(g) Block 4. Leave blank.
(h) Block 5. Enter the model designation of equipment for which the form was initiated.
If the item has no
model designation, leave blank.
(i) Block 6. Enter the National Stock Number of equipment listed in block 3.
When completing this form for
bulk items having multiple NSN's, leave blank.
(j) Block 7. Enter the symbol of the maintenance activity performing the maintenance.
No entry shall be
made in the "yes" or "no" blocks.
(k) Block 8. Enter the appropriate utilization code.
(l) Block 9. Place a')V' or an "X" in the "yes" block if the item is a DA directed sampling item.
For all other
equipment, place a " " or an "X" in the "no" block.
(m) Block 10.
Enter the hour reading (rounded to the nearest hour) from the hour meter.
If not applicable,
leave blank.
(n) Block 11.
Enter the mileage reading (rounded to the nearest mile) from the odometer.
If not applicable,
leave blank.
(o) Block 12.. Leave blank.
(p) Block 13. Leave blank.
(q) Block 14. Enter a 'V" or an "X" in the space provided to indicate when the failure was detected. Exception.
Leave blank if no failure is involved, or DA directed sampling items organizational maintenance.
(r) Block 15. Place a "K" or an "X" in the space provided that most accurately describes the condition at time
of first indication of trouble.
Exception.
Leave blank if block 14 was left blank, or DA directed sampling items
organizational maintenance.
(s) Block 16. Enter "Warranty Claim Actions."
(t) Block 20, column d. Enter noun identifying the part or assembly.
(u) Block 20, column e. Enter serial number of the part or assembly.
(v) Block 20, column g. Enter the number of man-hours required for the task of replacing the defective part.
Use the appropriate TB time schedule guide, if available, otherwise record actual man-hours used.
(w) Block 20, column h. Enter NSN of defective part, or manufacturer's part number when NSN has not been
assigned.
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