Print Form Reset Form
MAINTENANCE REQUEST PAGE NO. NO OF PAGES REQUIREMENT CONTROL SYMBOL
CSGLD-1047(R1)
For use of this form, see DA PAM 738-750 and 738-751;
the proponent agency is DCSLOG "FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION I - CUSTOMER DATA SECTION II - MAINTENANCE ACTIVITY DATA
1a. UIC CUSTOMER 1b. CUSTOMER UNIT NAME 1c. PHONE NO 3a. WORK ORDER NUMBER (WON) 3b. SHOP 3c. PHONE NO
2a. SAMS-2 UIC/SAMS-I/TDA 2b. UTILIZATION CODE 2c. MCSR 4a. UIC SUPPORT UNIT 4b. SUPPORT UNIT NAME
SECTION III - EQUIPMENT DATA
5. TYPE MNT 6. ID 7. NSN 15a. FAILURE DETECTED DURING/WHEN DISCOVERED CODE (Enter code)
REQ CODE - See DA Pamphlet 738-750 and 738-751
15b. FIRST INDICATION OF TROUBLE/ HOW 16. MILES/KILOMETERS/HOURS/ROUNDS
8. MODEL RECOGNIZED CODE (Enter Code) M K
See DA Pamphlet 738-750 and 738-751
9. NOUN
10a. ORG WON/DOC NO 10b. EIC H R
11 SERIAL NUMBER 12. QTY 13. PD 17. PROJECT CODE 18. ACCOUNT PROCESSING 19. IN WARRANTY? 20. ADMIN NO
(if assigned) CODE (enter Y or N) N
14. MALFUNCTION DESCRIPTION (for DSU, GSU/AVIM, DEPOT use) 21. REIMBURSABLE CUSTOMER (if Intransit customer enter Y or N) Y
22. LEVEL OF WORK 23. SIGNATURE
F
24. DESCRIBE DEFICIENCIES OR SYMPTOMS ON THE BASIS OF COMPLETE CHECKOUT AND DIAGNOSTIC PROCEDURES IN EQUIPMENT TM (Do not
prescribe repairs)
25. REMARKS
PREPARATION INSTRUCTIONS FOR THIS PAGE
SECTION I SECTION III (Cont'd)
Block 1a. Enter UIC of submitting organization. Block 12. Enter the quantity of items being submitted.
Block 1b. Enter name of submitting organization. Block 13. Enter the maintenance priority designator
Block 1c. Enter number to be called when maint. is determined from DA PAM 710-2-1.
completed. Block 14. For DSU, GSU/AVIM, DEPOT use.
Block 2a. Enter UIC of supporting SAMS-2/SAMS-I/TDA Block 15a. Enter the code that most accurately describes when
if work is requested while in transit and away from your the fault or deficiency was detected. See DA Pamphlets
support maintenance unit. 738-750 and 738-751.
Block 2b. Enter utilization code. See DA Pamphlets Block 15b. Select one. Enter the code. See DA Pamphlets
738-750 and 738-751. 738-750 and 738-751.
Block 2c. Enter "Y" if reportable under AR 700-138. If Block 16. Enter the accumulated usage data in blocks, when
not, leave blank. equipment is subject to usage reporting.
Block 17. Enter the project code if one has been assigned. If
SECTION II not, leave blank.
Block 18. See DA Pamphlets 738-750 and 738-751.
Leave blank. To be completed by the support Block 19. Enter "Y" or "N" to indicate whether equipment is
maintenance DSU/GSU/AVIM/DEPOT. still under manufacturer's warranty.
Block 20. Enter the admin number assigned for property
SECTION III control purposes for the equipment being submitted.
Block 21. For DSU/GSU/AVIM/Depot use.
Block 5. Enter the Type Maintenance Request Code. Block 22. Enter level of work performed "O" for UNIT
See DA Pamphlet 738-750 and 738-751. LEVEL/AVUM, "F" for DSU/AVIM, "H" for GSU, "D" for DEPOT,
Block 6. Enter ID associated with block 7. See DA "K" for contractor or "L" for Spc Rpr Act.
