manufacturer, include the shipper's or supplier's name/city/state in block 7c.
Item 8. Manufacturer's Part Number. Self explanatory.
Item 9. Serial/Lot/Batch No. As applicable, enter the serial number, lot number, or batch number of the deficient material. Use item 22 if required.
Item 10. Enter the contract number in block 10a, the purchase order number in block 10b, the requisition number in block 10c, and the government bill of lading (GBL) number in block 10d.
Item 11. Item is New, Repaired, or Overhauled. Check the appropriate block to identify . if the material is either new, repaired or overhauled.
Item 12. Date Manufactured, Repaired, or Overhauled. If the material is repaired or overhauled, enter the last repair or overhaul date.
Item 13. Enter operating time at failure (based on entry in block 12). Indicate the time material had been in service since new or since last repair, modification, or overhaul for rework material.
Item 14. Government Furnished Material. Government furnished material is any material that belongs to the government and is furnished to a contractor for some purpose. Check the appropriate block.
Item 15. Quantity. Quantity is a count of each individual item, disregarding unit of issue.
a. Received. Enter the number of items received.
b. Inspected. Enter the number of items inspected.
c. Deficient. Enter the number of items that were determined to be deficient as a result of inspection.
d. In Stock. Enter the number of items in stock, as applicable.
Item 16. Deficient Item Works On or With. Not applicable when reporting common/general type material received from supply but not installed or peculiar to a specific type of aircraft.
Item 17. Dollar Value of Deficient Items. Enter the dollar value of the material reported as being deficient, if known.
Item 18. Estimated Repair Cost. Enter the estimated cost and man-hours required to correct the discrepancy.
Item 19. Item Under Warranty. Check appropriate block in block 19a, and enter the expiration date of warranty in block 19b.
Item 20. Work Unit Code/Equipment Identification Code. Enter the most specific code available.
Item 21. Action or Disposition. Check one of the blocks to indicate the nature of the action taken or requested concerning the deficient material. If an exhibit is being held, indicate the number of days the exhibit will be held by completing the space provided (holding exhibit for XX days). If none of the blocks indicate the action or disposition taken or requested, check the other block and identify the nature of the action taken or requested in Item 22.
Item 22. Details. This item provides valuable information concerning the deficiency. For a fully comprehensive report, the following types of information should be entered in this item, if applicable and available:
The requisition number under which the material was received.
Describe how the safety of personnel or the activity mission is affected by the use of the defective item.
Name of the activity that supplied the material.
Date of receipt.
Date of packaging.
Explain what is wrong with the item or how it is different from an acceptable item to the best of the originator's ability. Explain how the item does not function with relating parts or assemblies, etc. Include specific violations of specifications, pertinent regulations, instructions, contracts, etc. Indicate if an exhibit is being held.Continue Reading