Appendix_C-DA_2404.pdf

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W91QVN-18-R-0092
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W91QVN18R0092
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EQUIPMENT INSPECTION AND MAINTENANCE WORKSHEET

For use of this form, see DA PAM 738-750 and 738-751; the proponent agency is DCSLOG

HOT

STARTS

d.HOURSb. ROUNDS

FIRED

c.4a.

TIMESIGNATURETIME8b.

MILES

9b. 10.9

3. REGISTRATION/SERIAL/NSN

a.

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" equipment may be operated under specific limitations as directed by higher authority or as prescribed locally, until corrective action can be accomplished.

Indicates that a requiredHORIZONTAL DASH "(-)" inspection, component replacement, maintenance operation check, or test flight is due but has not been accomplished, or an overdue MWO has not been accomplished.

Indicates a material defect otherDIAGONAL "(/)" than a deficiency which must be corrected to increase efficiency or to make the item completely serviceable.

LAST NAME INITIAL IN BLACK, BLUE-BLACK INK,

OR PENCIL - Indicates that a completely satisfactory condition exists.

FOR AIRCRAFT - Status symbols will be recorded in red.

ALL INSPECTIONS AND EQUIPMENT CONDITIONS RECORDED ON THIS FORM HAVE BEEN DETERMINED

IN ACCORDANCE WITH DIAGNOSTIC PROCEDURES AND STANDARDS IN THE TM CITED HEREON.

8a. (Person(s) performing inspection) (Maintenance Supervisor) MANHOURS

REQUIRED

SIGNATURE

TM

ITEM

NO.

a

STATUS

b

DEFICIENCIES AND SHORTCOMINGS

c

INITIAL

WHEN

CORRECTED

e

CORRECTIVE ACTION

d

DA FORM 2404, APR 79 Replaces edition of 1 Jan 64, which will be used USAPPC V1.10

DEFICIENCIES AND SHORTCOMINGS

TM

ITEM

NO.

a

STATUS

b c

INITIAL

WHEN

CORRECTED

e

CORRECTIVE ACTION

d

USAPPC V1.10

NOMEN:
ORGANIZATION:
MILES:
ROUNDS:
HOT STARTS:
DATE:
REG/SERIAL/NSN:
TM DATE: 1 JAN 2002
TM NUMBER: MIL-HDBK-138B
TM DATE1:
TM NUMBER1:
HOURS:
TIME1:
MANHRS REQD:
TIME:
TM ITEM NO:
0:
4:
3:
3:
0:
1:
2:
4:
3:
0:
0:
1:
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1:
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0:
1:
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1:
2:
3:
0:
STATUS:
1:
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2:
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0:

INITIALS:
1:
2:
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11:
0:
0:
1:
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0:
1:
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0:
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DEFICIENCIES:
1:
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11:
0:
0:
1:
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0:
0:
1:
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3:
4:
0:
1:
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0:
1:
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0:
1:
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CORRECTIVE ACTION:
1:
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0:
0:
1:
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0:
1:
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11:
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13:
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15:
0:
1:
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7:
8:
9:
10:
0:
1:
2:

TYPE: CSC

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