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Download DA Form 984-R, also known as the Munitions Surveillance Report. This form is to assist in testing munitions as the enter military possession. It will also track depreciating flaws that the munitions may experience, making it easier to decide if the ammunition is safe and if the munitions should be requisitioned, depending on test results.

How To Fill-In

Step 1 – Section A – This section requires vital information with regard to the munitions as presented, complete the following:

  • 1.Installation
  • 2. Record Number
  • 3. Date Of Record (yyyy/mm/dd format)
  • 4. Item
  • 5. Lot Number
  • 6. Packed
  • 7.NSN/DODIC
  • 8. Current Storage
  • 9. Past Storage
  • 10. Sample Size
  • 11. Manufacturer/Date Of Manufacture
  • 12. Condition Of Packing (comment)
  • 13. Condition Of Ammunition Items (comment)
  • 14. Remarks And Brief History
  • 15.a. Condition Code Before Test
  • b.Condition Code After Visual Inspection
  • c. Condition Code After Test
  • 16. Signature (of QASAS Chief)

Step 2 – Section B (Page 2 of the form) – Complete the following  rows in blocks 1. through 11 :

  • 1. Date Of Test
  • 2.a. Tested IAW
  • 2.b. Revision
  • 2.c. Date Of SB
  • 3. Temperature (Ambient (f))
  • 4. Relative Humidity
  • 5. Wind Velocity (mph) Critical
  • 6. Visibility – Minor
  • 7. Box Number
  • 8. Sample Number
  • 9. Component Lot Numbers a. and b.
  • 10. Results – a. through g.
  • 11. Defects/Defectives – Check appropriate boxes:
  • Critical
  • Major
  • Minor
  • a. through c.
  • 12. Non-Function – Check appropriate boxes:
  • Critical
  • Major
  • Minor
  • a. through c.

Step 3 – Block 13.- Place any remarks with regard to any of the tested ammunition in block 13.

Step 4 – Blocks 14.and 15.

  • 14. Total
  • 15. Recommended Functional Code

These forms are fillable online and/or printable for manual completion and/or sending.

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