Begin by matching the form to your task. DA Form 5168-R is titled SAFETY CLEARANCE ORDER (ELECTRICAL FACILITIES) (LRA), and you reach for it when you need to safety clearance order (electrical facilities) (lra). Once that matches, check the date. The edition here is 06/01/1999, published with the status ACTIVE. After that, glance at the length: you will be working through 1 page(s) and somewhere near 140 fields.
Next, find out whether you are the one who fills it. In most cases you complete the entries yourself, and an administrator in your unit reviews what you wrote before it moves on. If you are the administrator, you will be working from what the individual gives you. Either way, USACE owns the form and TM 5-682 tells you when to raise it and where it goes afterward, so read the directive first if your situation is not routine.
Begin with the first block and follow the printed order. You will enter your name first, exactly as your official records show it, followed by your identification number, your organisation, and the date of preparation. Resist the urge to jump to the substantive blocks and return to the header later. Those first entries are the index for the whole record, and an error there costs you the ability to retrieve it.
Now for the body. Use tab to advance through the fields; the order was set when the form was built and following it keeps you from leaving gaps. Check boxes and option buttons take a click. Where the options are mutually exclusive, choosing one will clear another, which is how the group is meant to behave. As you type longer entries, watch the field edge. One-line fields do not wrap, and anything past the edge prints missing even when you can still read it on screen — when that happens, put the text in remarks or on a continuation sheet. Leave nothing blank because it does not apply; enter the mark that means it does not apply, so the reviewer knows you read the question.
Save the signature for last. Sign by hand, or by whatever electronic method your office accepts, and understand that until you do the document is a draft no matter how complete it looks. If the form calls for a reviewing official, an approving authority, or a witness, take those signatures in the order the blocks print, and have each signer date it on the day they sign rather than the day you prepared it. Before you hand it over, read it once more from the top. You are looking for three things in particular: a mandatory field you left empty, digits transposed in your identification number, and a date written with day and month the wrong way round. Check one more thing if you built this form from a copy you had lying around — old entries survive in a reused file, and they will go forward as though you meant them.
Read the Privacy Act statement when it appears on the page, before you fill in the personal details it covers. It sets out the authority for collecting the information, the purpose behind it, the routine uses it may be put to, and whether your disclosure is required or voluntary. Then keep in mind what you have created — a completed copy carries personal data, and you handle and store it under the rules that apply to such records.
Download the form
Now pick your file. You have PDF, XFDL to choose from, and the choice depends on one thing: whether you will type the entries or write them by hand. Choose the fillable pdf when you want to type, tab between fields and keep a clean copy on your computer. Choose the printable pdf when you intend to print the blank first and write on paper. The pages look identical either way, so you are not giving anything up by picking the wrong one — you are only choosing how you work.
Then take care with how you open what you downloaded. Your browser will happily display a pdf, and for reading that is enough — but for typing it is not, because some in-browser viewers accept keystrokes and then throw them away when the tab closes. Put the file somewhere on disk, open it in a proper reader, type into one field and save, and confirm the text is still there when you reopen. If you picked up the xfdl copy, get the IBM Lotus Forms Viewer before you go any further, because nothing else will open the file.
One last point before you move on: every format is free. No registration stands between you and the file, and what you download is the published form, unaltered.
What the form asks for
- ACCEPT
- ContentArea1
- DATEA
- DETAILS
- DETAILS_1
- DETAILS_10
- DETAILS_11
- DETAILS_12
- DETAILS_13
- DETAILS_14
- DETAILS_15
- DETAILS_16
- DETAILS_17
- DETAILS_18
- DETAILS_19
- DETAILS_2
- DETAILS_3
- DETAILS_4
- DETAILS_5
- DETAILS_6
- DETAILS_7
- DETAILS_8
- DETAILS_9
- EQUIP
With the form signed, send it where TM 5-682 tells you to send it — usually to the office it names, or through your unit administrative channel, or straight into your own record, depending on why you raised it. Keep a copy for yourself before it leaves your hands. How long the receiving office holds it is not your decision or theirs; the records schedule for the series settles that, and local habit does not override it.
Should the package need more than one document, search by series and number. Within the DA series, forms under the same proponent or the same prescribing directive tend to be required as a set, and a form referenced on the page you are filling usually accompanies it. Collect the continuations, covers and transmittals up front so the submission goes complete the first time.
Before you reuse a saved copy, look at the edition date printed on it. The proponent revises the form from time to time, and your stored file will not tell you when that happens — you compare its date against the current edition yourself. If a revision has come out since you last filed one of these, leave the earlier submission alone; the change does not reach backwards.
Read this before you go. The file you download is a reproduction of a published Department of the Army document, offered as it was published. We are an independent site with no connection to the Department of the Army and no authority to issue anything, and we make no statement about whether your completed form will be accepted anywhere. Treat what you read here as information, not legal advice. Take real questions — about an entry, a requirement, or your eligibility — to USACE or to your servicing administrative office.
Questions and answers
- What is DA Form 5168-R?
- SAFETY CLEARANCE ORDER (ELECTRICAL FACILITIES) (LRA)
- Which edition is current?
- 06/01/1999
- Who is responsible for this form?
- USACE
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 41-ITEM ALSO PRODUCED IN ELECTRONIC MEDIA,