What is DD Form 2164? It is a Department of Defense form titled DD Form 2164, X-Ray Verification/Certification Worksheet, November 1978, and its job is straightforward: X-Ray Verification/Certification Worksheet. That single line covers most of what people want to know before they download it.
Will you need a different form because of where you serve? No. DD forms are Department-wide instruments, and that scope is what separates them from service publications. One edition, all branches, defense agencies included.
Who decides this form exists? not stated owns it; not stated directs its use. If someone told you to file this, the authority traces back to those.
How current is this? Edition not stated, publisher status not stated. That is the version described throughout this page.
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.
Download the form
Which files are here? These: PDF. How much work is involved? 2 pages, about 200 entry fields.
Why do two kinds of pdf exist? Because two kinds of user exist. One completes the form on screen and forwards a file; the other prints a blank and fills it by hand. The fillable release has interactive boxes, the printable release is a static image of the same page.
Does typing matter? It does. Your completed form will probably be scanned, forwarded and filed, and typed text comes through each of those steps unchanged while handwriting degrades. If pen is your only option, block capitals give the receiving clerk a fighting chance.
Is xfdl worth downloading? Only if you have the viewer. The format comes from IBM Lotus Forms, which carried Defense form distribution for a long stretch, and no ordinary pdf application will read it.
What does any of this cost? Nothing. Every format listed is a free download. One practical note: save the file and open it in a desktop pdf reader, because browser previews often ignore interactive fields and lose what you typed.
Where do you start? At the top. Identification first, the substance of the entry second, certification last. Why that order? Because fields lower on the page often depend on data you established in the header, and filling out of sequence produces contradictions.
What if your copy is old? Replace it. Check the date printed on the form against not stated. Old blanks circulate for years in shared folders, and because a DD revision lands across the whole Department at once, the receiving office will be working from the new layout.
What if a specific field still puzzles you? Read the instructions printed on the form, then not stated. Which wins if they differ? The directive.
What happens after you finish? It routes to the office specified in not stated or in local guidance. And your own record? Save a duplicate first; nobody regrets having one.
How do you find a form referenced inside this one? By its number alone. The DD sequence runs across the entire Department, so a number identifies exactly one document regardless of which service cited it.
Can you assume a matching number is the same form? No, and this is where downloads go wrong. Read the prefix. Army numbering and Department numbering are independent systems, so the digits alone tell you nothing about which document you need.
Why do editions change at all? Three reasons, mostly: the prescribing directive gets reissued, the information collected changes, or the required notice language is amended. Are you notified when it happens? No. Which is why confirming not stated at the moment you download is worth the few seconds.
Will your completed form be accepted? That is not a question this page can answer. What you have here is a published Department of Defense document, a description of it and instructions for filling it out. Nothing on the page is legal advice, and nothing here determines what any office does with a submission. Where do the remaining questions go? To not stated, to your 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?