Pamphlets 738-750 and 738-751. Block 23. Enter the signature of the CO or the CO's designated
Block 7. Enter the NSN or stock number of the item representative when the priority designator is 01-10. For
being submitted. priority designators 11-15, leave blank.
Block 8. Enter model of item being submitted. Block 24. Enter a brief description of the deficiencies or
Block 9. Enter noun/nomenclature of item being symptoms that you feel require attention at this level of maint.
submitted. Block 25. Self-explanatory.
Block 10a. Enter Work Order Number (WON)/DOC NO
assigned when item is submitted. Otherwise, leave blank.
Block 10b. Enter End Item Code. See AMDF.
Block 11. Enter serial number of item being submitted.
34a. SUBMITTED BY 35a. ACCEPTED BY 35c. DATE Block 34a. Enter first initial and last name of submitter.
Block 34b. Enter ordinal date submitted (YYDDD).
Block 35a. Enter first initial and last name of person accepting
maint. request.
34b. DATE 35b. STATUS 35d. TIME Block 35b. Enter the initial status. See DA Pamphlets 738-750 and
738-751.
Block 35c. Enter ordinal date accepted (YYDDD).
Block 35d. Enter military time.
DA FORM 2407, JUL 94 PREVIOUS EDITIONS OF DA FORM 2407 AND DA FORM 5504 ARE OBSOLETE RECEIPT COPY 1
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
Print Form Reset Form
MAINTENANCE REQUEST PAGE NO. NO OF PAGES REQUIREMENT CONTROL SYMBOL
CSGLD-1047(R1)
For use of this form, see DA PAM 738-750 and 738-751;
the proponent agency is DCSLOG "FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION I - CUSTOMER DATA SECTION II - MAINTENANCE ACTIVITY DATA
1a. UIC CUSTOMER 1b. CUSTOMER UNIT NAME 1c. PHONE NO 3a. WORK ORDER NUMBER (WON) 3b. SHOP 3c. PHONE NO
2a. SAMS-2 UIC/SAMS-I/TDA 2b. UTILIZATION CODE 2c. MCSR 4a. UIC SUPPORT UNIT 4b. SUPPORT UNIT NAME
SECTION III - EQUIPMENT DATA
5. TYPE MNT 6. ID 7. NSN 15a. FAILURE DETECTED DURING/WHEN DISCOVERED CODE (Enter code)
REQ CODE - See DA Pamphlet 738-750 and 738-751
15b. FIRST INDICATION OF TROUBLE/ HOW 16. MILES/KILOMETERS/HOURS/ROUNDS
8. MODEL RECOGNIZED CODE (Enter Code) M K
See DA Pamphlet 738-750 and 738-751
9. NOUN
10a. ORG WON/DOC NO 10b. EIC H R
11 SERIAL NUMBER 12. QTY 13. PD 17. PROJECT CODE 18. ACCOUNT PROCESSING 19. IN WARRANTY? 20. ADMIN NO
(if assigned) CODE (enter Y or N) N
14. MALFUNCTION DESCRIPTION (for DSU, GSU/AVIM, DEPOT use) 21. REIMBURSABLE CUSTOMER (if Intransit customer enter Y or N) Y
22. LEVEL OF WORK 23. SIGNATURE
F
24. DESCRIBE DEFICIENCIES OR SYMPTOMS ON THE BASIS OF COMPLETE CHECKOUT AND DIAGNOSTIC PROCEDURES IN EQUIPMENT TM (Do not
prescribe repairs)
25. REMARKS
26. TECHNICAL REFERENCES
SECTION IV - TASK REQUIREMENTS DATA
27a. FILE 27b. 27c. 27 d. TASK DESCRIPTION 27e. QTY 27f. WORK 27g. 27h. MH 27i MH
INPUT TASK ACT TO BE RPR CENTER FAILURE PROJ EXP
ACT CD NO CODE CODE
SECTION V - PART REQUIREMENTS
28a. FILE 28b. 28c. 28d. NSN OR PART NUMBER 28e. 28f. 28g. 28h. 28i. 28j. STORAGE 28k. 28l.
