DA Form 5811 R – Fill Out and Use This PDF

Updated: Nov 2, 2026

The DA Form 5811-R is officially designated as the Certificate for Lost or Damaged Class 5 Ammunition Items. Its primary use, as outlined in DA PAM 710-2-1, involves the documentation and certification of incidents concerning the loss or damage of classified ammunition, under the auspices of the DCSLOG. Detailed within this form are provisions for certifying the circumstances of the loss or damage, determining accountability, and outlining the subsequent actions required, whether it be no further action, administrative adjustments, repairs, or formal reporting.

For individuals responsible for the custody and management of Class 5 Ammunition Items, accurately completing the DA 5811-R form is crucial for maintaining operational integrity and accountability within military logistics operations. Ensure accuracy and compliance by clicking the button below to fill out the form.

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How to Fill Out DA Form 5811

DA Form 5811 at a glance

What it is: Certificate for lost or damaged class 5 ammunition items.

Who signs: Box 7a: signature. Box 7b: date. In Part II, Box 13a: signature. Box 13b: title. Box 13c: date.

A filled-in DA Form 5811 example: lost and damaged ammunition items

DA Form 5811 example filled out, example: lost and damaged ammunition items — A unit member certifies lost and damaged ammunition on DA Form 5811. Two items are lost, two are damaged, and none involves negligence. Part II is left blank because Part I is shown; none of its entries is real.

How to fill out DA Form 5811, box by box

Boxes 1 to 5, the items

In Part I, the certification, you certify that the items described in blocks 1-5 were as stated. Circumstances of the loss or damage are accurately described.

Enter the stock number in Box 1, the description in Box 2 and the quantity in Box 3.

Box 4, item was (Check): a. lost b. damaged.

Box 5, damaged by negligence? (Check) a. yes b. no.

Box 6, the circumstances

Box 6: circumstances of loss or damage.

Box 7, the signature and date

Box 7a: signature. Box 7b: date.

Part II, the action, Boxes 8 to 13

In Part II, the action, Box 8: I have reviewed the evidence pertaining to the loss or damage as stated, and I agree or do not agree that the loss or damage to the class 5 item (s) was or was not due to negligence, willful misconduct, or deliberate unauthorized use.

Check all that apply. Box 9: no further action is required.

Box 10: an administrative adjustment shall be made in the property book for the class 5 item (s) that were not lost through negligence, willful misconduct, or deliberate unauthorized use.

Box 11: the damaged class 5 item(s) shall be repaired as fair wear and tear as the damage was not caused by negligence, willful misconduct, or deliberate unauthorized use.

Box 12: the circumstances surrounding the loss or damage warrant the processing of a formal Report or Survey that will be initiated immediately by the responsible property officer.

In Part II, Box 13a: signature. Box 13b: title. Box 13c: date.

Common questions about DA Form 5811

What is DA form 5811 used to document?

Certificate for lost or damaged class 5 ammunition items. For use of this form, see DA PAM 700-16; the proponent agency is DCS, G-4.

Sources

[1] DA Form 5811 (JUN 2021), Certificate - Lost or Damaged Class 5 Ammunition Items, Department of the Army (the Official source link on this page).

DA Form 5811 PDF Details

The DA Form 5811-R is mandated under DA PAM 710-2-1 to record accountability incidents involving Class 5 ammunition. Section 1 of the form captures the item's National Stock Number (NSN), nomenclature, unit of issue, quantity, and whether the item was lost or damaged. Section 2 requires a narrative description of the circumstances surrounding the incident, including the date, location, and the individual responsible for custody. Section 3 is completed by a reviewing authority who documents the determination of negligence, selects the appropriate action (no further action, administrative adjustment, repair, or formal report of survey), and signs the form. Properly completing all three sections is essential for maintaining supply accountability under Army Regulation 710-2.

This form is required when Class 5 ammunition items are reported lost during training exercises, field operations, or storage, or when physical damage renders them unserviceable. The proponent agency, DCSLOG, reviews completed forms to ensure compliance with Army logistics policies. Failure to file DA Form 5811-R when required can result in adverse administrative action against the responsible individual. All entries must be legible, accurate, and supported by witness statements where applicable.

Question	Answer
Form Name	DA Form 5811
Form Length	1 page
Fillable?	Yes
Fillable fields	44
Avg. time to fill out	15 sec
Other names	da form 5811, 5811 r, da 5811, da form 5811 fillable