EQUIPMENT INSPECTION AND MAINTENANCE W ORKSHEET
For use of this form, see DA PAM 738, 780, and 738-751: the proponent agency is DCSLOG
1. ORGANIZATION
2. NOMENCLATURE AND MODEL
262d QM BN
3.
4a. MILES
b. HOURS
c. ROUNDS
d. HOT
5. DATE
6. TYPE INSPECTION
REGISTRATION/SERIAL/NSN
FIRED
4 AUG
BEFORE-OPERATION
STARTS
98
NG 04219
7.
APPLICABLE REFERENCE
TM NUMBER
TM DATE
TM NUMBER
TM DATE
TM 10-6630
FEB 99
COLUMN A - Enter TM Item Number
COLUMN d - Show corrective action for deficiency or
shortcoming listed in Column c.
COLUMN B - Enter the applicable condition status symbol.
COLUMN e - Individual ascertaining completed corrective
COLUMN C - Enter deficiencies and shortcomings.
action initial in this column.
STATUS SYMBOLS
"X" - Indicates a deficiency in the equipment that places it in an
DIAGONAL "(/)" - Indicates a materiel defect other than a
inoperable status.
deficiency which must be corrected to increase efficiency or
to make the item completely serviceable.
CIRCLED "X" - Indicates a deficiency; however, the equipment
may be operated under specific limitations as directed by
LAST NAME, INITIAL IN BLACK, BLUE-BLACK INK, OR
higher authority or as prescribed locally, until corrective
PENCIL - indicates that a completely satisfactory condition
action can be accomplished.
exists.
HORIZONTAL DASH "(-)" - Indicates that the required
FOR AIRCRAFT - Status symbols will be recorded in red.
inspection, component replacement, maintenance operation
check, or test flight is due but has not been accomplished, or
an overdue MW O has not been accomplished.
ALL INSPECTIONS AND EQUIPMENT CONDITIONS RECORDED ON THIS FORM HAVE BEEN DETERMINED
IN ACCORDANCE W ITH DIAGNOSTIC PROCEDURES AND STANDARDS IN THE TM CITED HEREON.
8a. SIGNATURE (Person performing
8b. TIME
9a. SIGNATURE (Maintenance
9b. TIME
10. MANHOURS
inspection)
Supervisor)
REQUIRED
0830
P. Moynihan PFC
TM
INITIAL
ITEM
STATUS
DEFICIENCIES AND SHORTCOMINGS
CORRECTIVE ACTION
W HEN
NO.
CORRECTED
a
b
c
d
e
/
ENGINE OIL LOW
ADDED 1 QT
PM
/
FUEL LOW
ADDED 3 GALLONS
PM
/
HAIRLINE CRACK IN ENGINE HOUSING
SUPPORT
/
LOOSE BATTERY CABLES
TIGHTENED CABLES
PM
DA FORM 2404, APR 79
Edition of 1 Jan 64, which will be used
Figure 4-3. DA Form 2404 (Equipment Inspection and Maintenance Worksheet).
4-5
QM 4922
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