DA FORM 4106 Fillable – Army Pubs 4106 PDF

DAFORMFILLABLE.COM | DA FORM 4106 Fillable – Army Pubs 4106 PDF – DA FORM 4106, also known as the Incident Report, is a critical document used within the military to report and document incidents comprehensively. This form is essential for maintaining accurate records and ensuring proper accountability in various situations.

DA FORM 4106 – Incident Report

Form Number DA Form 4106
Form Title Incident Report
Form Date 02/01/2004
Form Proponent TSG

Overview of DA FORM 4106

DA FORM 4106 was published on February 1, 2004, and it remains an active document used by the military. The form’s proponent is the The Surgeon General (TSG), and it is governed by the prescribing directive AR 40-68. Notably, this form requires a Privacy Act Statement as per AR 340-21 and is only available in electronic media format.

Key Characteristics of DA FORM 4106

  • Pub/Form Number: DA FORM 4106
  • Pub/Form Date: 02/01/2004
  • Pub/Form Title: Incident Report
  • Pub/Form Proponent: TSG
  • Pub/Form Status: Active
  • Prescribed Forms/Prescribing Directive: AR 40-68
  • Footnotes:
    • 14 – Requires Privacy Act Statement (AR 340-21)
    • 42 – Item only produced in electronic media
  • Security Classification: Unclassified
  • Dist Restriction Code: A – Approved for public release; distribution is unlimited
  • Pub/Form IDN: 990001
  • Pub/Form PIN: 002596

Purpose and Use of DA FORM 4106

The primary purpose of DA FORM 4106 is to document incidents thoroughly. This can include a range of situations such as accidents, injuries, or other notable occurrences that need to be officially recorded. Proper documentation is crucial for maintaining accountabilitytransparency, and legal compliance.

Importance of Accurate Incident Reporting

Accurate incident reporting is vital for several reasons:

  1. Accountability: Ensures that all parties involved are held accountable for their actions.
  2. Transparency: Provides a clear record of events, which is essential for audits and reviews.
  3. Legal Compliance: Helps meet legal and regulatory requirements, thereby protecting the organization from potential legal issues.

How to Complete DA FORM 4106

Filling out DA FORM 4106 correctly is essential for the integrity of the incident report. Here are the key sections that need to be completed:

Section 1: Incident Details

This section requires detailed information about the incident, including the date, time, location, and a brief description of what occurred. It’s crucial to be as precise and thorough as possible to ensure the report is accurate.

Section 2: Personnel Involved

List all individuals involved in the incident. This includes their names, ranks, and roles in the incident. Accurate identification helps in the follow-up and investigation processes.

Section 3: Witnesses

If there were any witnesses to the incident, their details should be recorded in this section. Witness accounts can provide additional perspectives and information about the incident.

Section 4: Description of Incident

A detailed narrative of the incident should be provided here. This should include the sequence of events leading up to the incident, the incident itself, and any immediate actions taken afterward.

Section 5: Actions Taken

Document any actions taken in response to the incident. This could include medical treatment, disciplinary actions, or procedural changes implemented to prevent future occurrences.

Section 6: Signature

The form must be signed by the individual completing the report and any other required authorities. This confirms the accuracy and completeness of the information provided.

Since DA FORM 4106 involves documenting sensitive information, it is governed by the Privacy Act Statement as stipulated in AR 340-21. This ensures that all personal data is handled with the utmost confidentiality and used only for official purposes.

Distribution and Accessibility

The form is unclassified and has a distribution restriction code of A, meaning it is approved for public release and can be distributed without limitations. This makes it accessible to all relevant personnel who need to report incidents.


DA FORM 4106 – Incident Report is a fundamental tool for documenting incidents within the military. Its thorough and structured format ensures that all necessary information is captured, promoting accountability, transparency, and compliance. By understanding how to complete and utilize this form effectively, military personnel can contribute to maintaining accurate and reliable incident records.

For more detailed information or access to the form, individuals can refer to the official prescribing directive AR 40-68 or consult with their administrative office.

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