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| TMNO_4: 3 |
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| TMNO_6: 4 |
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| TMNO_8: 5 |
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| TMNO_12: 7 |
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| DEFIC: GREASED AND LUBRICATED VEHICLE |
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| DEFIC_2: CHECKED ALL FLUIDS |
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| DEFIC_4: CHECKED LIGHTS |
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| DEFIC_6: CLEANED BATTERY |
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| DEFIC_8: CHECKED TIRE PSI |
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| DEFIC_10: TESTED ANTI-FREEZE |
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File details come from the government source that posted it. Updated .