Encl (3) to COMDTINST 3574.5B
Page 2 of CG-3029 (Rev. 5-87)
1. STATUS - Duty status: "A" Active or "R" Reserve (ONLY ONE PER FORM)
2. RANGE/LOCATION - Name of facility where training was conducted i.e., RTC Yorktown,
BlueHill Rod & Gun Club.
3. UNIT TRAINED - Name and OPFAC of unit that received training (ONLY ONE PER FORM).
4. INSTRUCTOR(S) - Rank/rate and names of HH or HJ qualified instructors conducting training.
5. NAME - Self explanatory.
6. RANK/RATE - Abbreviate appropriate rank/rate, i.e., CDR, FT2.
7. SSN - Social security number.
8. WEAPON TYPE, DATE, TRAINING LEVEL, AND SCORE - The type of weapon, the date of
record firing, the level assigned by
COMDTINST M8370.11 (series),
and the score.
I Initial service entry training.
II Small Arms Instructor, intelligence investigators, and MLE/Port Security personnel.
III Unit security personnel, quarterdeck watchstanders and personnel assigned emergency or
non-wartime contingency billets.
SENIOR INSTRUCTOR SIGNATURE -Last name, unit, and OPFAC of senior HH instructor
conducting training. Form shall be signed by the senior
instructor. If not, provide reason why.
10. DATE - Date of signature.