Start here if you have been told to submit DD Form 1924. First, know what you are filling: Surgical Checklist. The document is titled DD Form 1924, Surgical Checklist, October 1993..
Then look at the edition date: not stated, publisher status not stated. After that, ask whether the form covers your situation. It almost certainly does regardless of your branch — DD forms run Department-wide rather than through a single service.
Once you know the form fits, find out when you file it. not stated sets the requirement, and not stated maintains the form itself. Your own command or agency adds local timing on top of that, so ask your administrative office if the deadline matters to you.
Last in this stage, choose your method: complete it on screen, or print the blank form and fill it out in pen. The sections below take each route step by step.
Start at the header. Complete your identification before anything else, then work through the main entries, then finish at the certification. Skipping around causes contradictions between the top of the form and the bottom.
Check the edition before you type a word. The date appears on the face of the form; it should read not stated. When it does not, discard the file and take a fresh copy from this page. Department-level revisions replace the blank across all services simultaneously, which means an old printout can be out of step everywhere.
If a particular field puzzles you, read the instructions printed on the form first, then go to not stated. When the two disagree, follow the directive.
Download the form
Begin by choosing a file. Available here: PDF. Plan for 1 pages and about 58 entries.
Take the pdf if you are unsure. Then check which kind you have: if the boxes highlight when you click them, you have a fillable pdf and can type straight into it, and your entries save with the file. If nothing highlights, you have a printable pdf — send it to a printer and use black ink.
Type when you can. Printed entries stay legible after the form is scanned, copied and forwarded, and handwriting often does not survive that trip. If you must write by hand, use block capitals and press firmly.
What the form asks for
- Patient's identification.
- Unit/Room/Bed.
- Clinical records. Initial or mark N/A if not applicable. SF 515 - Tissue examination.
- SF 516 - Operation report.
- SF 517 - Anesthesia.
- SF 518 - Blood transfusion: number of units.
- SF 518 - Blood transfusion.
- SF 522 - Operative permit (signed and witnessed).
- SF 509 - Progress note (contains physician's informed consent).
- Blood transfusion consent.
- Medication administration record.
- IV flow sheet.
- History and physical.
- SF 511 - T.P.R. graphic.
- Nurses notes.
- Doctor's orders.
- X-ray (only the required) reports.
- Required X-ray films.
- Laboratory reports (only the required) hematology.
- Required laboratory urine test reports.
- EKG.
- Initial or N/A.
- Other (specify), line 1.
- Other (specify), line 2.
Now that it is complete, send it where not stated or your local procedure says it goes. Before you do, make yourself a copy — scan it or save the file elsewhere. It costs you nothing and saves you the whole exercise if the original goes missing.
When DD Form 1924 references another form, search on the series and number. Because DD numbers are common to every military department, the number by itself identifies exactly one document.
Here is where people go wrong. They see a number in an instruction and download whichever form matches it. But DA and DD are separate systems — Army-specific in one case, Department-wide under not stated in the other — so check which series you were sent to before you take the file.
Do not archive this file and reuse it in a year. Forms are reissued as directives are revised, as data requirements shift, and as statutory notice text is amended. Your protection is simple: download fresh each time and confirm the edition date.
One thing this page does not do: tell you whether your submission will be accepted. We publish the document and explain how to complete it, and that is where our role ends. Nothing here is legal advice. Take questions about eligibility, applicability or procedure to not stated, to your servicing personnel office, or to the office named in not stated.
Questions and answers
- What is DD Form 1924?
- DD Form 1924, Surgical Checklist, October 1993.
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?