DA Form 4676-R
1 Dec 77
TM 1-1520-238-PM
1–8
PHASED MAINTENANCE CHECKLIST (SUPPLEMENTAL SHEET)
For use of this form, see TM 55-1510 series and TM 55-1520 series, the proponent agency is the US Army Materiel Development and Readiness Command.
DATE
PHASE NO.
AREA NAME AND NUMBER
AIRCRAFT SERIAL NO.
TOTAL HOURS THIS AREA
INSPECT
AREA
NO.
INSPECT
ITEM
NO
INSPECTION REQUIREMENTS
STATUS
FAULTS AND/OR REMARKS
ACTION TAKEN
INITIAL
“FOD REMINDER”
Check work area for tools and parts after completion of maintenance and Inspection.
Figure 3.
Example of Checklist Supplemental Sheet (Sheet 2 of 2)
