manufacturer, include the shippers or suppliers
name/city/state in block 7c.
Item 8. Manufacturers Part Number. Self
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
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
Item 11. Item is New, Repaired, or Over-
hauled. Check the appropriate block to identify
. if the material is either new, repaired or
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
Item 15. Quantity. Quantity is a count of
each individual item, disregarding unit of issue.
Received. Enter the number of
Inspected. Enter the number of
Deficient. Enter the number of
items that were determined to be
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
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 Identi-
fication Code. Enter the most specific code
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
l Name of the activity that supplied the
. 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 originators 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.