(10a) ORGWON/DOC NO: Enter organization work order number or organization document number.
(10b) EIC: Enter the end item code (EIC). See Army Master Data File (AMDF).
(11) Serial Number
- Enter the serial number of the item in Block 9.
- For nontactical wheeled vehicles, use the register number.
- Leave blank if the form is used for more than one item.
- Leave blank if the equipment has more than one serial number.
- Mandatory entry if equipment is (inoperable) INOP.
(12) QTY: Enter the number of items. (Must be only one item listed if equipment is reportable under
AR 700-138 and is NMC.)
(13) PD: Enter the Priority Designator (See DA Pam 710-2-1).
(14) Malfunction Description (DS, GS, AVIM, Depot Use).
(15a) Failure Detected During/When Discovered Code.
- Enter Failure Detected Code from Table B-3 or When Discovered Code from DA Pam 738-
751.
- Leave blank if no failure occurred.
(15b) First Indication of Trouble/How Recognized Code: Enter First Indication of Trouble Code from
Table B4 or How Recognized Code from DA PAM 738-751.
(16) Miles/Kilometers/Hours/Rounds: Enter hour reading (to nearest hour) beside the "H" from the
hour meter mounted on the equipment. If the equipment has no meter, leave blank.
(17) Project Code: Enter the project code if one has been assigned. If not, leave blank.
(18) Account Processing Code: Enter the Account Processing Code (APC) if required by your unit.
The APC is a code prescribed locally for costing and budget identification of customers and
organizations (reference TM 38-711-13). If not required, leave blank.
(19) In Warranty? - enter Y or N to indicate whether equipment is still under manufacturer's warranty. If
Y, submit one work request for each serial numbered item.
(20) Admin Number: Enter the bumper number/materiel control number or administrative number
assigned to the item of equipment.
(21) Reimbursable Customer: For DSU/GSU/AVIM/Depot use.
(22) Work Performed By: Enter code for level of work from Table B-24 (Maintenance Management
Update 3-14).
(23) Signature: The commander or the commander's designated representative will sign for all priority
01 through 10 requests. This signature approves the use of the PD.
(24) Describe Deficiencies or Symptoms.
- Using the information in column "c" of DA Form 2404, briefly describe the fault or symptoms.
For example, print "Engine does not develop full power" or "Equipment uses two quarts of oil
daily," etc. Do not ask for general or specific repair of parts to be replaced; for example, do
not tell support to "replace the hydraulic system" or "repair as needed."
- When the form is asking for work on more than one item with the same NSN, list the number
of items, their serial numbers (if they have serial numbers), and anything else support will
need. INOP equipment (equipment reported on the Materiel Condition Status Report),
components/subsystems of reportable equipment, or command maintenance significant
equipment) must have its own separate forms.
- When the form is for components or assemblies with a recoverability code of A, D, F, H, or L,
give the end item NSN. Put the NSN on the last line of Block 25. You will find recoverability
codes in the RC code column on the AMDF. You will also find the codes listed as part of the
item's Source, Maintenance, and Recoverability (SMR) code in the parts manual.
- If you need more room, use a DA Form 2407-1.
- When the form is requesting standard repair after a battle-damage expedient has been
applied, print "BDAR" in bold letters before describing the fault or symptoms. NOTE: The end
item's Battlefield Damage and Assessment Repair (BDAR) TM and AR 750-1 describe when
and how BDAR repairs will be made.
(25) Remarks. When the item in Block 7 needs onsite or deferred maintenance, support will note that
action here. Shop office NCO will make one of these entries for onsite or deferred work:
- Maintenance request received on (date), signature of shop office NCO.
4-6
QM 5181
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