INPUT TASK ID SFX QTY QTY NMCS FAILURE LOCATION INITIALS COST
ACT CD NO NO CD RQD ISSUED CD CODE $
28m. TOTAL MANHOURS 28n. TOTAL MANHOURS COSTS $ 28o. TOTAL PARTS COSTS$
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION VI - COMPLETION DATA
29. QTY RPR 30. QTY CONDEMN 31. QTY NRTS 32. EVAC WON 33. EVAC UNIT NAME
SECTION VII - ACTION SIGNATURES
34a. SUBMITTED BY 35a. ACCEPTED BY 35c. DATE 36a. WORK STARTED BY 37a. INSPECTION BY 38a. PICKED UP BY
34b. DATE 35b. STATUS 35d. TIME 36b. STATUS 36c. DATE 36d. TIME 37b. STATUS 37c. DATE 37d. TIME 38b. STATUS 38c. DATE 38d. TIME
DA FORM 2407, JUL 94 NMP COPY 2
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
Print Form Reset Form
MAINTENANCE REQUEST PAGE NO. NO OF PAGES REQUIREMENT CONTROL SYMBOL
CSGLD-1047(R1)
For use of this form, see DA PAM 738-750 and 738-751;
the proponent agency is DCSLOG "FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION I - CUSTOMER DATA SECTION II - MAINTENANCE ACTIVITY DATA
1a. UIC CUSTOMER 1b. CUSTOMER UNIT NAME 1c. PHONE NO 3a. WORK ORDER NUMBER (WON) 3b. SHOP 3c. PHONE NO
2a. SAMS-2 UIC/SAMS-I/TDA 2b. UTILIZATION CODE 2c. MCSR 4a. UIC SUPPORT UNIT 4b. SUPPORT UNIT NAME
SECTION III - EQUIPMENT DATA
5. TYPE MNT 6. ID 7. NSN 15a. FAILURE DETECTED DURING/WHEN DISCOVERED CODE (Enter code)
REQ CODE - See DA Pamphlet 738-750 and 738-751
15b. FIRST INDICATION OF TROUBLE/ HOW 16. MILES/KILOMETERS/HOURS/ROUNDS
8. MODEL RECOGNIZED CODE (Enter Code) M K
See DA Pamphlet 738-750 and 738-751
9. NOUN
10a. ORG WON/DOC NO 10b. EIC H R
11 SERIAL NUMBER 12. QTY 13. PD 17. PROJECT CODE 18. ACCOUNT PROCESSING 19. IN WARRANTY? 20. ADMIN NO
(if assigned) CODE (enter Y or N) N
14. MALFUNCTION DESCRIPTION (for DSU, GSU/AVIM, DEPOT use) 21. REIMBURSABLE CUSTOMER (if Intransit customer enter Y or N) Y
22. LEVEL OF WORK 23. SIGNATURE
F
24. DESCRIBE DEFICIENCIES OR SYMPTOMS ON THE BASIS OF COMPLETE CHECKOUT AND DIAGNOSTIC PROCEDURES IN EQUIPMENT TM (Do not
prescribe repairs)
25. REMARKS
26. TECHNICAL REFERENCES
SECTION IV - TASK REQUIREMENTS DATA
27a. FILE 27b. 27c. 27d. TASK DESCRIPTION 27e. QTY 27f. WORK 27g. 27h. MH 27i MH
INPUT TASK ACT TO BE RPR CENTER FAILURE PROJ EXP
ACT CD NO CODE CODE
SECTION V - PART REQUIREMENTS
28a. FILE 28b. 28c. 28d. NSN OR PART NUMBER 28e. 28f. 28g. 28h. 28i. 28j. STORAGE 28k. 28l.
