If you are a member of the military, then you are probably familiar with the DA Form 4379. This form is used to document and report foreign contacts by service members. If you have recently traveled overseas or have interacted with someone who is not a United States citizen, then it is important to report this information using the DA Form 4379. Failing to properly report foreign contacts can result in disciplinary action, so be sure to submit your completed form as soon as possible.
| Question | Answer |
|---|---|
| Form Name | Da Form 4379 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | OBSTRUCTIONS, da form 4379, FUZE, 1961 |
AMMUNITION MALFUNCTION REPORT
For use of this form, see AR
1.REPORT NO.
Requirements Control Symbol - CSGLD 1961
2. MALFUNCTIONING ITEM |
3. ITEM COMPONENTS |
4.MALFUNCTION DESCRIPTION
5. |
SITE OF MALFUNCTION |
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6. |
UNIT CONTROLLING SITE |
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7. |
UNIT USING AMMUNITION |
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8a. |
DATE MALFUNCTION |
8b. TIME |
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OCCURRED |
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9a. |
CASUALTIES (No. Killed) |
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9b. |
CASUALTIES (Hospitalized) |
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9c. |
CASUALTIES (Other Injuries) |
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9d. |
DESCRIPTION |
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10. |
DAMAGE |
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10c. |
DESCRIPTION |
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a. |
WEAPON DAMAGED? |
Yes |
No |
N/A |
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b.DAMAGE REPAIRABLE
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AT UNIT LEVEL? |
Yes |
No |
N/A |
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11. |
DETONATION |
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c. |
M FROM WEAPON |
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d. M FROM NEAREST PERSON |
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a. None |
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b. In Weapon |
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12. |
Quantity Remaining |
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13. |
EXHIBITS AVAILABLE |
(Hold Exhibits Pending Disposition Instructions |
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per AR |
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a. |
FIRING SITE |
b. |
LOCAL STORAGE |
c. SUSPENDED? |
a. Fragments |
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b. Intact Components |
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YES |
NO |
c. Weapon |
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d. None |
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14.Firing Conditions for Malfunction Lot
a. |
WEAPON |
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b. |
TARGET |
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c. |
RANGE |
d. |
AZIMUTH |
e. |
ELEVATION |
f. |
ZONE |
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g. FUZE SETTING |
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h. |
FIRED HOW MANY ROUNDS PER MINUTE |
i. |
FOR HOW MANY MINUTES BEFORE |
j. |
TOTAL FIRED FROM WEAPON ON DAY OF |
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FROM WEAPON |
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MALFUNCTION |
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MALFUNCTION |
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k. |
TOTAL MALFUNCTIONED |
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l. |
TOTAL FIRED |
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m. |
MALFUNCTION RATE |
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% |
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15. |
Terrain |
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a. |
FIRING SITE |
b. |
DOWN RANGE |
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c. POSSIBLE OBSTRUCTIONS |
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d. CLEAR VIEW OF FLIGHT PATH |
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M |
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16.Weather Conditions
a. |
VISIBILITY |
b. |
PRECIPITATION |
c. |
TEMPER- |
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d. |
PRIOR 24 HOURS |
e. |
RELATIVE |
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ATURE |
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HUMIDITY |
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F |
HIGH |
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LOW |
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F |
F |
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17. |
Malfunction Lot Storage Conditions |
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18. |
Packaging of Malfunction Lot |
YES |
NO |
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a. |
Firing Site: |
Open |
Enclosed |
b. Local Storage: |
Open |
Enclosed |
a. |
Original Package? |
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c. |
UNPACKED HOW |
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d. MAGAZINE TYPE |
e. |
STORED HOW |
b. |
Original Seal? |
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MANY HRS. BEFORE |
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MANY MONTHS |
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c. |
Package Adequate? |
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MALFUNCTION |
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d. |
Package Damaged? |
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19.ADDITIONAL DATA (If more space is needed, use continuation sheet or back of form)
20a. |
FOR ADDITIONAL DATA, CONTACT |
21a. |
PERSON COMPLETING REPORT |
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b. |
TELEPHONE NO. (Include Area Code) |
b. |
TELEPHONE NO. (Include Area Code) |
c. |
DATE |
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DA FORM 4379, APR 01 |
DA FORM 4379, JAN 89 MAY BE USED |
USAPA V1.00 |