Service manual

STP 11-25R13-SM-TG
W - 1
APPENDIX W – DA FORM 5164-R (HANDS-ON EVALUATION)
W-1. Introduction.
The DA Form 5164-R (Hands-On Evaluation) allows the trainer to keep a record of the performance
measures a soldier passes or fails on each task. Instructions for using this form follow.
W-2. Prior to evaluating the soldier.
a. Obtain a blank copy of DA Form 5164-R, which you may locally reproduce on 8 1/2- by 11-inch
paper.
b. Enter the task title and 10-digit number for the task from the evaluation guide of the soldier's
manual task summary.
c. In column a, enter the number of each performance measure from the evaluation guide.
d. In column b, enter the performance measure corresponding to the performance measure
number in column a. (You may abbreviate this information if necessary.)
e. Enter the feedback statement from the evaluation guide just below the last performance
measure.
f. Locally reproduce the partially completed form if you are evaluating more than one soldier on
the task or the same soldier on more than one task.
W-3. During the evaluation.
a. Enter the date just before evaluating the soldier's task performance.
b. Enter the evaluator's name and the soldier's name and unit.
c. For each performance measure, column b, enter a check in column c (PASS) or column d
(FAIL), as appropriate.
d. Compare the number of performance measures the soldier passes (and if applicable, which
ones) against the task standard shown in the Feedback statement. If the standard is met or exceeded,
check the GO block under STATUS; otherwise check the NO-GO block.
Figure W-1 is a sample of a completed DA Form 5164-R.