INPUT TASK ID SFX QTY QTY NMCS FAILURE LOCATION INITIALS COST
ACT CD NO NO CD RQD ISSUED CD CODE $
28m. TOTAL MANHOURS 28n. TOTAL MANHOURS COSTS $ 28o. TOTAL PARTS COSTS$
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION VI - COMPLETION DATA
29. QTY RPR 30. QTY CONDEMN 31. QTY NRTS 32. EVAC WON 33. EVAC UNIT NAME
SECTION VII - ACTION SIGNATURES
34a. SUBMITTED BY 35a. ACCEPTED BY 35c. DATE 36a. WORK STARTED BY 37a. INSPECTION BY 38a. PICKED UP BY
34b. DATE 35b. STATUS 35d. TIME 36b. STATUS 36c. DATE 36d. TIME 37b. STATUS 37c. DATE 37d. TIME 38b. STATUS 38c. DATE 38d. TIME
DA FORM 2407, JUL 94 CONTROL COPY 3
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
Print Form Reset Form
MAINTENANCE REQUEST PAGE NO. NO OF PAGES REQUIREMENT CONTROL SYMBOL
CSGLD-1047(R1)
For use of this form, see DA PAM 738-750 and 738-751;
the proponent agency is DCSLOG "FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION I - CUSTOMER DATA SECTION II - MAINTENANCE ACTIVITY DATA
1a. UIC CUSTOMER 1b. CUSTOMER UNIT NAME 1c. PHONE NO 3a. WORK ORDER NUMBER (WON) 3b. SHOP 3c. PHONE NO
2a. SAMS-2 UIC/SAMS-I/TDA 2b. UTILIZATION CODE 2c. MCSR 4a. UIC SUPPORT UNIT 4b. SUPPORT UNIT NAME
SECTION III - EQUIPMENT DATA
5. TYPE MNT 6. ID 7. NSN 15a. FAILURE DETECTED DURING/WHEN DISCOVERED CODE (Enter code)
REQ CODE - See DA Pamphlet 738-750 and 738-751
15b. FIRST INDICATION OF TROUBLE/ HOW 16. MILES/KILOMETERS/HOURS/ROUNDS
8. MODEL RECOGNIZED CODE (Enter Code) M K
See DA Pamphlet 738-750 and 738-751
9. NOUN
10a. ORG WON/DOC NO 10b. EIC H R
11 SERIAL NUMBER 12. QTY 13. PD 17. PROJECT CODE 18. ACCOUNT PROCESSING 19. IN WARRANTY? 20. ADMIN NO
(if assigned) CODE (enter Y or N) N
14. MALFUNCTION DESCRIPTION (for DSU, GSU/AVIM, DEPOT use) 21. REIMBURSABLE CUSTOMER (if Intransit customer enter Y or N) Y
22. LEVEL OF WORK 23. SIGNATURE
F
24. DESCRIBE DEFICIENCIES OR SYMPTOMS ON THE BASIS OF COMPLETE CHECKOUT AND DIAGNOSTIC PROCEDURES IN EQUIPMENT TM (Do not
prescribe repairs)
25. REMARKS
26. TECHNICAL REFERENCES
SECTION IV - TASK REQUIREMENTS DATA
27a. FILE 27b. 27c. 27d. TASK DESCRIPTION 27e. QTY 27f. WORK 27g. 27h. MH 27i MH
INPUT TASK ACT TO BE RPR CENTER FAILURE PROJ EXP
ACT CD NO CODE CODE
SECTION V - PART REQUIREMENTS
28a. FILE 28b. 28c. 28d. NSN OR PART NUMBER 28e. 28f. 28g. 28h. 28i. 28j. STORAGE 28k. 28l.
