EQUIPMENT INSPECTION AND MAINTENANCE WORKSHEET
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
6-INCH SINGLE-STAGE PUMP
3.
REGISTRATION/SERIAL/NSN
4a. MILES
b. HOURS
c. ROUNDS
d. HOT
5. DATE
6. TYPE INSPECTION
NG 04219
FIRED
STARTS
4 AUG 98
BEFORE-OPERATION
7.
APPLICABLE REFERENCE
TM NUMBER
TM DATE
TM NUMBER
TM DATE
TM 10-4320-307-10
FEB 66
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
DIAGONAL "(/)" - Indicates a materiel defect other than a
an 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
LAST NAME, INITIAL IN BLACK, BLUE-BLACK INK, OR
directed by higher authority or as prescribed locally, until
PENCIL - indicates that a completely satisfactory
corrective action can be accomplished.
condition 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 MWO has not been
accomplished.
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. 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
WHEN
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 4-2, DA Form 2404.
4-11
QM 5183
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