STP 10-92A34-SM-TG Soldier's Manual and Trainer's ... - AskTOP

STP 10-92A34-SM-TGAppendix ASample DA Form 5164-R (Hands-on Evaluation)This appendix provides a sample of DA Form 5164-R (see Figure A-1) for the tasks in this STP. TheDA Form 5164-R allows the trainer to keep a record of the performance measures a Soldier passes orfails on each task. Trainers should use the following instructions when completing DA Form 5164-R.Prior to Evaluating the Soldier.• The form also can be downloaded from the Army Publishing Directorate website(www.apd.army.mil/forms).• Enter the task title and 10-digit number for the task from the evaluation guide of the SM tasksummary.• In column (a), enter the number of each performance measure from the evaluation guide.• In column (b), enter the performance measure corresponding to the performance measurenumber in column (a). (You may abbreviate this information if necessary.)• Enter the feedback statement from the evaluation guide just below the last performance measure.• Locally reproduce the partially completed form if you are evaluating more than one Soldier on thetask or the same Soldier on more than one task.During the Evaluation.• Enter the date just before evaluating the Soldier's task performance.• Enter the evaluator's name and the Soldier's name and unit.• For each performance measure in column (b), enter a check in column (c) PASS or column (d)FAIL as appropriate.• Compare the number of performance measures the Soldier passes (and if applicable, whichones) against the task standard shown in the feedback statement. If the standard is met orexceeded, check the GO block under STATUS; otherwise, check the NO-GO block.7 May 2008 A-1