INPUT TASK ID SFX QTY QTY NMCS FAILURE LOCATION INITIALS COST
ACT CD NO NO CD RQD ISSUED CD CODE $
28m. TOTAL MANHOURS 28n. TOTAL MANHOURS COSTS $ 28o. TOTAL PARTS COSTS$
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION VI - COMPLETION DATA
29. QTY RPR 30. QTY CONDEMN 31. QTY NRTS 32. EVAC WON 33. EVAC UNIT NAME
SECTION VII - ACTION SIGNATURES
34a. SUBMITTED BY 35a. ACCEPTED BY 35c. DATE 36a. WORK STARTED BY 37a. INSPECTION BY 38a. PICKED UP BY
34b. DATE 35b. STATUS 35d. TIME 36b. STATUS 36c. DATE 36d. TIME 37b. STATUS 37c. DATE 37d. TIME 38b. STATUS 38c. DATE 38d. TIME
DA FORM 2407, JUL 94 ORGANIZATION COPY 4
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
Print Form Reset Form
MAINTENANCE REQUEST PAGE NO. NO OF PAGES REQUIREMENT CONTROL SYMBOL
CSGLD-1047(R1)
For use of this form, see DA PAM 738-750 and 738-751;
the proponent agency is DCSLOG "FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION I - CUSTOMER DATA SECTION II - MAINTENANCE ACTIVITY DATA
1a. UIC CUSTOMER 1b. CUSTOMER UNIT NAME 1c. PHONE NO 3a. WORK ORDER NUMBER (WON) 3b. SHOP 3c. PHONE NO
2a. SAMS-2 UIC/SAMS-I/TDA 2b. UTILIZATION CODE 2c. MCSR 4a. UIC SUPPORT UNIT 4b. SUPPORT UNIT NAME
SECTION III - EQUIPMENT DATA
5. TYPE MNT 6. ID 7. NSN 15a. FAILURE DETECTED DURING/WHEN DISCOVERED CODE (Enter code)
REQ CODE - See DA Pamphlet 738-750 and 738-751
15b. FIRST INDICATION OF TROUBLE/ HOW 16. MILES/KILOMETERS/HOURS/ROUNDS
8. MODEL RECOGNIZED CODE (Enter Code) M K
See DA Pamphlet 738-750 and 738-751
9. NOUN
10a. ORG WON/DOC NO 10b. EIC H R
11 SERIAL NUMBER 12. QTY 13. PD 17. PROJECT CODE 18. ACCOUNT PROCESSING 19. IN WARRANTY? 20. ADMIN NO
(if assigned) CODE (enter Y or N) N
14. MALFUNCTION DESCRIPTION (for DSU, GSU/AVIM, DEPOT use) 21. REIMBURSABLE CUSTOMER (if Intransit customer enter Y or N) Y
22. LEVEL OF WORK 23. SIGNATURE
F
24. DESCRIBE DEFICIENCIES OR SYMPTOMS ON THE BASIS OF COMPLETE CHECKOUT AND DIAGNOSTIC PROCEDURES IN EQUIPMENT TM (Do not
prescribe repairs)
25. REMARKS
26. TECHNICAL REFERENCES
SECTION IV - TASK REQUIREMENTS DATA
27a. FILE 27b. 27c. 27d. TASK DESCRIPTION 27e. QTY 27f. WORK 27g. 27h. MH 27i MH
INPUT TASK ACT TO BE RPR CENTER FAILURE PROJ EXP
ACT CD NO CODE CODE
SECTION V - PART REQUIREMENTS
28a. FILE 28b. 28c. 28d. NSN OR PART NUMBER 28e. 28f. 28g. 28h. 28i. 28j. STORAGE 28k. 28l.
INPUT TASK ID SFX QTY QTY NMCS FAILURE LOCATION INITIALS COST
ACT CD NO NO CD RQD ISSUED CD CODE $
28m. TOTAL MANHOURS 28n. TOTAL MANHOURS COSTS $ 28o. TOTAL PARTS COSTS$
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
SECTION VI - COMPLETION DATA
29. QTY RPR 30. QTY CONDEMN 31. QTY NRTS 32. EVAC WON 33. EVAC UNIT NAME
SECTION VII - ACTION SIGNATURES
34a. SUBMITTED BY 35a. ACCEPTED BY 35c. DATE 36a. WORK STARTED BY 37a. INSPECTION BY 38a. PICKED UP BY
34b. DATE 35b. STATUS 35d. TIME 36b. STATUS 36c. DATE 36d. TIME 37b. STATUS 37c. DATE 37d. TIME 38b. STATUS 38c. DATE 38d. TIME
DA FORM 2407, JUL 94 FILE COPY 5
"FOR USE BY MAINTENANCE ACTIVITY ONLY"
