DA Form 5165-r "Field Expedient Squad Book"

What Is DA Form 5165-R?

DA Form 5165-R, Field Expedient Squad Book is a form that allows the trainer to keep track of the performance of a group of Soldiers (e.g. a crew, section, or squad) with the same military occupational specialty (MOS) and matching skill level during field training.

The latest edition of the form - sometimes incorrectly referred to as the DD Form 5165-R - was released by the Department of the Army (DA) in June 2010. An up-to-date DA Form 5165-R fillable version is available for digital filing and download below or can be found through the Army Publishing Directorate website.

This form was designed to support the assessment process carried out by the military commanders and may be used to record the data collected during field training for any MOS and proficiency level.

DA Form 5164-R (Hands-on Evaluation) can also be utilized for evaluating Soldiers' proficiency throughout their career in order to record and track changes in their performance.

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How to Fill out DA Form 5165-R?

Procedural guidelines and additional information can be found in the STP 10-92A12-SM-TG (Soldier's Manual and Trainer's Guide - MOS 92A), released in May 2008. DA Form 5165-R instructions are as follows:

  1. The trainer conducting the assessment must prepare a blank copy of the DA 5165-R. If needed, the form may be reproduced locally on 8 by 11 inch paper.
  2. The Soldiers' names, the task numbers and abbreviated titles for the evaluated tasks are entered in the appropriate lines of the chart.
  3. The names of the Soldiers under evaluation should be entered one name per column, at the top of the form. Newly assigned Soldiers may be added to the evaluation if there are blank columns available.
  4. If the Soldier demonstrated proficiency in a task, the date of the evaluation must be recorded (in pencil) in the GO block, under STATUS. This information should be kept current by always recording the most recent date on which the Soldier demonstrated task proficiency.
  5. If the Soldier failed to demonstrate task proficiency, the date must be recorded in the NO-GO block. Soldiers who failed to perform the task should be retrained and reevaluated until they manage to meet the standards. When that occurs, the date is entered in the appropriate GO block with the previous entry from the NO-GO block erased.
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Download DA Form 5165-r "Field Expedient Squad Book"

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SHEET
FIELD EXPEDIENT SQUAD BOOK
OF
For use of this form, see STP 10-92A12-SM-TG; the proponent agency is TRADOC.
SOLDIER'S NAME
USER APPLICATION
STATUS
TASK NUMBER AND TITLE
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
PREVIOUS EDITIONS ARE OBSOLETE.
DA FORM 5165-R, JUN 2010
APD LC v1.00
SHEET
FIELD EXPEDIENT SQUAD BOOK
OF
For use of this form, see STP 10-92A12-SM-TG; the proponent agency is TRADOC.
SOLDIER'S NAME
USER APPLICATION
STATUS
TASK NUMBER AND TITLE
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
GO
NO-GO
PREVIOUS EDITIONS ARE OBSOLETE.
DA FORM 5165-R, JUN 2010
APD LC v1.00