bo 3500.1n - Marine Corps Base Camp Pendleton

BO 3500.1N
25 Mar 08
AMMUNITION MALFUNCTION REPORT
MALFUNCTION REPORT ROUGH
Ref: MCO 8025.1
Unit Identification: ___________________
Report Serial Number: __________________
Point of Contact: ________________________________________
Telephone # DSN: __________________ Comm: _________________
Ammunition Data: _________________________________________
NSN: _____________________________________________________
DODIC: Nomenclature: Lot#: _______________________________
(In case of a 155mm where the projectile with fuse, propellant charge, &
primer are loaded into the weapons separately, the above blocks must be done
for each item).
Description of Malfunction:
Provide a narrative of what occurred, whether there were any non-standard
conditions:
____________________________________________________________________________
____________________________________________________________________________
Indicate the number of casualties:
Minor Injuries requiring outpatient care: _____________
Major Injuries requiring hospitalization: _____________
Fatalities: __________
Prevailing Conditions:
Time: _________
Date: _________
Weather Conditions: ____________________
G-3