AK Pamphlet 350-20 Eighth Army Range and Training Area

Appendix N
Ammunition Malfunction Report
1. A verbal report will be submitted to the servicing Range Control Center immediately upon
discovery of malfunction. A written report (in the same format) will be provided to the servicing
Range Control Center within 24 hours of initial report.
2. Reporting format:
Line 1 - Type of malfunction: ______
Line 2 - Did unit properly conduct all appropriate malfunction procedures as outlined in the TM
for the weapon system involved?
__________________
Line 3 - What is the training range designation and grid or six digit grid location of the actual
malfunction? __________________________________________
Line 4 - Time of actual incident: _________________
Line 5 - Names of ROIC and RSO: __________________
Line 6 - Unit designation: __________________
Line 7 - Ammunition information: _______
a. Type of munitions that malfunctioned (e.g. 105mm, M392 or M18):
______________________________
b. Type of fuse installed (if applicable): ______
Line 8 - Number of rounds that malfunctioned: ____________
Line 9 - Model or Lot number of ammunition (round and fuse): _______
Line 10 - Type of fuse or Lot number:
Line 11 - Type of fuse mated on round:
Line 12 - Location and name of POC:
Line 13 - If injuries occurred, provide name/rank/SSAN of individuals involved and type of
injuries sustained:
________________________________________________
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AK Pam 350-20, 10 October 2006