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APPENDIX D

PMCS CHECKLISTS

Use of Forms

Forms are prepared to schedule inspections and preventive maintenance and to record the results of inspections and the need for repairs. They are also used to report preventive maintenance performed, to note repairs made, and to request services of support maintenance. In addition, forms are used to keep track of the time equipment is in use or out of service, and to provide data for reports on the condition and status of equipment.

Responsibility for Record Keeping

Most maintenance records are the responsibility of the TAMMS clerk. However, some forms should be filled out by equipment operators and repairers Some forms require only one or two brief comments; others require many detailed entries. Some are filed in the appropriate equipment logbook. Others are turned over to the TAMMS clerk or maintenance supervisor for further action. The maintenance forms that pipeline equipment operators and repairers should be familiar with are briefly described in this appendix. DA Pamphlet 738-750 gives additional information on all these forms except DA Form 4177 and DA Form 10-242.

DD Form 314

DD Form 314 is used to show when equipment is scheduled for periodic preventive maintenance and when maintenance has been performed. The reverse side of DD Form 314 is used to record the time a piece of equipment was not mission capable either because of maintenance or because repairers were waiting for parts from supply. Not all preventive maintenance should be recorded on DD Form 314. Only preventive maintenance that is performed on a time or mileage basis should be scheduled and recorded on DD Form 314. For example, DD Form 314 should be used to schedule and record maintenance that is done every 3 months, after 1,000 hours of operation, or every 5,000 miles.

DA Form 2404

DA Form 2404 is used to report any faults or malfunctions discovered by an equipment operator. It is also used by organizational maintenance personnel to record periodic maintenance services and spot check inspections. This form is a temporary record of needed and completed repairs. DA Form 2404 should be destroyed after all uncorrected faults have been recorded on DA Forms 2402 and 2407 or action has been taken to request repair parts. However, if the equipment is not combat ready because of needed repairs, DA Form 2404 should be kept on file until the equipment has been repaired.

DA Form 2407

DA Form 2407 is used by organizational maintenance personnel mainly to request support maintenance. It is used when organizational maintenance personnel cannot repair a piece of equipment because of a lack of ability or proper tools. All copies of DA Form 2407 are sent with the faulty equipment to the support activity. The receipt copy is sent back to the owning organization where it is kept on file until the equipment is returned. DA Form 2407 is also used to report maintenance on certain sample items and to submit warranty claims. DA Form 2407-1 is used where there are not enough lines on DA Form 2407. DA Form 2405 is used by the owning organization to keep a record of DA Forms 2407 sent to support maintenance.

DA Form 2409

DA Form 2409 is used to keep a complete maintenance history on a piece of equipment. Its use is mandatory for some pieces of equipment. See DA Pamphlet 738-750. DA Form 2409 should be maintained as a separate equipment log. Every inspection or test specified in the appropriate TM should be noted on the front of DA Form 2409. Every corrective action taken by organizational personnel should be noted on the back of the form. The form is kept for 6 months after the last inspection or corrective action noted.

DA Form 4177

DA Form 4177 is used to schedule inspections and preventive maintenance on a fixed utility or structure such as storage tank. It is also used to record completed maintenance and repairs to tank. Additional information on scheduling inspections and performing required maintenance on storage tanks is in Chapter 12 of this manual. DA Form 4177 should be kept on file locally for the duration of the equipment. All lines on the reverse side of the form should be used. Instructions for preparing the format are given as follows.

Front of DA Form 4177

The front of DA Form 4177 should be filled out as follows:

  • Enter the location and identification number of the tank in the Equipment Number block.
  • Briefly describe the tank in the Description block. Include the capacity of the tank.
  • Enter the name of the person who will perform the preventive maintenance on the tank in the Preventive Maintenance To Be Done By block.
  • Review the appropriate TMs and list the inspections to be performed and the maintenance actions to be taken in the Work To Be Done blocks.
  • Number the work list consecutively in the Item Nr block.
  • Enter the number of the TMs and the paragraph which describes the work to be performed in the Reference block.
  • Enter how often the inspection or maintenance action should be performed in the Frequency block.
  • Enter the day and the time the work should be performed in the Time block.
  • Place a check in each block at the top of the form where the months are listed if inspections are made on some items each month. Write SA in the appropriate blocks for semiannual maintenance and A in the appropriate block for annual maintenance.

Back of DA Form 4177

The back of DA Form 4177 should be filled out as given below.

  • Enter the date the work was performed in the Date block.
  • Enter the corresponding item number for the work performed in the Work Done block. These numbers are listed on the front of the form. Special maintenance and repairs performed on the storage tank, but not listed on the front of the form, should be described briefly.
  • Enter initials in the Initial block.

DA Form 10-5464-R

DA Form 10-5464-R is usually filled out by a pipeline patroller to report a pipeline leak. The completed form is turned over to the pipeline supervisor to be signed by the section chief and platoon leader. To fill out this form--

  • Enter the date and time in the blocks in the top right corner labeled Date and Time.
  • Enter the name of the unit that the report goes to in the To block and the name of the unit the report is from in the From block.
  • Enter name and grade in the Reported By block.
  • Enter name of platoon and section in the Platoon And Section block.
  • Enter the number of the pump station nearest the leak and the number of the joint where the leak was found in the Location Of Leak blocks.
  • Enter an estimate of the amount of leaked fuel in Fuel Lost block.
  • Enter the apparent cause of the leak in the Apparent Cause Of Leak blocks.
  • Enter a description of the kind of repair made in the Disposition block.
  • Enter a description of any other actions taken to protect life and property in the Precautions Taken block.



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