The United States Army | U.S. Army TMDE Activity

CALIBRATION AND REPAIR REQUIREMENTS WORKSHEET

For use of this form, see TB 750-25, the proponent agency is USAMC

1. FROM (Customer Address) *Required*

2. DATE (YYYYMMDD) *Required*

3. REQUESTED ACTION *Required*

Add - New TMDE

Delete

Add - New System Code

Change

4a. REQUESTOR'S NAME *Required*

4b. PERSONNEL TYPE *Required*

4c. REQUESTOR'S ORGANIZATION / UIC *Required*

4d. REQUESTOR'S EMAIL ADDRESS *Required* *Required*

4e. REQUESTOR'S PHONE NUMBER *Required* *Required*

5a. ALTERNATIVE POC NAME *Required*

5b. PERSONNEL TYPE *Required*

5c. ALTERNATE'S ORGANIZATION / UIC *Required*

5d. ALTERNATE'S EMAIL ADDRESS *Required* *Required*

5e. ALTERNATE'S PHONE NUMBER *Required* *Required*

ITEM INFORMATION

6. NATIONAL STOCK NUMBER *Required*

7. MANUFACTURER *Required*

8. MODEL NUMBER *Required*

9. ITEM DESCRIPTION *Required*

10. IS THIS ITEM IN THE TB 43-180? *Required*

Yes (continue to block 17)

No (continue to block 11)

11. DID A PEO / PD AUTHORIZE THIS PURCHASE? *Required*

Yes

No

a. If yes, what organization purchased and fielded this item?
*Required*

b. If no, what organization authorized purchase? *Required*

12. WAS THE PREFERRED ITEMS LIST (PIL) CHECKED BEFORE PURCHASING THIS ITEM? *Required*

Yes

No

13. WHAT WEAPON SYSTEM / PLATFORM WILL THE ITEM BE USED FOR?
*Required*

14. LOCATION(S) THIS ITEM WILL BE FIELDED TO?
*Required*

15. QUANTITY OF ITEMS ORDERED / FIELDED?
*Required*

16. DO YOU HAVE CALIBRATION PROCEDURES AND OEM MANUALS? *Required*

Yes

No

17. REMARKS

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