You have arrived looking for DD Form 2164. Before you download, confirm this is the right document: X-Ray Verification/Certification Worksheet. Full title: DD Form 2164, X-Ray Verification/Certification Worksheet, November 1978.
Next, check the edition. You want not stated, currently carried as not stated by the publisher. Then confirm the form applies to you — this is a Department of Defense form, so you use it whether you serve in the Army, Navy, Air Force, Marine Corps, Space Force or Coast Guard under Defense jurisdiction.
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
Step one is picking the format. You have PDF to choose from, across 2 pages, with approximately 200 fields to complete.
Whichever you pick, you pay nothing — every format here is a free download. One last tip: open your pdf in a desktop reader rather than in a browser tab, because browser viewers sometimes drop the interactive fields you need.
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.
With the form finished, route it to the office named in not stated or in your organization's own instruction. Keep a copy first. People rarely regret having one and frequently regret not having one.
If the form points you to another document, you can find it by number alone. DD numbering runs across the whole Department, so you do not need to work out which service issued it — one number, one form, everywhere.
Be careful when a procedure pairs this form with a service form. Read the prefix, not just the digits. Service forms answer to a service proponent, while DD forms answer to not stated or an equivalent Department office, and the two sequences were never aligned. Grabbing the wrong prefix gets you a form that has nothing to do with your task.
Plan to repeat this step whenever the form comes up again. Revisions follow directive changes, changes in what data is collected, and updates to notice language. Since nobody notifies you, check not stated at download and you have covered it.
Finally, understand the limits of what you have read. This page distributes a published Department of Defense form and describes how to fill it out. It does not give legal or procedural advice, and it cannot promise any outcome for your particular case. For that, contact not stated, your administrative office, or the authority identified 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?