PWS Attachment 5 - DA 2404 Lifting Device Inspection Maintenance Worksheet.pdf

PDF 94 KB Posted Jun 16, 2026

Attached to: Total 100% SMALL BUSINESS SET-ASIDE FOR Preventative Maintenance and Repair Services for Hoisting/Lifting Equipment
Solicitation number: W911QX26QA081
Issued by: Department of the Army Materiel Command Army Contracting Command Aberdeen Proving Ground

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Written by GovTribe AI · Jun 16, 2026

DA Form 2404, Equipment Inspection and Maintenance Worksheet, is a U.S. Army administrative form used to document equipment inspections and maintenance activities in accordance with diagnostic procedures and standards outlined in applicable Technical Manuals (TMs). The form is administered by the proponent agency DCS, G-4, and referenced in DA PAM 750-8. This template provides columns for recording TM item numbers, condition status symbols, identified deficiencies and shortcomings, corrective actions, and personnel sign-off upon completion of corrective measures.

The form utilizes standardized status symbols to classify equipment condition: an "X" indicates inoperable equipment requiring immediate correction; a circled "X" indicates a deficiency allowing limited operation under specific constraints; a horizontal dash indicates overdue maintenance or inspections; a diagonal slash indicates material defects affecting efficiency; and a last name initial in black, blue-black ink, or pencil indicates satisfactory condition. The worksheet captures organizational information, equipment nomenclature and model, registration/serial/NSN, operational metrics (miles, hours, rounds fired, hot starts), inspection date, inspection type, and applicable TM references with dates. Personnel performing inspections and maintenance supervisors must sign and timestamp the document, with required manhours noted for completed corrective actions. For aircraft, all status symbols are recorded in red ink.

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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

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

ITEM

NO.

STATUS

DEFICIENCIES AND SHORTCOMINGS

INITIAL

WHEN

CORRECTED

CORRECTIVE ACTION

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

ITEM

NO.

STATUS

b c

INITIAL

WHEN

CORRECTED

CORRECTIVE ACTION

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

b. HOURS

ROUNDS FIRED

10.

9a. SIGNATURE

3. REGISTRATION/SERIAL/NSN

1. ORGANIZATION

2. NOMENCLATURE AND MODEL

5. DATE

6. TYPE INSPECTION

APPLICABLE REFERENCE

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.

STATUS

DEFICIENCIES AND SHORTCOMINGS

INITIAL

WHEN

CORRECTED

CORRECTIVE ACTION

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.

STATUS

b c

INITIAL

WHEN CORRECTED

CORRECTIVE ACTION

DA FORM 2404, FEB 2011

APD LC v1.00ES 1.00

DA FORM 2404, FEB 2011

EQUIPMENT INSPECTION AND MAINTENANCE WORKSHEET

APD

TIME_B:

TIME_A:

MANHOURS:

ORGANIZ: DEVCOM -

REGISTRAT:

NOMENMODEL:

TYPEINSPEC:

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DEFIC:

Conducted annual inspection IAW TB 43-0142

DEFIC_1:

DEFIC_2: Stenciled IAW TB 43-0142

DEFIC_3: NPI:

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CORRECT:

No leaks, All functions work properly.

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CORRECT_2: Pass/Fail

CORRECT_3: MAX CAP :

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Next Periodic Inspection due:______________

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TMNUM_A: TB 43-0142

TMNUM_B:

MILES: -

ROUNDS: -

HOURS: -

HOTSTARTS: -

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TMDATE_B:

TMDATE_A: FEB 97

DATE:

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File details come from the government source that posted it. Updated Jun 16, 2026.