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DD Form 2164 — DD Form 2164, X-Ray Verification/Certification Worksheet, November 1978

X-Ray Verification/Certification Worksheet

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The scope here is Department-wide. DD Form 2164 — DD Form 2164, X-Ray Verification/Certification Worksheet, November 1978 — exists to X-Ray Verification/Certification Worksheet, and it applies across the services rather than inside one. That is what the DD prefix encodes: joint issue, single edition, every branch and defense agency working from identical paper.

not stated is the prescribing publication and not stated the office responsible for the document. Deadlines belong to local implementing guidance, not to either of those, so a submission date is a question for the receiving office.

Use not stated, status not stated. Older printings circulate widely and lose their currency Department-wide the moment a new edition issues.

Available: PDF, across 2 pages, roughly 200 fields. That is the whole scope of the download decision.

Fillable pdf is the default choice. Its boxes hold typed entries inside the document; the printable release is a static image of the same page with no interactive layer. Since DD forms routinely cross between services and agencies before they are filed, typed entries matter more here than on a form that stays inside one office.

Xfdl needs IBM Lotus Forms Viewer or a compatible client — a pdf reader will not open it. The format was the Defense standard for electronic forms across the Department for years, which is why it persists in DD distribution long after most users moved to pdf.

All formats are free. One operational note: save the file locally and open it in a desktop reader. Browser-embedded viewers drop field properties and lose typed data without warning.

What the form asks for

  • Action. Press space bar to mark X in first box if required, second box if not required, or third box if taken.
  • Location (include building and room number).
  • Date and time of service.
  • Date next service due.
  • 1. Control no. 1 (master control). Manufacturer.
  • Model (include type, style, size, focal spots, etc.).
  • Serial number (housing).
  • 2. Control no. 2 (room control). Manufacturer.
  • Model.
  • 3. Radiographic tube. Manufacturer.
  • Model.
  • Serial number.
  • Serial number.
  • 4. Radiographic tube (auxiliary tube). Manufacturer.
  • Model.
  • Serial number.
  • 5. Fluoroscopic tube. Manufacturer.
  • Model.
  • Serial number.
  • Part 2 - Visual inspection of equipment. 6. Certification labels are affixed and visible. X if no action required.
  • Type of action required.
  • X if action taken.
  • Initial and date.
  • 7. Steel counterweight cables. X if no action required.

Start by matching the printed date to not stated. Old blanks accumulate in shared folders for years. Because the Department reissues to all services in one action, nobody is still accepting the previous layout by local custom.

Unclear entries — read the form face, then not stated; the directive prevails.

Route it where not stated or local procedure directs, and keep a copy first. On a Department form the receiving office is frequently outside your own chain — another service, a defense agency, a joint command — which makes recovering a lost original slower than it would be internally.

Look up cross-referenced forms by series and number. DD numbering is unified across the Department, which removes the usual step of identifying which service issued the thing.

Do not read across from a service number. DA numbering is Army-specific under an Army proponent; DD numbering is Department-wide under not stated or an equivalent Department office. The sequences are unrelated, so identical digits in each identify two different documents. Read the prefix, not the digits.

Three drivers of revision: directive reissue, altered collection requirements, updated statutory notice text. No notification accompanies any of them, so download fresh and confirm not stated rather than reusing an archived file.

Limits of this page: it distributes a published Department of Defense document and describes it. No legal advice, no procedural ruling, no statement about whether any submission will be accepted. Applicability, eligibility and procedure belong to not stated, to a servicing personnel office, or to the office named in not stated.

Questions and answers

What is DD Form 2164?
DD Form 2164, X-Ray Verification/Certification Worksheet, November 1978
Which edition is current?
Not stated by the publisher
Who is responsible for this form?
Not stated
In which formats can it be downloaded?
PDF

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