Fill in block 1 with the date the investigation process will be initiated. Write out the date as all numbers without dashes and in the order of year, month, and day. Complete block 3 with the date of when the item was lost, stolen, damaged, or destroyed with the same number sequence of year, month, and day without dashes.
Enter the National Stock Number, manufacturer's number or other number in block 4. Describe the item in block 5 such as the serial number, model number or the controlled inventory item number. If the item is not standard stock, provide a brief description that gives enough information for identification. Attach more forms if indicating more items and the descriptions.
Fill in the number of items lost, damaged, stolen or destroyed in block 6. Put it in as the number including pair, dozen, and each when applicable. Include the unit cost for the individual item in block 7 and the total cost if the circumstances involve more than one item in block 8.
Write in the situation that occurred concerning the item being investigated in block 9 including checking the box on whether the item was lost, damaged or destroyed. Also mark in if it was an organization, installation, or the Office of Compliance Inspections and Examinations. Describe the entire incident including the involved person's name, grade and social security number, and also the date and place of the incident. The description must answer the five basic questions of who, what, when, where, and how. Include any exhibits available and attach additional pages.
Fill in block 11a with the base, unit designation, state and country, office symbol, and zip code. Enter the typed name, DSN, signature and date of when the report is signed in blocks 11b through 11e. The person who filled out boxes 1 through 9 must complete this section.
- Department of Defense Financial Management Regulation; Office of the Under Secretary of Defense (Comptroller) - Summary of Major Changes to DoD 7000.14-r, Volume 12, Chapter 7 Financial Liability For Government Property Lost, Damaged, Destroyed, or Stolen
- U.S. Army IMCOM - Fort Wainwright, Alaska: Installation Management Command Pacific Region; Property Accountability Standard Operating Procedures
- government security system image by Stephen Orsillo from Fotolia.com