Da Form 4379 PDF Details

Ammunition malfunctions can lead to serious accidents and operational failures, impacting both safety and efficiency within the armed services. Recognizing the critical nature of these incidents, the DA 4379 form serves as a thorough report dedicated to cataloging the specific details of ammunition malfunctions. This document is an essential piece of administrative protocol, mandated for use by the Department of the Army Regulation 75-1, with the Deputy Chief of Staff for Logistics (DCSLOG) as the overseeing body. The form meticulously captures various elements tied to a malfunction event, including identifying the malfunctioning item and its components, providing a detailed malfunction description, and noting the site of malfunction alongside the unit controlling and using the ammunition. It goes further to document the date and time of occurrence, any casualties (ranging from fatalities to non-hospitalized injuries), and the extent of damage caused, including whether the weapon was damaged and if repairs can be managed at the unit level. Additionally, it covers detonation details, the quantity of ammunition remaining, and whether certain exhibits are available for further examination. The form also inquires about the firing conditions at the time of malfunction, including the weapon used, target, range, and environmental conditions like weather and terrain, which could influence a malfunction's outcome. The storage conditions of the malfunction lot and packaging details are required entries, ensuring a comprehensive analysis of factors leading to the incident. This form not only aids in immediate response and preventive measures but also contributes to long-term ammunition safety and quality control within military operations.

QuestionAnswer
Form NameDa Form 4379
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesOBSTRUCTIONS, da form 4379, FUZE, 1961

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AMMUNITION MALFUNCTION REPORT

For use of this form, see AR 75-1; the proponent agency is DCSLOG

1.REPORT NO.

Requirements Control Symbol - CSGLD 1961

2. MALFUNCTIONING ITEM

3. ITEM COMPONENTS

4.MALFUNCTION DESCRIPTION

5.

SITE OF MALFUNCTION

 

6.

UNIT CONTROLLING SITE

 

7.

UNIT USING AMMUNITION

 

 

 

 

 

 

 

 

 

8a.

DATE MALFUNCTION

8b. TIME

 

 

 

 

 

 

 

OCCURRED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9a.

CASUALTIES (No. Killed)

 

9b.

CASUALTIES (Hospitalized)

 

9c.

CASUALTIES (Other Injuries)

 

 

 

 

 

 

 

 

 

9d.

DESCRIPTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

DAMAGE

 

 

 

10c.

DESCRIPTION

 

 

a.

WEAPON DAMAGED?

Yes

No

N/A

 

 

 

b.DAMAGE REPAIRABLE

 

AT UNIT LEVEL?

Yes

No

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

DETONATION

 

 

 

 

c.

M FROM WEAPON

 

d. M FROM NEAREST PERSON

 

a. None

 

b. In Weapon

 

 

 

 

 

 

12.

Quantity Remaining

 

 

13.

EXHIBITS AVAILABLE

(Hold Exhibits Pending Disposition Instructions

 

 

 

 

 

 

 

per AR 75-1, para. 2-1).

a.

FIRING SITE

b.

LOCAL STORAGE

c. SUSPENDED?

a. Fragments

 

b. Intact Components

 

 

 

 

YES

NO

c. Weapon

 

d. None

 

 

 

 

 

 

 

14.Firing Conditions for Malfunction Lot

a.

WEAPON

 

 

 

 

b.

TARGET

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

RANGE

d.

AZIMUTH

e.

ELEVATION

f.

ZONE

 

 

g. FUZE SETTING

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

h.

FIRED HOW MANY ROUNDS PER MINUTE

i.

FOR HOW MANY MINUTES BEFORE

j.

TOTAL FIRED FROM WEAPON ON DAY OF

 

FROM WEAPON

 

 

 

MALFUNCTION

 

 

 

MALFUNCTION

 

 

 

 

 

 

 

 

 

 

 

k.

TOTAL MALFUNCTIONED

 

 

l.

TOTAL FIRED

 

 

m.

MALFUNCTION RATE

 

 

 

 

 

 

 

 

 

%

 

 

 

 

 

 

 

 

 

 

 

15.

Terrain

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

FIRING SITE

b.

DOWN RANGE

 

c. POSSIBLE OBSTRUCTIONS

 

 

 

d. CLEAR VIEW OF FLIGHT PATH

 

 

 

 

 

 

 

 

 

 

M

 

 

 

 

 

 

 

 

 

 

 

16.Weather Conditions

a.

VISIBILITY

b.

PRECIPITATION

c.

TEMPER-

 

d.

PRIOR 24 HOURS

e.

RELATIVE

 

 

 

 

 

ATURE

 

 

 

 

 

HUMIDITY

 

 

 

 

 

 

F

HIGH

 

LOW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

Malfunction Lot Storage Conditions

 

 

 

18.

Packaging of Malfunction Lot

YES

NO

 

 

 

 

 

 

 

 

 

 

 

a.

Firing Site:

Open

Enclosed

b. Local Storage:

Open

Enclosed

a.

Original Package?

 

 

 

 

 

 

 

 

 

 

 

 

c.

UNPACKED HOW

 

d. MAGAZINE TYPE

e.

STORED HOW

b.

Original Seal?

 

 

 

MANY HRS. BEFORE

 

 

 

MANY MONTHS

 

 

 

 

 

 

 

 

c.

Package Adequate?

 

 

 

MALFUNCTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

Package Damaged?

 

 

 

 

 

 

 

 

 

 

 

 

 

19.ADDITIONAL DATA (If more space is needed, use continuation sheet or back of form)

20a.

FOR ADDITIONAL DATA, CONTACT

21a.

PERSON COMPLETING REPORT

 

 

 

 

 

 

 

 

b.

TELEPHONE NO. (Include Area Code)

b.

TELEPHONE NO. (Include Area Code)

c.

DATE

 

 

 

 

 

 

DA FORM 4379, APR 01

DA FORM 4379, JAN 89 MAY BE USED

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