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This appendix implements STANAG 2143.


Correct and properly prepared documentation of EOD accidents/incidents will serve as a record of items reported, personnel responding, disposition, and references used. Such data will be useful in case evidence information is requested of EOD personnel. This data will also be useful for unit historical data purposes.

Initial information on and documentation of an accident/incident at the first echelon level is usually received from a unit or individual by way of a UXO spot report. This report is discussed in some detail in FM 21-16 and in the supplemental information section of the Signal Operating Instructions.

Once an accident/incident is reported (by whatever means) through EOD channels, EOD personnel will transcribe relevant information onto a DA Form 3265-R. This form, formally titled "Explosive Ordnance Incident Report," then becomes the official record of actions taken by EOD personnel in response to the reported accident/incident.

DA FORM 3265-R

A reproducible copy of this form is provided at the back of this field manual. It should locally be reproduced on 8 1/2-by 11-inch paper. The form can also be computer generated. Information should be entered in either blue or black ink. The reverse side can be used as a continuation for any of the information blocks on the front. When doing so, be sure to clearly identify (by block number and/or letter) the block being continued. Figure E-1 depicts a sample of a properly completed DA Form 3265-R. Instructions for completing the form follow.

Heading Information

The top of the form contains four blocks for header information--unit number, control number, and incident category (unusual or routine). Complete these blocks as follows:

Unit Number. The unit number consists of the unit designation, numerically sequenced incident identifier, and year of the incident. For example, 49-003-95 would mean that the 49th Ordnance Company (EOD) has had its third incident for 1995.

Control Number. The control number (as assigned by the EOD battalion) is entered.

Unusual (block 3) or Routine (block 4). This reflects the incident category as determined by the EOD unit commander according to policy established by the EOD Battalion. An "X" is put in the appropriate box.

Section A: Initial Information

Use Section A (blocks 5 through 11) to enter the following initial information received concerning the incident: Date/Time Reported, Reported By, Phone Number, Address, Incident Location, Point of Contact, and Item(s) Reported. Complete these blocks as follows:

Date/Time Reported. Enter the date and time the incident was reported to the EOD unit. List all times Zulu. Use the world map shown as Figure E-2 to determine the appropriate Zulu time.

Reported By. Enter the name of the person reporting the incident.

Phone Number. Enter the phone number of the person cited in block 6. This information, which may be a call sign and frequency, may be classified. If information is classified, the report must be secured IAW AR 380-5 and DOD 5200.2-R.

Address. Enter the address of the person cited in block 6.

Incident Location. In block 9, enter the street, city, state, coordinates, or landmarks as appropriate.

Point of Contact. Enter the name, location, and phone number (or call sign) of a person who knows the way to the incident site. You may need to add additional information for EOD team linkup with this individual.

Item(s) Reported. In block 11, tentatively identify or describe the items being reported. This block can also be used to list any protective measures taken by the person reporting the incident.

Section B: Action By EOD

Use Section B (blocks 12 through 18) to enter the following information concerning action taken by the EOD unit or team in response to an accident/incident: Personnel Dispatched, Date/Time, Travel Data, Work Hours, Confirmed Identification, Disposition, and Incident Narrative. Complete these blocks as follows:

Personnel Dispatched. In block 12, enter the name and grade of all persons dispatched to the incident site.

Date/Time. In the appropriate portion of block 13, enter the time the EOD team departed the unit area, the time the team arrived at the incident site, and the time the EOD team returns to the unit area after completion of the incident response.

Travel Data. In the appropriate portion of block 14, enter the time spent in aircraft traveling to and from the incident site (if appropriate) and the total mileage for any vehicles used in traveling to or from the incident site.

Work Hours. In the appropriate portion of block 15, enter the total work hours spent traveling to and from the incident site and the actual work hours spent in responding to an incident (from time of departure from the unit area to completion of disposal) excluding travel time.

Confirmed Identification. In block 16, enter model number (include lot number when available) for standard items for which you have confirmed identification. For nonstandard items, enter a description.

Disposition. In block 17, enter information concerning the disposition of the item. For example, was the item rendered safe, placed in a safe holding area, or destroyed? This information may include a reference citation (including specific paragraph number) if appropriate.

Incident Narrative. Use this block to cite significant actions and details as well as any problems encountered. If classified information is entered, the report must be secured IAW AR 380-5 and DOD 5200.2-R.

Section C: Authentication

Section C (blocks 19 through 21) is used to record (typed or printed) the name and grade of the EOD unit commander and his authenticating signature, the unit telephone number, and the date of signature.

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