Transcription of AMMUNITION MALFUNCTION REPORT REPORT …
1 AMMUNITION MALFUNCTION REPORT For use of this form, see AR 75-1; the proponent agency is DCSLOG REPORT ControlSymbol - CSGLD 1961 MALFUNCTIONING ITEMITEM COMPONENTSMALFUNCTION DESCRIPTIONSITE OF MALFUNCTIONUNIT CONTROLLING SITEUNIT USING AMMUNITIONDATE MALFUNCTIONOCCURREDTIMECASUALTIES (No. Killed) CASUALTIES (Hospitalized) CASUALTIES (Other Injuries) DESCRIPTION10. DAMAGED?DAMAGE REPAIRABLEAT UNIT LEVEL?YesNoN/AYesNoN/ADESCRIPTION11. DETONATIONa. Noneb. In WeaponM FROM WEAPONM FROM NEAREST PERSON12. Quantity RemainingFIRING SITELOCAL STORAGEc. SUSPENDED? AVAILABLE (Hold Exhibits Pending Disposition Instructionsper AR 75-1, para. 2-1). a. Fragmentsc. Weaponb. Intact Componentsd. None14. Firing Conditions for MALFUNCTION LotWEAPONTARGETRANGEAZIMUTHELEVATIONZONE FUZE HOW MANY ROUNDS PER MINUTEFROM HOW MANY MINUTES FIRED FROM WEAPON ON DAY OFMALFUNCTIONTOTAL MALFUNCTIONEDTOTAL FIREDMALFUNCTION RATE%15.
2 TerrainFIRING SITEDOWN RANGEPOSSIBLE OBSTRUCTIONSCLEAR VIEW OF FLIGHT PATHM16. Weather ConditionsVISIBILITYPRECIPITATIONTEMPER- ATUREFd. PRIOR 24 HOURSRELATIVEHUMIDITYFFLOW17. MALFUNCTION Lot Storage Conditionsa. Firing Site:Open Enclosed b. Local Storage: Open EnclosedUNPACKED HOWMANY HRS. BEFOREMALFUNCTIONMAGAZINE TYPESTORED HOWMANY MONTHS18. Packaging of MALFUNCTION LotYESNOa. Original Package?b. Original Seal?c. Package Adequate?d. Package Damaged?ADDITIONAL DATA (If more space is needed, use continuation sheet or back of form) FOR ADDITIONAL DATA, CONTACTTELEPHONE NO. (Include Area Code) PERSON COMPLETING REPORTTELEPHONE NO. (Include Area Code) DATEUSAPA FORM 4379, APR 01DA FORM 4379, JAN 89 MAY BE 10c.
